Structural changes in the thigh muscles following trans-femoral amputation

Putz, Cornelia; Block, Julia; Gantz, Simone; Heitzmann, Daniel; Dreher, Thomas; Lehner, Burkhard; Alimusaj, Merkur; Wolf, S.I.; Müller, Sebastian

doi:10.1007/s00590-017-1929-5

Cited by 18 publications

(12 citation statements)

References 22 publications

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“…In the present case, the femoral artery diameter was approximately 1 mm smaller in ALL (7.16 mm) than non-ALL (8.12 mm), which may indicate a reduction in conduit artery size due to disuse and/or thigh muscle atrophy after the subject's amputation 15 years previously. This is in agreement with the approximate reduction of 12% in maximum thigh circumference in ALL compared to non-ALL supported by previous studies [34,35,39]. The diameter in ALL may be around the lower value of the normal range in healthy legs [37].…”

Section: Magnitude Of Lbf At Pre-exercise and During Exercisesupporting

confidence: 92%

“…The finding is that a workloaddependent LBF increase was not seen in ALL compared to non-ALL, although peak muscle contractile effort increased with an increase in muscle contraction intensity. An amputated limb may potentially limit fitness, with lower muscle strength and/or muscle metabolism in ALL compared to the non-ALL [4,[33][34][35]. Further, older adults with lower limb amputations due to vascular disease have a lower aerobic capacity and limited leg oxygen uptake [36].…”

Section: Discussionmentioning

confidence: 99%

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Time-course of thigh muscle contraction-induced blood flow magnitude in amputated lower limb with prosthesis during dynamic knee extensions: A case study

Osada¹,

Ishiyama²,

Ueno³

2018

Phys Ther Rehabil

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Background:The increase in exercising leg blood flow (LBF) is directly proportional to the workload performed, in relation to the interplay between cardiovascular regulation and muscle energy metabolism. However, little information is available on exercise LBF in thigh muscle contractions in amputated lower legs (ALL) via the stump fitting prosthesis. Case presentation: A 79-year-old male patient performed 3-min one-legged repeat/dynamic knee extensor exercise at a target muscle contraction frequency (1-s thigh muscle contraction and 1-s relaxation, 90 repetitions) on each leg (left ALL as trans-tibial amputation using a patellar tendon-bearing prosthesis and right non-ALL) at six different contraction intensities. Simultaneous measurement of blood velocity/flow (Doppler ultrasound) in the femoral artery, blood pressure, leg vascular conductance and muscle strength were performed at pre-exercise, during 3-min exercise and 5-min recovery. There was a 12% reduction in the maximum thigh circumference in the ALL compared to non-ALL. LBF was lower in the ALL than non-ALL at pre-exercise and during exercise. In non-ALL, there was a good positive linear relationship (r=0.922, P<0.01) between mean peak muscle strength and mean exercising LBF during 30-s steady-state before the end of exercise, but the same relationship was not seen (r=0.220, P=ns) in the ALL. Conclusions: The present clinical intervention study showed no significant thigh LBF increase in the ALL with incremental workload (peak muscle strength). This might be due to a mismatch of the workloaddependent LBF increase in the disused and/or atrophic thigh muscle-resection stump of the ALL compared to non-ALL, which in ALL may be due to remaining muscle contractile effort with a reduced arterial inflow and/or lack of venous return in relation to the arteriovenous pressure gradient and/or hydrostatic pressure through the lower leg.

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Section: Magnitude Of Lbf At Pre-exercise and During Exercisesupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Time-course of thigh muscle contraction-induced blood flow magnitude in amputated lower limb with prosthesis during dynamic knee extensions: A case study

Osada¹,

Ishiyama²,

Ueno³

2018

Phys Ther Rehabil

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“…However, after above-knee amputation, the quadricep muscles lose their knee extension function. The vastus muscles atrophy [41] and the rectus femoris becomes a monoarticular hip flexor. In this study, we show that the biceps femoris, a biarticular hamstring muscle in nonamputee individuals, provides a viable alternative to drive the knee extension torque generated by a robotic prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Stand-Up, Squat, Lunge, and Walk With a Robotic Knee and Ankle Prosthesis Under Shared Neural Control

Hunt

Hood

Lenzi

2021

IEEE Open J. Eng. Med. Biol.

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We propose a shared neural control approach combining neural signals from the user's residual limb with robot control to improve functional mobility in individuals with above-knee amputation. The proposed shared neural controller enables subjects to stand up under a variety of conditions, squat, lunge, walk, and seamlessly transition between activities which is not possible with other prostheses or controllers. Further, we show that the proposed shared neural controller reduces muscle effort and increased symmetry during standing up compared to conventional passive prostheses. No other available technology can enable individuals with above-knee amputations to achieve this level of mobility.

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“…larger amounts of fat embedded in the residual limb. Such fatty muscle degeneration was found, when residual limb muscles were compared to the corresponding muscles of the uninvolved side [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

The influence of hip muscle strength on gait in individuals with a unilateral transfemoral amputation

et al. 2020

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Introduction A unilateral transfemoral amputation (TFA) has a major impact on function. A leg-length discrepancy is the primary structural change, accompanied by the loss of lower-limb muscle volume and function. Prostheses can help individuals with a TFA to regain function, but such individuals still do not reach the functional level of unimpaired peers and exhibit gait deviations. This study gives insight into the causality between residual limb strength and gait deviations in individuals with a TFA. Methods A convenient sample of 13 male individuals with a TFA (38.0 ± 12.6y; 179.7cm ± 6.5cm; 82.9kg ± 12.4kg) was recruited for this study. One participant with TFA was excluded, as he differed from the rest of the cohort, in residual limb length and the use of walking aids. A cohort of 18 unimpaired subjects served as a reference group (REF; nine females; 44y ± 13y; 174cm ± 9cm; 71kg ± 12kg). All participants underwent a conventional clinical gait analysis using a marker based 3D motion capture system and force platforms. Kinematics and kinetics were determined utilizing standard modelling methods. All subjects underwent a strength test, using a custom-made device to determine isometric moments of the hip joint in abduction, adduction, extension, and flexion. Peak values for maximum isometric moments for each movement direction and selected kinematic and kinetic values were derived from the results. Differences between subjects with TFA and unimpaired were compared using a Mann-Whitney U Test and associations between groups by Spearman's rank correlation.

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Structural changes in the thigh muscles following trans-femoral amputation

Abstract: MRI is an excellent diagnostic tool to evaluate fatty degeneration after TFA. The highest amount of fatty degeneration of the quadriceps muscle was monitored within the first 10 months. Early physiotherapy is important to strengthen the remaining stump muscles during rehabilitation.

Cited by 18 publications

References 22 publications

Time-course of thigh muscle contraction-induced blood flow magnitude in amputated lower limb with prosthesis during dynamic knee extensions: A case study

Time-course of thigh muscle contraction-induced blood flow magnitude in amputated lower limb with prosthesis during dynamic knee extensions: A case study

Stand-Up, Squat, Lunge, and Walk With a Robotic Knee and Ankle Prosthesis Under Shared Neural Control

The influence of hip muscle strength on gait in individuals with a unilateral transfemoral amputation

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