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Limb Salvage With Intrepid Dynamic Exoskeletal Orthosis Versus Transtibial Amputation: A Comparison of Functional
Katharine I Mangan1, Trevor D Kingsbury, Brittney N Mazzone
1*Department of Orthopaedic Surgery, Naval Hospital Oak Harbor, Oak Harbor, WA; †Gait Analysis Laboratory, Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA; ‡BADER Consortium, University of Delaware, Newark, DE; and §Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA.
Objectives:
To determine if there is a difference in functional gait outcomes between patients with limb injuries treated with either transtibial amputation or limb preservation with the Intrepid Dynamic Exoskeletal Orthosis.
Design:
Retrospective prognostic study.
Setting:
Tertiary referral military hospital.
Patients:
This study included 10 transtibial amputees and 10 limb preservation patients using the Intrepid Dynamic Exoskeletal Orthosis who were matched by body mass index after excluding for nontraumatic, proximal ipsilateral, contralateral, spine, or traumatic brain injuries. Transtibial amputation patients were also excluded if they did not have a gait study between 6 and 12 months after independent ambulation. Limb preservation were excluded if they did not complete the "Return to Run" program.
Interventions:
An observational study of functional outcomes using instrumented gait analysis.
Outcome Measures:
Spatiotemporal, kinetic (vertical ground reaction force), unified deformable power, work, and efficiency.
Results:
Limb preservation patients walked with a significantly slower cadence (P = 0.036) and spent less time on their affected limb in stance (P = 0.045), and longer in swing (P = 0.019). Amputees had significantly increased maximum positive power in both limbs (P = 0.004 and P = 0.029) and increased maximum negative power on the unaffected limb (P = 0.035). Amputees had significantly increased positive and negative work in the affected limb (P = 0.0009 and P = 0.014) and positive work in the unaffected limb (P = 0.042). There was no significant difference in the kinetic data or efficiency.
Conclusions:
Limb preservation patients spend less time on their affected limb as a percentage of the gait cycle. The unified deformable power demonstrated more dynamic gait in amputees, with peak values closer to normative data.
Level Of Evidence:
Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.
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