Document Type : Original Articles

Authors

1 Department of physical education, humanities of sciences, university of kashan, Isfahan, Iran

2 Rehabilitation Faculty, Orthotics and Prosthetics Department, Isfahan University of Medical Sciences, Isfahan, Iran

3 Rehabilitation Faculty, Orthotics and Prosthetics Department, Shiraz University of Medical Sciences, Isfahan, Iran

Abstract

Background: there is little knowledge explaining how forces applied on knee, hip and L5-S1 joint between the sound and prosthetic leg in unilateral Below-Knee Amputation (BKA), so the aim of this study was to assess the interaction of knee, hip and L5-S1 joint contact forces between sound and prosthetic leg in patients with unilateral BKA during walkingMethods: Five patients with BKA were recruited in this study. A Qualisys motion system capture with seven cameras and a Kistler force plate were used to record kinematics and kinetics variables of walking. The forces applied on knee, hip and L5-S1 joint contact forces (JCF) were calculated by using Open-SIM software. SPSS software was used to analyze data at an alpha set point of 0.05.Result: The propulsive and second peaks of ground reaction forces applied on sound leg were significantly higher than prosthetic leg (p<0.05). Although the forces applied on hip, knee and L5-S1 joint in the sound leg were higher compared to prosthetic leg, the interaction between side and joint factor was not significant (p>0.05).Conclusion: The results of this study showed that the meaningful JCF applied on the sound leg were more than that of prosthetic leg. Insignificant increases in JCF on the sound leg during life can create cumulative forces on knee and low-back and endanger these joints at the risk of knee OA and chronic low-back pain. Balanced forces applied on sound and prosthetic leg is important, if this is the case, so indicating using a proper usage of socket pin and prosthetic feet which may have beneficial impact on sound side loads.

