The effect of prosthetic foot push-off on mechanical loading associated with knee osteoarthritis in lower extremity amputees

Morgenroth, David C.; Segal, Ava D.; Zelik, Karl E.; Czerniecki, Joseph M.; Klute, Glenn K.; Adamczyk, Peter G.; Orendurff, Michael S.; Hahn, Michael E.; Collins, Steven H.; Kuo, Arthur D.

doi:10.1016/j.gaitpost.2011.07.001

Cited by 134 publications

(115 citation statements)

References 31 publications

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“…Use of a powered prosthesis decreases frontal plane knee moments, which have been associated with knee osteoarthritis, in the UL during walking on level ground compared to use of an ESAR prosthesis (Morgenroth et al, 2011;Grabowski and D' Andrea, 2013). Furthermore, use of a powered prosthesis decreased sagittal plane angular momentum on a range of slopes compared to an ESAR prosthesis (Pickle et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Individual Leg and Joint Work during Sloped Walking for People with a Transtibial Amputation Using Passive and Powered Prostheses

Jeffers

Grabowski

2017

Front. Robot. AI

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People with a transtibial amputation using passive-elastic prostheses exhibit reduced prosthetic ankle power and push-off work compared to non-amputees and compensate by increasing their affected leg (AL) hip joint work and unaffected leg (UL) ankle, knee, and hip joint and leg work during level-ground walking. Use of a powered ankle-foot prosthesis normalizes step-to-step transition work during level-ground walking over a range of speeds for people with a transtibial amputation, but the effects on joint work during level-ground, uphill, and downhill walking have not been assessed. We investigated how use of passive-elastic and powered ankle-foot prostheses affect leg joint biomechanics during level-ground and sloped walking. 10 people with a unilateral transtibial amputation walked at 1.25 m/s on a dual-belt force-measuring treadmill at 0°, ±3°, ±6°, and ±9° using their own passive-elastic and a powered prosthesis (BiOM T2, BionX Medical Technologies, Inc., Bedford, MA, USA) while we measured kinematic and kinetic data. We calculated AL and UL prosthetic, ankle, knee, hip, and individual leg positive, negative, and net work. Use of a powered compared to passive-elastic anklefoot prosthesis resulted in greater AL prosthetic and individual leg net work on uphill and downhill slopes. Over a stride, AL prosthetic positive work was 23-30% greater (p < 0.05) during walking on uphill slopes of +6°, and +9°, prosthetic net work was up to 10 times greater (more positive) (p ≤ 0.005) on all uphill and downhill slopes and individual leg net work was 146 and 82% more positive (p < 0.05) at uphill slopes of +6° and +9°, respectively, with use of the powered compared to passive-elastic prosthesis. Greater prosthetic positive and net work through use of a powered ankle-foot prosthesis during uphill and downhill walking improves mechanical work symmetry between the legs, which could decrease metabolic cost and improve functional mobility in people with a transtibial amputation.

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Section: Discussionmentioning

confidence: 99%

Individual Leg and Joint Work during Sloped Walking for People with a Transtibial Amputation Using Passive and Powered Prostheses

Jeffers

Grabowski

2017

Front. Robot. AI

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“…Despite these similarities in mean and peak loading rates between those with and without transtibial limb loss in the present study, vertical ground reaction force impulses were larger on the intact limb among subjects with transfemoral limb loss compared with control subjects. Typically, larger impulses to the intact limb result from insufficient power in the trailing prosthetic limb for lifting and propelling the body's center of mass [20]. Older adults with knee arthritis typically have greater external knee adduction moments than individuals without arthritis [8], and these moments strongly predict radiographic evidence of arthritis progression [19].…”

Section: Discussionmentioning

confidence: 99%

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

Pruziner

Werner

Copple

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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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 [

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“…Major lower-limb amputation is a prominent example, affecting more than 600,000 people in the United States, disproportionately affecting disadvantaged groups, and expected to double in prevalence by the year 2050 [1]. Individuals with amputation experience decreased walking performance using conventional, passive prostheses, including increased metabolic energy consumption, slower preferred walking speed, increased likelihood of falling, increased loading and injury of the unimpaired limb, and restricted social and recreational engagement [2][3][4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

A Universal Ankle–Foot Prosthesis Emulator for Human Locomotion Experiments

Caputo

Collins

2014

Journal of Biomechanical Engineering

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130

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Robotic prostheses have the potential to significantly improve mobility for people with lower-limb amputation. Humans exhibit complex responses to mechanical interactions with these devices, however, and computational models are not yet able to predict such responses meaningfully. Experiments therefore play a critical role in development, but have been limited by the use of productlike prototypes, each requiring years of development and specialized for a narrow range of functions. Here we describe a robotic ankle-foot prosthesis system that enables rapid exploration of a wide range of dynamical behaviors in experiments with human subjects. This emulator comprises powerful off-board motor and control hardware, a flexible Bowden cable tether, and a lightweight instrumented prosthesis, resulting in a combination of low mass worn by the human (0.96 kg) and high mechatronic performance compared to prior platforms. Benchtop tests demonstrated closedloop torque bandwidth of 17 Hz, peak torque of 175 Nm, and peak power of 1.0 kW. Tests with an anthropomorphic pendulum "leg" demonstrated low interference from the tether, less than 1 Nm about the hip. This combination of low worn mass, high bandwidth, high torque, and unrestricted movement makes the platform exceptionally versatile. To demonstrate suitability for human experiments, we performed preliminary tests in which a subject with unilateral transtibial amputation walked on a treadmill at 1.25 ms À1 while the prosthesis behaved in various ways. These tests revealed low torque tracking error (RMS error of 2.8 Nm) and the capacity to systematically vary work production or absorption across a broad range (from À5 to 21 J per step). These results support the use of robotic emulators during early stage assessment of proposed device functionalities and for scientific study of fundamental aspects of human-robot interaction. The design of simple, alternate end-effectors would enable studies at other joints or with additional degrees of freedom.

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The effect of prosthetic foot push-off on mechanical loading associated with knee osteoarthritis in lower extremity amputees

Cited by 134 publications

References 31 publications

Individual Leg and Joint Work during Sloped Walking for People with a Transtibial Amputation Using Passive and Powered Prostheses

Individual Leg and Joint Work during Sloped Walking for People with a Transtibial Amputation Using Passive and Powered Prostheses

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

A Universal Ankle–Foot Prosthesis Emulator for Human Locomotion Experiments

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