Energy consumption during prosthetic walking and physical fitness in older hip disarticulation amputees

Abstract

Abstract-The objective of this study is to investigate energy consumption during prosthetic walking and physical fitness in older hip disarticulation (HD) subjects and to examine the ambulatory outcome in a community setting. The subjects were seven unilateral HD amputees with an average age of 67.7 +/-3.9 yr. Energy consumption was measured during prosthetic walking at each individual's comfortable walking speed (CWS) by means of a portable telemetric system. An incremental exercise test was performed to evaluate fitness. The average CWS for the subjects was 30.5 +/-9.6 m/min. The average oxygen consumption rate at each CWS was 18.3 +/-2.4 mL/kg/min, and the average oxygen cost was 0.639 +/-0.165 mL/kg/m. The maximum oxygen uptake during exercise as a proportion of predicted maximum oxygen uptake (%VO 2 max) for the subjects was 57.2 +/-11.1. Five subjects continued prosthetic walking on return to their communities. Two subjects abandoned prosthetic walking. The %VO 2 max for the five who continued prosthetic walking after discharge ranged from 55.8 to 72.0. The subjects who abandoned prosthetic walking had lower %VO 2 max of 43.3 and 44.2. Energy consumption during prosthetic walking at CWS seemed not to be excessive. Older HD amputees in good physical condition were able to successfully walk with a prosthesis in a community setting. A lower level of fitness appears to make community walking prohibitive.

Predicting Walking Ability Following Lower Limb Amputation: An Updated Systematic Literature Review

“…Meta-analysis was not possible, as the studies of like outcome measures did not observe the same homogeneous patient characteristics; mainly, level, etiology, and mean ages were heterogeneous among these studies (10–14). …”

“…Linberg et al., in a high quality article, reported a significant difference in 6MWT performance between bilateral TTA patients and TFA patients, with bilateral TTA patients walking further (12). Chin et al reported, in a medium quality study, solely on the hip disarticulation amputee (HDA), where older HDA patients in good physical condition and with a low prevalence of comorbidities were able to successfully walk with a prosthesis in a community setting (10). Czerniecki et al reported the rates of success were similar: 35%, 31%, and 33% of amputees with transmetatarsal (TM), TTA, and TFA, respectively, achieved mobility success when seen in a comprehensive inpatient rehabilitation unit (27).…”

Hyperbaric oxygen for patients with above-knee amputations, persistent ischemia, and nonreconstructable vascular disease

“…[3][4][5] Those who survive are often disfigured, institutionalized, and dependent on others for mobility. [6][7][8] For these reasons, alternative methods to treat nonhealing proximal limb stumps in this population of patients are very attractive. 9 HBOT is an adjunctive treatment that increases oxygen tension, improves cellular metabolism in ischemic tissues, and inhibits inflammation.…”

Evaluation of Gait Performance of a Hemipelvectomy Amputation Walking with a Canadian Prosthesis

“…Those with hip disarticulation miss their abilities to stand and walk efficiently (without use of crutch or walker) and have to use especial prosthesis [2, 4]. Various types of components have been designed for hip disarticulation and hip pelvectomy to enable the subject to stand and walk [4, 5]; however, they have several problems including high energy consumption during walking, slow walking speed, style of walking which is not cosmetically appealing, and limitation in range of motion of leg joints [6–10]. As a result of small number of prosthetics users there is limited number of research on this topic.…”

“…As a result of small number of prosthetics users there is limited number of research on this topic. Furthermore, there are a few studies on kinetic and kinematic parameters of Canadian prosthesis users [6, 7, 9]. In one research study the loads applied on prosthesis were evaluated during walking of a subject with hip disarticulation amputation [8].…”