Unilateral transfemoral osseointegrated prostheses improve joint loading during walking.

Autor: Vandenberg NW; Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States., Stoneback JW; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States., Davis-Wilson H; Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States., Christiansen CL; Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States., Awad ME; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States., Melton DH; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States., Gaffney BMM; Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States; Center for Bioengineering, University of Colorado Denver, Aurora, CO, United States. Electronic address: brecca.gaffney@ucdenver.edu.
Jazyk: angličtina
Zdroj: Journal of biomechanics [J Biomech] 2023 Jun; Vol. 155, pp. 111658. Date of Electronic Publication: 2023 May 26.
DOI: 10.1016/j.jbiomech.2023.111658
Abstrakt: People with unilateral transfemoral amputation using socket prostheses are at increased risk for developing osteoarthritis in both the residual hip and intact lower-limb joints. Osseointegrated prostheses are a surgical alternative to socket prostheses that directly attach to the residual femur via a bone-anchored implant, however their multi-joint loading effect is largely unknown. Our objective was to establish how osseointegrated prostheses influence joint loading during walking. Motion capture data (kinematics, ground reaction forces) were collected from 12 participants at baseline, with socket prostheses, and 12-months after prosthesis osseointegration during overground walking at self-selected speeds. Subject-specific musculoskeletal models were developed at each timepoint relative to osseointegration. Internal joint moments were calculated using inverse dynamics, muscle and joint reaction forces (JRFs) were estimated with static optimization. Changes in internal joint moments, JRFs, and joint loading-symmetry were compared using statistical parametric mapping (p≤ 0.05) before and after osseointegration. Amputated limb hip flexion moments and anterior JRFs decreased during terminal stance (p = 0.002, <0.001; respectively), while amputated limb hip abduction moments increased during mid-stance (p < 0.001), amputated hip rotation moment changed from internal to external throughout early stance (p < 0.001). Intact limb hip extension and knee flexion moments (p = 0.028, 0.032; respectively), superior and resultant knee JRFs (p = 0.046, 0.049; respectively) decreased during the loading response following prosthesis osseointegration. These results may indicate that the direct loading transmission of these novel prostheses create a more typical mechanical environment in bilateral joints, which is comparable with loading observed in able-bodied individuals and could decrease the risk of development or progression of osteoarthritis.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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