Higher knee contact forces might underlie increased osteoarthritis rates in high functioning amputees: a pilot study
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Published version
Author(s)
Ding, Ziyun
Jarvis, Hannah
Bennett, Alexander
Baker, Richard
Bull, Anthony
Type
Journal Article
Abstract
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.
Date Issued
2021-04-01
Date Acceptance
2020-05-01
Citation
Journal of Orthopaedic Research, 2021, 39 (4), pp.850-860
ISSN
0736-0266
Publisher
Wiley
Start Page
850
End Page
860
Journal / Book Title
Journal of Orthopaedic Research
Volume
39
Issue
4
Copyright Statement
© 2020 The Authors. Journal of Orthopaedic Research published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
The Royal British Legion
Identifier
https://onlinelibrary.wiley.com/doi/full/10.1002/jor.24751
Grant Number
BMPF_P60304
Subjects
Science & Technology
Life Sciences & Biomedicine
Orthopedics
knee contact force
knee osteoarthritis
musculoskeletal modeling
unilateral transtibial amputee
MUSCULOSKELETAL MODEL
JOINT CONTACT
THIGH MUSCLES
WALKING
LOAD
ADJUSTMENTS
CARTILAGE
STRENGTH
SYMMETRY
STANCE
knee contact force
knee osteoarthritis
musculoskeletal modeling
unilateral transtibial amputee
Orthopedics
0903 Biomedical Engineering
1103 Clinical Sciences
1106 Human Movement and Sports Sciences
Publication Status
Published
Date Publish Online
2020-05-19