Keywords

  1. Dillingham TR, Pezzin LE, MacKenzie EJ. Limb amputation and
  2. limb deficiency: epidemiology and recent trends in the United
  3. States. Southern medical journal. 2002;95(8):875-83.
  4. Devan H, Hendrick P, Ribeiro DC, Hale LA, Carman A.
  5. Asymmetrical movements of the lumbopelvic region: Is this a
  6. potential mechanism for low back pain in people with lower limbamputation? Medical hypotheses. 2014;82(1):77-85.
  7. Sagawa Y, Turcot K, Armand S, Thevenon A, Vuillerme N,
  8. Watelain E. Biomechanics and physiological parameters during
  9. gait in lower-limb amputees: a systematic review. Gait & posture.
  10. ;33(4):511-26.
  11. Prinsen EC, Nederhand MJ, Rietman JS. Adaptation strategies of
  12. the lower extremities of patients with a transtibial or transfemoral
  13. amputation during level walking: a systematic review. Archives
  14. of physical medicine and rehabilitation. 2011;92(8):1311-25.
  15. Yu C-h, Hung Y-C, Lin Y-H, Chen G-X, Wei S-H, Huang C-H, et
  16. al. A 3D mathematical model to predict spinal joint and hip joint
  17. force for trans-tibial amputees with different SACH foot pylon
  18. adjustments. Gait & posture. 2014;40(4):545-8.
  19. Hendershot BD, Bazrgari B, Nussbaum MA. Persons with
  20. unilateral lower-limb amputation have altered and asymmetric
  21. trunk mechanical and neuromuscular behaviors estimated using
  22. multidirectional trunk perturbations. Journal of biomechanics.
  23. ;46(11):1907-12.
  24. Michaud SB, Gard SA, Childress DS. A preliminary investigation
  25. of pelvic obliquity patterns during gait in persons with transtibial
  26. and transfemoral amputation. Journal of rehabilitation research
  27. and development. 2000;37(1):1-10.
  28. Nolan L, Wit A, Dudziñski K, Lees A, Lake M, Wychowañski M.
  29. Adjustments in gait symmetry with walking speed in trans-femoral
  30. and trans-tibial amputees. Gait & posture. 2003;17(2):142-51.
  31. Dingwell J, Davis B, Frazder D. Use of an instrumented treadmill
  32. for real-time gait symmetry evaluation and feedback in normal
  33. and trans-tibial amputee subjects. Prosthetics and Orthotics
  34. International. 1996;20(2):101-10.
  35. Struyf PA, van Heugten CM, Hitters MW, Smeets RJ. The
  36. prevalence of osteoarthritis of the intact hip and knee among
  37. traumatic leg amputees. Archives of physical medicine and
  38. rehabilitation. 2009;90(3):440-6.
  39. Giles L, Taylor J. Low-back pain associated with leg length
  40. inequality. Spine. 1981;6(5):510-21.
  41. Dehghani M, Shemshaki H, Eshaghi MA, Teimouri M.
  42. Diagnostic accuracy of preoperative clinical examination in
  43. upper limb injuries. Journal of Emergencies, Trauma and Shock.
  44. ;4(4):461.
  45. Dehghani M, Zarezadeh A, Shemshaki H, Moezi M, Nourbakhsh
  46. M. Hour glass constriction in advanced carpal tunnel syndrome.
  47. International journal of preventive medicine. 2013;4(4):438.
  48. Vahdatpour B, Raissi G, Hollisaz M. Study of the ulnar nerve
  49. compromise at the wrist of patients with carpal tunnel syndrome.
  50. Electromyography and clinical neurophysiology. 2007;47(3):183-6.
  51. Vahdatpour B, Sajadieh S, Bateni V, Karami M, Sajjadieh
  52. H. Extracorporeal shock wave therapy in patients with
  53. plantar fasciitis. A randomized, placebo-controlled trial with
  54. ultrasonographic and subjective outcome assessments. Journal
  55. of research in medical sciences: the official journal of Isfahan
  56. University of Medical Sciences. 2012;17(9):834.
  57. Sadeghi H, Allard P, Duhaime M. Muscle power compensatory
  58. mechanisms in below-knee amputee gait. American journal of
  59. physical medicine & rehabilitation. 2001;80(1):25-32.
  60. Beyaert C, Grumillier C, Martinet N, Paysant J, Andre J-M.
  61. Compensatory mechanism involving the knee joint of the intact
  62. limb during gait in unilateral below-knee amputees. Gait &
  63. posture. 2008;28(2):278-84.
  64. Engsberg JR, Lee AG, Patterson JL, Harder JA. External loading
  65. comparisons between able-bodied and below-knee-amputee
  66. children during walking. Archives of physical medicine and
  67. rehabilitation. 1991;72(9):657-61.
  68. Hurley G, McKenney R, Robinson M, Zadravec M, Pierrynowski
  69. M. The role of the contralateral limb in below-knee amputee
  70. gait. Prosthetics and orthotics international. 1990;14(1):33-42.
  71. Fey NP, Neptune RR. 3D intersegmental knee loading in belowknee
  72. amputees across steady-state walking speeds. Clinical
  73. Biomechanics. 2012;27(4):409-14.
  74. Karimi MT, Salami F, Esrafilian A, Heitzmann DW, Alimusaj
