Final published version, 2.13 MB, PDF document
Available under license: CC BY: Creative Commons Attribution 4.0 International License
Final published version
Licence: CC BY: Creative Commons Attribution 4.0 International License
Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Development, validation and use of a musculoskeletal model for transtibial amputation: biomechanical evidence for increased rates of osteoarthritis of the uninjured limb
AU - Jarvis, Hannah
AU - Ding, Ziyun
AU - Bennett, Alexander
AU - baker, richard
AU - Bull, Anthony
PY - 2021/4/30
Y1 - 2021/4/30
N2 - High functioning military transtibial amputees (TTAs) with well‐fitted state of the artprosthetics have gait that is indistinguishable from healthy individuals, yet they aremore likely to develop knee osteoarthritis (OA) of their intact limbs. This contrastswith the information at the knees of the amputated limbs that have been shown tobe at a significantly reduced risk of pain and OA. The hypothesis of this study is thatbiomechanics can explain the difference in knee OA risk. Eleven military unilateralTTAs and eleven matched healthy controls underwent gait analysis. Muscle forcesand joint contact forces at the knee were quantified using musculoskeletal modeling,validated using electromyography measurements. Peak knee contact forces for theintact limbs on both the medial and lateral compartments were significantly greaterthan the healthy controls (P ≤ .006). Additionally, the intact limbs had greater peaksemimembranosus (P = .001) and gastrocnemius (P ≤ .001) muscle forces comparedto the controls. This study has for the first time provided robust evidence of increasedforce on the non‐affected knees of high functioning TTAs that supports themechanically based hypothesis to explain the documented higher risk of knee OA inthis patient group. The results suggest several protentional strategies to mitigateknee OA of the intact limbs, which may include the improvements of the prostheticfoot control, socket design, and strengthening of the amputated muscles.
AB - High functioning military transtibial amputees (TTAs) with well‐fitted state of the artprosthetics have gait that is indistinguishable from healthy individuals, yet they aremore likely to develop knee osteoarthritis (OA) of their intact limbs. This contrastswith the information at the knees of the amputated limbs that have been shown tobe at a significantly reduced risk of pain and OA. The hypothesis of this study is thatbiomechanics can explain the difference in knee OA risk. Eleven military unilateralTTAs and eleven matched healthy controls underwent gait analysis. Muscle forcesand joint contact forces at the knee were quantified using musculoskeletal modeling,validated using electromyography measurements. Peak knee contact forces for theintact limbs on both the medial and lateral compartments were significantly greaterthan the healthy controls (P ≤ .006). Additionally, the intact limbs had greater peaksemimembranosus (P = .001) and gastrocnemius (P ≤ .001) muscle forces comparedto the controls. This study has for the first time provided robust evidence of increasedforce on the non‐affected knees of high functioning TTAs that supports themechanically based hypothesis to explain the documented higher risk of knee OA inthis patient group. The results suggest several protentional strategies to mitigateknee OA of the intact limbs, which may include the improvements of the prostheticfoot control, socket design, and strengthening of the amputated muscles.
M3 - Journal article
VL - 39
SP - 850
EP - 860
JO - Journal of Orthopaedic Surgery and Research
JF - Journal of Orthopaedic Surgery and Research
SN - 1749-799X
IS - 4
ER -