Does Intact Limb Loading Differ in Servicemembers With Traumatic Lower Limb Loss?

Abstract

Background The initiation and progression of knee and hip arthritis have been related to limb loading during ambulation. Although altered gait mechanics with unilateral lower limb loss often result in larger and more prolonged forces through the intact limb, how these forces differ with traumatic limb loss and duration of ambulation have not been well described.Questions/purposes The purpose of this study was to determine whether biomechanical variables of joint and limb loading (external adduction moments, vertical ground reaction force loading rates, and impulses) are larger in the intact limb of servicemembers with versus without unilateral lower limb loss and whether intact limb loading differs between shorter (B 6 months) versus longer (C 2 years) durations of ambulation with a prosthesis. 4.45-16.79; 10.18-12.81] 4.64-14.47; 8.26-9.74 82-19.51; 12.98-15.05]; ES = 0.43; p = 0.001), respectively. Intact limb mean and peak vertical ground reaction force loading rates were also larger in subjects with transfemoral limb loss with B 6 months and C 2 years of experience ambulating with a prosthesis versus control subjects .68] versus 9.03 BW/s [4.64-14.47; 8.26-9.74]; ES C 0.53; p \ 0.001;.05]; ES C 0.68; p \ 0.001, respectively). Similarly, intact limb vertical ground reaction force impulses ; ES C 0.53, p \ 0.001) were also larger among both groups of transfemoral subjects versus control subjects, respectively. Limb loading variables were not statistically different between times ambulating with a prosthesis within groups with transtibial or transfemoral limb loss. Conclusions Larger intact limb loading in individuals with traumatic transtibial loss were only noted early in the rehabilitation process, but these variables were present early and late in the rehabilitation process for those with transfemoral limb loss. Such evidence suggests an increased risk for early onset and progression of arthritis in the intact limb, especially in those with transfemoral limb loss. Clinical Relevance Interventions should focus on correcting modifiable gait mechanics associated with arthritis, particularly among individuals with transfemoral limb loss, to potentially mitigate the development and progression in this population.versus 9.03 BW/s [

Gait characteristics of transtibial amputees on level ground in a cohort of 53 amputees - Comparison of kinetics and kinematics with non-amputees

“…10,13 Other studies reported a statistically nonsignificant increase. 14,15,17 The results of this study concur with Sanderson et al 7 showing no difference between the sound side of the amputees and the CG. The effect size of r=0.04 also supports the null hypothesis that the two samples come from the same population and therefore show no differences.…”

“…The present study shows no difference of the external knee adduction moment on the sound side compared to non-amputees. This concurs with Lloyd et al 12 , Rabago et al 16 and Karimi et al 17 In contrast, Grabowski et al 13 and Royer et al 18 showed an increase by trend, whereas Esposito et al 14 and Pruziner et al 15 showed a decrease by trend. None of the results shown by these studies are statistically significant.…”

“…20 The latter also showed diverging results for the sound side of TTs in the literature: A significantly increased first peak on the sound side in comparison to healthy controls was reported in two studies. 10,13 Some studies showed a statistically non-significant increase, 11,14,15,17 while other studies showed no differences at all. 6,7 As the investigations cited did not show consistent results, the described higher prevalence of knee osteoarthritis on the sound side in TTs 21 could not be explained with certainty to be caused by higher loads on this knee.…”

“…Beside these temporalspatial parameters the results of kinetic and kinematic parameters enable a more detailed evaluation for the gait of TTs. Research studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] reporting such findings for TTs in comparison to nonamputees were summarized in Table 1.…”

Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation

“…Mean values for gait parameters of interest (step length, single limb stance time, BOS, double limb support time, gait speed, and step rate) were calculated using the average of the three trials. These gait variables were chosen for analysis because they have been linked to deviations identified with gait after LLA [18,23] and general physical function and health status [24–25]. …”