Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: Systematic review

Kannenberg, Andreas; Zacharias, Britta; Pröbsting, Eva

doi:10.1682/jrrd.2014.05.0118

Cited by 70 publications

(60 citation statements)

References 115 publications

(291 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[6,7] Access is often restricted to individuals with higher functional capability. This is in contrast to the findings of Kannenberg et al [8] and Wetz et al [9] who accentuated the overproportional benefits to individuals with more severe conditions and lower mobility grade ratings.…”

Section: Introductioncontrasting

confidence: 99%

Analysis of clinically important factors on the performance of advanced hydraulic, microprocessor-controlled exo-prosthetic knee joints based on 899 trial fittings

2016

View full text Add to dashboard Cite

The objective of this work is to evaluate whether clinically important factors may predict an individual's capability to utilize the functional benefits provided by an advanced hydraulic, microprocessor-controlled exo-prosthetic knee component.This retrospective cross-sectional cohort analysis investigated the data of above knee amputees captured during routine trial fittings. Prosthetists rated the performance indicators showing the functional benefits of the advanced maneuvering capabilities of the device. Subjects were asked to rate their perception. Simple and multiple linear and logistic regression was applied.Data from 899 subjects with demographics typical for the population were evaluated. Ability to vary gait speed, perform toileting, and ascend stairs were identified as the most sensitive performance predictors. Prior C-Leg users showed benefits during advanced maneuvering. Variables showed plausible and meaningful effects, however, could not claim predictive power. Mobility grade showed the largest effect but also failed to be predictive.Clinical parameters such as etiology, age, mobility grade, and others analyzed here do not suffice to predict individual potential. Daily walking distance may pose a threshold value and be part of a predictive instrument. Decisions based solely on single parameters such as mobility grade rating or walking distance seem to be questionable.

show abstract

Section: Introductioncontrasting

confidence: 99%

Analysis of clinically important factors on the performance of advanced hydraulic, microprocessor-controlled exo-prosthetic knee joints based on 899 trial fittings

2016

View full text Add to dashboard Cite

show abstract

“…Overall, the ICER was 16,132 Euro per QALY gained in amputees without DM and 20,332 Euro per QALY gained in amputees with DM. Several clinical and biomechanical studies [4][5][6][7][8][9][10][11][12][13][14][15] investigated the safety of the C-Leg compared to NMPKs. Results of these studies reported a reduction in falls and stumbles when patients used C-Legs instead of NMPKs.…”

Section: Discussionmentioning

confidence: 99%

“…The safe use of a prosthesis in activities of daily living is key for transfemoral amputees [4]. Several clinical and biomechanical studies as well as two systematic reviews [4][5][6][7][8][9][10][11][12][13][14][15] investigated the safety of using the microprocessor-controlled knee joint C-Leg (C-Leg). Compared with non-microprocessor-controlled (mechanical) knee joints (NMPK), the C-Leg reduced the number and frequency of stumbles and falls of up to 80% [6,8,9].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

et al. 2020

View full text Add to dashboard Cite

Background The safe use of a prosthesis in activities of daily living is key for transfemoral amputees. However, the number of falls varies significantly between different prosthetic device types. This study aims to compare medical and economic consequences of falls in transfemoral amputees who use the microprocessor-controlled knee joint C-Leg with patients who use non-microprocessor-controlled (mechanical) knee joints (NMPK). The main objectives of the analysis are to investigate the costeffectiveness and budget impact of C-Legs in transfemoral amputees with diabetes mellitus (DM) and without DM in Germany. Methods A decision-analytic model was developed that took into account the effects of prosthesis type on the risk of falling and fall-related medical events. Cost-effectiveness and budget impact analyses were performed separately for transfemoral amputees with and without DM. The study took the perspective of the statutory health insurance (SHI). Input parameters were derived from the published literature. Univariate and probabilistic sensitivity analyses (PSA) were performed to investigate the impact of changes in individual input parameter values on model outcomes and to explore parameter uncertainty. Results C-Legs reduced the rate of fall-related hospitalizations from 134 to 20 per 1000 person years (PY) in amputees without DM and from 146 to 23 per 1000 PY in amputees with DM. In addition, the C-Leg prevented 15 or 14 fall-related death per 1000 PY. Over a time horizon of 25 years, the incremental cost-effectiveness ratio (ICER) was 16,123 Euro per quality-adjusted life years gained (QALY) for amputees without DM and 20,332 Euro per QALY gained for amputees with DM. For the period of 2020-2024, the model predicted an increase in SHI expenditures of 98 Mio Euro (53 Mio Euro in prosthesis users without DM and 45 Mio Euro in prosthesis users with DM) when all new prosthesis users received C-Legs instead of NMPKs and 50% of NMPK user whose prosthesis wore out switched to C-Legs. Results of the PSA showed moderate uncertainty and a probability of 97-99% that C-Legs are cost-effective at an ICER threshold of 40,000 Euro (≈ German GDP per capita in 2018) per QALY gained. Conclusion Results of the study suggest that the C-Leg provides substantial additional health benefits compared with NMPKs and is likely to be cost-effective in transfemoral amputees with DM as well as in amputees without DM at an ICER threshold of 40,000 Euro per QALY gained.

show abstract

“…Elderly persons with TFA are thus at risk of denial of MPK consideration due to this requirement. However, limited community ambulators have been shown to gain as many (or more) of the benefits of MPK technology than their unlimited community ambulating peers (26). …”

Section: Discussionmentioning

confidence: 99%

Effects of the Genium Microprocessor Knee System on Knee Moment Symmetry During Hill Walking

et al. 2016

View full text Add to dashboard Cite

Use of the Genium microprocessor knee (MPK) system reportedly improves knee kinematics during walking and other functional tasks compared to other MPK systems. This improved kinematic pattern was observed when walking on different hill conditions and at different speeds. Given the improved kinematics associated with hill walking while using the Genium, a similar improvement in the symmetry of knee kinetics is also feasible. The purpose of this study was to determine if Genium MPK use would reduce the degree of asymmetry (DoA) of peak stance knee flexion moment compared to the C-Leg MPK in transfemoral amputation (TFA) patients. This study used a randomized experimental crossover of TFA patients using Genium and C-Leg MPKs (n = 20). Biomechanical gait analysis by 3D motion tracking with floor mounted force plates of TFA patients ambulating at different speeds on 5° ramps was completed. Knee moment DoA was significantly different between MPK conditions in the slow and fast uphill as well as the slow and self-selected downhill conditions. In a sample of high-functioning TFA patients, Genium knee system accommodation and use improved knee moment symmetry in slow speed walking up and down a five degree ramp compared with C-Leg. Additionally, the Genium improved knee moment symmetry when walking downhill at comfortable speed. These results likely have application in other patients who could benefit from more consistent knee function, such as older patients and others who have slower walking speeds.

show abstract

Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: Systematic review

Cited by 70 publications

References 115 publications

Analysis of clinically important factors on the performance of advanced hydraulic, microprocessor-controlled exo-prosthetic knee joints based on 899 trial fittings

Analysis of clinically important factors on the performance of advanced hydraulic, microprocessor-controlled exo-prosthetic knee joints based on 899 trial fittings

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

Effects of the Genium Microprocessor Knee System on Knee Moment Symmetry During Hill Walking

Contact Info

Product

Resources

About