The Amputated Limb Gluteus Medius is Biomechanically Disadvantaged in Patients with Unilateral Transfemoral Amputation.

Autor: Roda GF; Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA., Awad ME; Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Melton DH; University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Christiansen CL; University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; VA Eastern Colorado Health Care System, Aurora, CO, USA., Stoneback JW; Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Gaffney BMM; Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA. brecca.gaffney@ucdenver.edu.; University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. brecca.gaffney@ucdenver.edu.; Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. brecca.gaffney@ucdenver.edu.
Jazyk: angličtina
Zdroj: Annals of biomedical engineering [Ann Biomed Eng] 2024 Mar; Vol. 52 (3), pp. 565-574. Date of Electronic Publication: 2023 Nov 09.
DOI: 10.1007/s10439-023-03400-0
Abstrakt: Patients with transfemoral amputation (TFA) are at an increased risk of secondary musculoskeleteal comorbidities, primarily due to asymmetric joint loading. Amputated limb muscle weakness is also prevalent in the TFA population, yet all factors that contribute to muscle strength and thus joint loading are not well understood. Our objective was to bilaterally compare gluteus medius (GMED) muscle factors (volume, fatty infiltration, moment arm) that all contribute to joint loading in patients with TFA. Quantitative magnetic resonance (MR) images of the hip were collected from eight participants with unilateral TFA (2M/6F; age: 47.3 ± 14.7 y/o; BMI: 25.4 ± 5.3 kg/m 2 ; time since amputation: 20.6 ± 15.0 years) and used to calculate normalized GMED muscle volume and fatty infiltration. Six participants participated in an instrumented gait analysis session that collected whole-body kinematics during overground walking. Subject-specific musculoskeletal models were used to calculate bilateral GMED (anterior, middle, posterior) moment arms and frontal plane hip joint angles across three gait cycles. Differences in volume, fatty infiltration, hip adduction-abduction angle, and peak moment arms were compared between limbs using paired Cohen's d effect sizes. Volume was smaller by 36.3 ± 18.8% (d = 1.7) and fatty infiltration was greater by 6.4 ± 7.8% (d = 0.8) in the amputated limb GMED compared to the intact limb. The amputated limb GMED abduction moment arms were smaller compared to the intact limb for both overground walking (anterior: d = 0.9; middle: d = 0.1.2) and during normal range of motion (anterior: d = 0.8; middle: d = 0.8) while bilateral hip adduction-abduction angles were similar during overground walking (d = 0.5). These results indicate that in patients with TFA, the amputated limb GMED is biomechanically disadvantaged compared to the intact limb, which may contribute to the etiology of secondary comorbidities. This population might benefit from movement retraining to lengthen the amputated limb GMED abduction moment arm during gait.
(© 2023. The Author(s) under exclusive licence to Biomedical Engineering Society.)
Databáze: MEDLINE
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