Higher knee contact forces might underlie increased osteoarthritis rates in high functioning amputees : a pilot study

Ding, Z; Jarvis, HL; Bennett, AN; Baker, RJ; Bull, AMJ

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 has 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 modelling, 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 ≤ 0.006). Additionally, the intact limbs had greater peak semimembranosus (p = 0.001)and gastrocnemius (p ≤ 0.001) 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 TTAsthat 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 improvementsof the prosthetic foot control, socket design and strengthening of the amputated muscles.

Citation

Ding, Z., Jarvis, H., Bennett, A., Baker, R., & Bull, A. (2021). Higher knee contact forces might underlie increased osteoarthritis rates in high functioning amputees : a pilot study. Journal of Orthopaedic Research, 39(4), 850-860. https://doi.org/10.1002/jor.24751

• Journal Article Type: Article
• Acceptance Date: May 1, 2020
• Online Publication Date: May 19, 2020
• Publication Date: Apr 1, 2021
• Deposit Date: Jun 1, 2020
• Publicly Available Date: Jul 1, 2020
• Journal: Journal of Orthopaedic Research
• Print ISSN: 0736-0266
• Publisher: Wiley
• Volume: 39
• Issue: 4
• Pages: 850-860
• DOI: https://doi.org/10.1002/jor.24751
• Publisher URL: https://doi.org/10.1002/jor.24751
• Related Public URLs: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1554-527X
• Additional Information: Additional Information : ** Article version: VoR ** From Crossref via Jisc Publications Router **Journal IDs: pissn 0736-0266; eissn 1554-527X **History: issued 19-05-2020; published_online 19-05-2020 **License for this article: starting on 19-05-2020, , http://onlinelibrary.wiley.com/termsAndConditions#vor; Funders : Royal British Legion