  75. M, Putz C, et al. Sound side joint contact forces in below knee
  76. amputee gait with an ESAR prosthetic foot. Gait & Posture.
  77. ;58:246-51.
  78. Morgenroth DC, Gellhorn AC, Suri P. Osteoarthritis in the disabled
  79. population: a mechanical perspective. PM&R. 2012;4(5):S20-S7.
  80. Kušljugić¹ A, Kapidžić-Duraković S, Kudumović¹ Z, Čičkušić¹ A.
  81. Chronic low back pain in individuals with lower-limb amputation.
  82. Bosnian Journal of Basic Medical Sciences. 2006;6(2):67-70.
  83. Robert Gailey PhD P. Review of secondary physical conditions
  84. associated with lower-limb amputation and long-term prosthesis
  85. use. Journal of rehabilitation research and development.
  86. ;45(1):15.
  87. Burke M, Roman V, Wright V. Bone and joint changes in lower limb
  88. amputees. Annals of the rheumatic diseases. 1978;37(3):252-4.
  89. Esposito ER, Wilken JM. The relationship between pelvis–trunk
  90. coordination and low back pain in individuals with transfemoral
  91. amputations. Gait & posture. 2014;40(4):640-6.
  92. Hendershot BD, Wolf EJ. Three-dimensional joint reaction forces
  93. and moments at the low back during over-ground walking in
  94. persons with unilateral lower-extremity amputation. Clinical
  95. Biomechanics. 2014;29(3):235-42.
  96. Yoder AJ, Petrella AJ, Silverman AK. Trunk–pelvis motion,
  97. joint loads, and muscle forces during walking with a transtibial
  98. amputation. Gait & posture. 2015;41(3):757-62.
  99. Papi E, Ugbolue UC, Solomonidis S, Rowe PJ. Comparative study
  100. of a newly cluster based method for gait analysis and plug-in gait
  101. protocol. Gait & Posture. 2014;39(supplement 1):S9-S10.
  102. Kadaba M, Ramakrishnan H, Wootten M, Gainey J, Gorton
  103. G, Cochran G. Repeatability of kinematic, kinetic, and
  104. electromyographic data in normal adult gait. Journal of
  105. Orthopaedic Research. 1989;7(6):849-60.
  106. Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT,
  107. et al. OpenSim: open-source software to create and analyze
  108. dynamic simulations of movement. Biomedical Engineering,
  109. IEEE Transactions on. 2007;54(11):1940-50.
  110. Thelen DG, Anderson FC, Delp SL. Generating dynamic
  111. simulations of movement using computed muscle control. Journal
  112. of biomechanics. 2003;36(3):321-8.
  113. Steele KM, DeMers MS, Schwartz MH, Delp SL. Compressive
  114. tibiofemoral force during crouch gait. Gait & posture.
  115. ;35(4):556-60.
  116. Kendella P, Andertona W, Gustafsona JA, Farrokhia S.
  117. Quantifying Tibiofemoral Joint Contact Forces in Patients with
  118. Knee Osteoarthritis Using OpenSim. Highlighting Undergraduate
  119. Research at the University of Pittsburgh Swanson School of
  120. Engineering. 2015:48.
  121. Murray M, Seireg A, Sepic SB. Normal postural stability and
  122. steadiness: quantitative assessment. The Journal of Bone & Joint
  123. Surgery. 1975;57(4):510-6.
  124. Doyle TL, Newton RU, Burnett AF. Reliability of traditional and
  125. fractal dimension measures of quiet stance center of pressure
  126. in young, healthy people. Archives of physical medicine and
  127. rehabilitation. 2005;86(10):2034-40.
  128. Levangie PK, Norkin CC. Joint structure and function: a
  129. comprehensive analysis: FA Davis; 2011.
  130. Cavanagh PR, Lafortune MA. Ground reaction forces in distance
  131. running. Journal of biomechanics. 1980;13(5):397-406.
  132. Nuber G. Biomechanics of the foot and ankle during gait. Clinics
  133. in sports medicine. 1988;7(1):1-13.
  134. Whittle MW. Gait analysis: an introduction: Butterworth-
  135. Heinemann; 2014.
  136. Morgenroth DC, Orendurff MS, Shakir A, Segal A, Shofer J,
  137. Czerniecki JM. The relationship between lumbar spine kinematics
  138. during gait and low-back pain in transfemoral amputees. American
  139. Journal of Physical Medicine & Rehabilitation. 2010;89(8):635-43.
  140. da Costa BR, Vieira ER. Risk factors for work-related
  141. musculoskeletal disorders: a systematic review of recent
  142. longitudinal studies. American journal of industrial medicine.
  143. ;53(3):285-323.
  144. Devan H, Carman A, Hendrick P, Hale L, Ribeiro DC. Spinal,
  145. pelvic, and hip movement asymmetries in people with lowerlimb
  146. amputation: Systematic review. Journal of Rehabilitation
  147. Research & Development. 2015;52(1).
  148. Fujiwara A, Lim T-H, An HS, Tanaka N, Jeon C-H, Andersson
  149. GB, et al. The effect of disc degeneration and facet joint
  150. osteoarthritis on the segmental flexibility of the lumbar spine.
  151. Spine. 2000;25(23):3036-44.