Impact of amputation level and vaulting on loading parameters during level ground walking

Area of Science:

• Biomechanics
• Orthopedics
• Rehabilitation Engineering

Background:

• Contralateral limb loading increases with proximal lower limb amputation levels.
• Vaulting is a common compensatory mechanism that may influence limb loading.
• Previous research has not comprehensively compared loading across multiple amputation levels.

Purpose of the Study:

• To analyze the biomechanical effects of various lower limb amputation levels on the locomotor system.
• To investigate the impact of vaulting as a compensatory strategy on limb loading.
• To compare joint moments and ground reaction forces across transtibial, transfemoral, and hip disarticulation amputations.

Main Methods:

• Retrospective analysis of gait data from 82 individuals with lower limb amputations (44 transtibial, 30 transfemoral, 8 hip disarticulation).
• Statistical analysis of peak knee adduction, flexion, and extension moments, and vertical ground reaction force peaks and rates.
• Comparison between different amputation levels and between transfemoral amputees with and without vaulting.

Main Results:

• Increased amputation level correlated with decreased walking speed and increased stance duration asymmetry.
• Transfemoral amputees exhibiting vaulting walked faster than those without vaulting.
• Higher amputation levels led to increased vertical ground reaction force peaks, knee adduction and extension moments, and a steeper initial vertical ground reaction force curve, alongside decreased knee flexion moments.

Conclusions:

• Higher lower limb amputation levels significantly increase contralateral limb loading.
• Vaulting behavior is more prevalent with higher amputation levels and further exacerbates contralateral limb loading.
• Findings highlight the biomechanical challenges and compensatory strategies associated with higher amputation levels.