Muscle and prosthesis contributions to amputee walking mechanics: A modeling study

Silverman, Anne K.; Neptune, Richard R.

doi:10.1016/j.jbiomech.2012.06.008

Cited by 84 publications

(73 citation statements)

References 35 publications

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“…Finally, in line with previous studies [5,8], our patients walked slower than the control subjects mainly owing to reduced cadence, and with the pseudoknee relatively flexed during the gait cycle. The decreased propulsive force of the surgically treated side and loss of original function of the gastrocnemius, which facilitates swing initiation [25], are responsible for the smaller cadence, resulting in slower walking speed [8]. Compared with the only previous short-term study reporting values at a mean of 24 months followup [5], our patients walked with a better vertical force pattern during midstance and with increased knee flexion-extension ROM.…”

Section: Discussionmentioning

confidence: 73%

How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

Benedetti

Okita

Recubini

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Rotationplasty may be indicated for some children with osteosarcoma in the distal femur or proximal tibia; in properly selected patients, it may offer functional advantages over transfemoral amputation and more durable results than a prosthesis. The clinical and functional outcomes reported for this procedure generally have been limited to studies with a mean followup of approximately 8 years in terms of Musculoskeletal Tumor Society Score (MSTS), physical examination, and gait analysis. However, the effects of residual thigh-shank length on gait have not been explored to our knowledge. Questions/purposes We asked: (1) Do differences in the length of the surgically treated residual thigh-shank relative to the contralateral thigh result in altered gait patterns? (2) What were the clinical and functional impairments and radiographic findings of patients who underwent rotationplasty and who survived to adulthood? (3) Do gait analysis findings in adults differ from previously reported findings in children in terms of relevant gait parameters such as maximal ground reaction forces and sagittal knee angles? Methods From January 1986 to December 2009, 254 children (age range, 3-14 years) affected by high-grade bone sarcomas located in the distal half of the femur were surgically treated at our institute. Forty-two of these patients (16.5%) underwent rotationplasty. During this period, three adolescents older than 15 years were treated by rotationplasty owing to the tumor volume and extracompartmental involvement. In total, 45 patients underwent rotationplasty. From January 1986 to December 2000, rotationplasty generally was the preferred treatment for patients younger than 9 years with a high-grade bone sarcoma calling for an intra-or extraarticular resection of the distal femur, as long as the sciatic nerve could be spared. From January 2001, the procedure was not used as often. Of the 45 patients who underwent a rotationplasty, 14 died of disease at a mean of 37 months (31%); 31 patients (69%) were survivors at the time the study was done, 29 of whom were continuously disease free (64%) and two had no evidence of disease after a pulmonary metastasectomy (5%). These 31 patients were invited to participate in the study, and 25 of the 31 agreed to participate. There were 15 males and 10 females with a mean age of 23.8 years (SD, 7.5 years) and mean followup of 15 years (SD, 5.8 years). Clinical assessment included the MSTS score (total score ranges between 0 and 30 with 0 Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advo...

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Section: Discussionmentioning

confidence: 73%

How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

Benedetti

Okita

Recubini

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The greater MTC on the intact side must have partly resulted from the significantly decreased stance limb knee flexion on the prosthetic side ( Table 2), which would have raised the COM and swing (intact) limb. The reduced stance limb knee flexion observed on the prosthetic side likely reflects a strategy to reduce the knee flexor moment when supporting body weight during single-limb stance [23][24][25][26]. It has been reported previously that a change of 3.3° stance limb knee angle would alter MTC by ±0.45 cm [8].…”

Section: Discussionmentioning

confidence: 83%

Toe clearance when walking in people with unilateral transtibial amputation: Effects of passive hydraulic ankle

Johnson¹,

Asha²,

Munjal

et al. 2014

J Rehabil Res Dev

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Abstract-Most clinically available prosthetic feet have a rigid attachment or incorporate an "ankle" device allowing elastic articulation during stance, with the foot returning to a "neutral" position at toe-off. We investigated whether using a foot with a hydraulically controlled articulating ankle that allows the foot to be relatively dorsiflexed at toe-off and throughout swing would increase minimum toe clearance (MTC). Twenty-one people with unilateral transtibial amputation completed overground walking trials using their habitual prosthetic foot with rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment (hyA-F). MTC and other kinematic variables were assessed across multiple trials. When using the hyA-F, mean MTC increased on both limbs (p = 0.03). On the prosthetic limb this was partly due to the device being in its fully dorsiflexed position at toe-off, which reduced the "toes down" foot angle throughout swing (p = 0.01). Walking speed also increased when using the hyA-F (p = 0.001) and was associated with greater swing-limb hip flexion on the prosthetic side (p = 0.04), which may have contributed to the increase in mean MTC. Variability in MTC increased on the prosthetic side when using the hyA-F (p = 0.03), but this did not increase risk of tripping.

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“…The increased energy dissipation would have been due to the hydraulically damped 'ankle' articulation. This suggests that the speed increases were not a result of an increase in 'propulsion' but were driven by an attenuation of the 'braking effect' (Silverman & Neptune, 2012) that would have otherwise been exerted by the prosthetic-foot during prosthetic-limb stance. This braking effect comes from resistance to forwards shank rotation as the foot deforms during loading, which prolongs the period in which the fore-aft ground reaction force (GRF) is directed posteriorly and/or increases the magnitude of this force.…”

Section: Introductionmentioning

confidence: 97%

Impact on the biomechanics of overground gait of using an ‘Echelon’ hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees

Asha

Munjal

Kulkarni³

et al. 2014

Clinical Biomechanics

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Muscle and prosthesis contributions to amputee walking mechanics: A modeling study

Cited by 84 publications

References 35 publications

How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

Toe clearance when walking in people with unilateral transtibial amputation: Effects of passive hydraulic ankle

Impact on the biomechanics of overground gait of using an ‘Echelon’ hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees

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