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 - Higher knee contact forces might underlie increased osteoarthritis rates in high functioning amputees: A pilot study.
AU - Ding, Z
AU - Jarvis, HL
AU - Bennett, AN
AU - Baker, R
AU - Bull, AMJ
PY - 2021/4/1
Y1 - 2021/4/1
N2 - High functioning military transtibial amputees (TTAs) with well-fitted state of the art prosthetics have gait that is indistinguishable from healthy individuals, yet they are more likely to develop knee osteoarthritis (OA) of their intact limbs. This contrasts with the information at the knees of the amputated limbs that have been shown to be at a significantly reduced risk of pain and OA. The hypothesis of this study is that biomechanics can explain the difference in knee OA risk. Eleven military unilateral TTAs and eleven matched healthy controls underwent gait analysis. Muscle forces and joint contact forces at the knee were quantified using musculoskeletal modeling, validated using electromyography measurements. Peak knee contact forces for the intact limbs on both the medial and lateral compartments were significantly greater than the healthy controls (P ≤ .006). Additionally, the intact limbs had greater peak semimembranosus (P = .001) and gastrocnemius (P ≤ .001) muscle forces compared to the controls. This study has for the first time provided robust evidence of increased force on the non-affected knees of high functioning TTAs that supports the mechanically based hypothesis to explain the documented higher risk of knee OA in this patient group. The results suggest several protentional strategies to mitigate knee OA of the intact limbs, which may include the improvements of the prosthetic foot control, socket design, and strengthening of the amputated muscles.
AB - High functioning military transtibial amputees (TTAs) with well-fitted state of the art prosthetics have gait that is indistinguishable from healthy individuals, yet they are more likely to develop knee osteoarthritis (OA) of their intact limbs. This contrasts with the information at the knees of the amputated limbs that have been shown to be at a significantly reduced risk of pain and OA. The hypothesis of this study is that biomechanics can explain the difference in knee OA risk. Eleven military unilateral TTAs and eleven matched healthy controls underwent gait analysis. Muscle forces and joint contact forces at the knee were quantified using musculoskeletal modeling, validated using electromyography measurements. Peak knee contact forces for the intact limbs on both the medial and lateral compartments were significantly greater than the healthy controls (P ≤ .006). Additionally, the intact limbs had greater peak semimembranosus (P = .001) and gastrocnemius (P ≤ .001) muscle forces compared to the controls. This study has for the first time provided robust evidence of increased force on the non-affected knees of high functioning TTAs that supports the mechanically based hypothesis to explain the documented higher risk of knee OA in this patient group. The results suggest several protentional strategies to mitigate knee OA of the intact limbs, which may include the improvements of the prosthetic foot control, socket design, and strengthening of the amputated muscles.
U2 - 10.1002/jor.24751
DO - 10.1002/jor.24751
M3 - Journal article
C2 - 32427347
VL - 39
SP - 850
EP - 860
JO - Journal of orthopaedic research : official publication of the Orthopaedic Research Society
JF - Journal of orthopaedic research : official publication of the Orthopaedic Research Society
IS - 4
ER -