Increased loading of the lateral knee compartment in the unamputated knee during gait in persons with unilateral transfemoral/through-knee amputations
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Aims
People with unilateral transfemoral/through-knee amputations (UTF) are at risk of mechanically mediated contralateral knee osteoarthritis (OA). This study aims to identify the mechanical indicators of the development and progression of unamputated knee OA in the UTF population.
Methods
Level-ground gait data were collected from 14 male traumatic UTF participants and 14 uninjured matched controls using optical motion capture systems and force plates. Inverse kinematics, inverse dynamics, and static optimization musculoskeletal modelling simulations were conducted.
Results
UTF demonstrated higher unamputated ankle plantarflexion angles (by 4.9°, p = 0.012), peak-to-peak pelvic obliquity angles (by 2.9°, p = 0.040), and unamputated limb second peak ground reaction force (by 0.1 body weight (BW), p = 0.002) than controls. The UTF unamputated knee maximum loading rate was 0.9 Nm/kg.s higher than controls (p = 0.002). Additionally, UTF presented higher loading of the lateral compartment of the unamputated knee than controls, as characterized by the first peak (by 0.3 BW, p = 0.033), second peak (by 0.8 BW, p = 0.008), and impulse (by 22.0 BW.s/m, p < 0.001).
Conclusion
Traumatic UTF need to adopt new movement strategies to account for the limb loss. Although beneficial for successful ambulation, these compensatory movement strategies increase joint loading in the unamputated knee, which may increase the risk of OA and soft-tissue injuries. Mitigation strategies need to be proposed to improve ambulatory biomechanics with a view to improving long-term musculoskeletal health, while maintaining optimal functional levels.
People with unilateral transfemoral/through-knee amputations (UTF) are at risk of mechanically mediated contralateral knee osteoarthritis (OA). This study aims to identify the mechanical indicators of the development and progression of unamputated knee OA in the UTF population.
Methods
Level-ground gait data were collected from 14 male traumatic UTF participants and 14 uninjured matched controls using optical motion capture systems and force plates. Inverse kinematics, inverse dynamics, and static optimization musculoskeletal modelling simulations were conducted.
Results
UTF demonstrated higher unamputated ankle plantarflexion angles (by 4.9°, p = 0.012), peak-to-peak pelvic obliquity angles (by 2.9°, p = 0.040), and unamputated limb second peak ground reaction force (by 0.1 body weight (BW), p = 0.002) than controls. The UTF unamputated knee maximum loading rate was 0.9 Nm/kg.s higher than controls (p = 0.002). Additionally, UTF presented higher loading of the lateral compartment of the unamputated knee than controls, as characterized by the first peak (by 0.3 BW, p = 0.033), second peak (by 0.8 BW, p = 0.008), and impulse (by 22.0 BW.s/m, p < 0.001).
Conclusion
Traumatic UTF need to adopt new movement strategies to account for the limb loss. Although beneficial for successful ambulation, these compensatory movement strategies increase joint loading in the unamputated knee, which may increase the risk of OA and soft-tissue injuries. Mitigation strategies need to be proposed to improve ambulatory biomechanics with a view to improving long-term musculoskeletal health, while maintaining optimal functional levels.
Date Issued
2025-07-01
Date Acceptance
2025-03-07
Citation
Bone & Joint Research, 2025, 14 (7), pp.633-641
ISSN
2046-3758
Publisher
The British Editorial Society of Bone & Joint Surgery
Start Page
633
End Page
641
Journal / Book Title
Bone & Joint Research
Volume
14
Issue
7
Copyright Statement
© 2025 Toderita et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
Publication Status
Published
Date Publish Online
2025-07-11