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