Carolyn E Taylor1, Yue Zhang2, Yuqing Qiu3, Heath B Henninger4, K Bo Foreman5, Kent N Bachus6. 1. Department of Orthopaedics, University of Utah, 590 Wakara Way, Rm A100, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, Rm 3100, Salt Lake City, UT, United States. Electronic address: carolyn.taylor@utah.edu. 2. Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way Rm 1n400, Salt Lake City, UT, United States. Electronic address: zhang.yue@hsc.utah.edu. 3. Study Design and Biostatistics Center, University of Utah, 295 Chipeta Way Rm 1n400, Salt Lake City, UT, United States. Electronic address: yuqing.qiu@hsc.utah.edu. 4. Department of Orthopaedics, University of Utah, 590 Wakara Way, Rm A100, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, Rm 3100, Salt Lake City, UT, United States. Electronic address: heath.henninger@utah.edu. 5. Department of Veterans Affairs, 500 Foothill Dr (151), Salt Lake City, UT, United States; Department of Orthopaedics, University of Utah, 590 Wakara Way, Rm A100, Salt Lake City, UT, United States; Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, United States. Electronic address: bo.foreman@hsc.utah.edu. 6. Department of Veterans Affairs, 500 Foothill Dr (151), Salt Lake City, UT, United States; Department of Orthopaedics, University of Utah, 590 Wakara Way, Rm A100, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, Rm 3100, Salt Lake City, UT, United States. Electronic address: kent.bachus@hsc.utah.edu.
Abstract
BACKGROUND: Percutaneous osseointegrated (OI) docking of prosthetic limbs returns loading directly to the residual bone of individuals with amputations. Lower limb diaphyseal biomechanics have not been studied during the wide range of daily activities performed by individuals with lower extremity amputations; therefore, little is known about the loads experienced at the bone-endoprosthetic interface of a percutaneous OI device. RESEARCH QUESTION: Does residual limb length and/or gender influence loading magnitudes in the diaphysis of the femur or tibia during daily activities? METHODS: This observational study used motion capture data from 40 non-amputee volunteers performing nine activities ranging from low to high demand, to virtually simulate residual limbs of amputees. To simulate diaphyseal bone loading in individuals with lower limb amputations, virtual joints were defined during post-processing at 25, 50, and 75 % of residual limb length of both the femur and the tibia, representing six clinically relevant residual limb lengths for OI device placement. Peak axial distractive and compressive forces, torsional moments, and bending moments were calculated for each activity. Comparisons were made between genders and between different levels of the simulated residual limb. RESULTS: For simulated above and below knee amputations, short residual limbs showed the highest average bending, torsion, and axial distractive loads, while axial compressive loads were highest for long residual limbs. Absolute maxima for all subjects showed this same trend, except in below knee torsion, where 75 % residual tibia length showed the maximum. The highest demand activities yielding peaks in all directions were cutting with right leg planted, jump, run, and fall. SIGNIFICANCE: Overall, individuals with shorter residual limbs experienced higher diaphyseal forces. This should be taken into consideration during surgical implantation of percutaneous OI devices where residual limb length can potentially be shortened, and during rehabilitation of percutaneous OI patients. Published by Elsevier B.V.
BACKGROUND: Percutaneous osseointegrated (OI) docking of prosthetic limbs returns loading directly to the residual bone of individuals with amputations. Lower limb diaphyseal biomechanics have not been studied during the wide range of daily activities performed by individuals with lower extremity amputations; therefore, little is known about the loads experienced at the bone-endoprosthetic interface of a percutaneous OI device. RESEARCH QUESTION: Does residual limb length and/or gender influence loading magnitudes in the diaphysis of the femur or tibia during daily activities? METHODS: This observational study used motion capture data from 40 non-amputee volunteers performing nine activities ranging from low to high demand, to virtually simulate residual limbs of amputees. To simulate diaphyseal bone loading in individuals with lower limb amputations, virtual joints were defined during post-processing at 25, 50, and 75 % of residual limb length of both the femur and the tibia, representing six clinically relevant residual limb lengths for OI device placement. Peak axial distractive and compressive forces, torsional moments, and bending moments were calculated for each activity. Comparisons were made between genders and between different levels of the simulated residual limb. RESULTS: For simulated above and below knee amputations, short residual limbs showed the highest average bending, torsion, and axial distractive loads, while axial compressive loads were highest for long residual limbs. Absolute maxima for all subjects showed this same trend, except in below knee torsion, where 75 % residual tibia length showed the maximum. The highest demand activities yielding peaks in all directions were cutting with right leg planted, jump, run, and fall. SIGNIFICANCE: Overall, individuals with shorter residual limbs experienced higher diaphyseal forces. This should be taken into consideration during surgical implantation of percutaneous OI devices where residual limb length can potentially be shortened, and during rehabilitation of percutaneous OI patients. Published by Elsevier B.V.
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