Absent loading response knee flexion: The impact on gait kinetics and centre of mass motion in individuals with unilateral transfemoral amputation, and the effect of microprocessor controlled knee provision.

BACKGROUND: Individuals with unilateral transfemoral amputation walk with increased levels of asymmetry, and this is associated with reduced gait efficiency, back pain and overuse of the intact limb. This study investigated the effect of walking with a unilateral absence of loading response knee flexion on the symmetry of anterior-posterior kinetics and centre of mass accelerations. METHODS: A retrospective cohort study design was used, assessing three-dimensional gait data from individuals with unilateral transfemoral amputation (n = 56). The anterior-posterior gait variables analysed included; peak ground reaction forces, impulse, centre of mass acceleration, as well as rate of vertical ground reaction force increase in early stance. With respect to these variables, this study assessed the symmetry between intact and prosthetic limbs, compared intact limbs against a healthy unimpaired control group, and evaluated effect on symmetry of microprocessor controlled knee provision. FINDINGS: Significant between-limb asymmetries were found between intact and prosthetic limbs across all variables (p < 0.0001). Intact limbs showed excessive loading when compared with control group limbs after speed normalisation across all variables (p < 0.0001). No improvement in kinetic symmetry following microprocessor controlled knee provision was found. INTERPRETATION: The gait asymmetries for individuals with transfemoral amputation identified in this study suggest that more should be done by developers to address the resultant overloading of the intact limb, as this is thought to have negative long-term effects. The provision of microprocessor controlled knees did not appear to improve the asymmetries faced by individuals with transfemoral amputation, and clinicians should be aware of this when managing patient expectations.

Impact of PPAM aid use on the time to prosthetic limb delivery in patients with unilateral transtibial amputation: A retrospective analysis.

BACKGROUND: The pneumatic postamputation mobility (PPAM) aid is the most commonly used early walking aid in the United Kingdom in transtibial amputation (TTA) and promotes wound healing and prepares the stump for prosthetic limb fitting. Optimal guidelines for PPAM aid use and how these factors affect achievement of rehabilitation milestones have not yet been conclusively established. OBJECTIVE: To investigate the relationship between PPAM aid use and the time taken to achieve rehabilitation milestones in patients undergoing unilateral TTA. STUDY DESIGN: Retrospective case note analysis. METHODS: Case notes of patients from one National Health Service amputation rehabilitation center who were identified as having a unilateral TTA in 2017-2018 and fitted with a prosthesis were reviewed. RESULTS: One hundred seven patients (67.5% male; mean age of 59.9 years) were identified. Use of PPAM aid during inpatient physiotherapy was associated with the days to reach referral, casting, delivery of prosthetic limb, and inpatient discharge dates (r (105) =-0.345; -0.400; -0.423; 0.546, respectively, all P < 0.05). Frequency of PPAM aid use was associated with the time to reach casting (r (105) =-0.533, P < 0.05) and delivery (r (105) =-0.513, P < 0.05). The days to being PPAM aid use and the frequency of PPAM aid use were predictive of the days to reach referral, casting, delivery, and inpatient discharge. CONCLUSIONS: The use of the PPAM aid is associated with a reduction in the time taken to reach rehabilitation milestones. Early and more frequent use of PPAM aid during rehabilitation will decrease the time fit and delivery of the prosthetic limb.