Long-term gait stability and adaptive mechanisms decades after rotationplasty: a gait analysis study

Although rotationplasty patients typically regain good mobility, the altered anatomy, reduced muscle volume, and impaired proprioception may compromise gait stability. This study evaluated long-term gait stability in rotationplasty patients compared with a control group without lower limb pathology.

In this cross-sectional study, 3D-gait analysis using a 12-camera Vicon system was performed at self-selected walking speed. Gait stability was quantified using temporal-spatial variability and the margin of stability (MoS) in mediolateral (ML) and anterior-posterior (AP) directions. Parameters were compared between the rotationplasty and contralateral limbs with a control group of eleven participants. Perceived balance and walking ability were assessed with the Prosthesis Evaluation Questionnaire. Associations between stability metrics and perceived outcomes were explored using Spearman correlations.

Twenty-nine survivors (mean follow-up 32.3 years) were included. Compared with the control group, patients demonstrated greater step width (mean difference(MD) = 31.1 mm; p = 0.007) and step-width variability (MD = 7.8 mm; p < 0.001) and shorter stance time on the rotationplasty limb but longer on the contralateral limb (both p < 0.001). AP MoS were lower (MD = -68.6 and - 65.9 mm; both p < 0.001), whereas ML MoS were higher in people with rotationplasty (MD = 29.0 and 9.2 mm; both p = 0.049) compared with the control group. No significant correlations were found between gait stability measures and balance or ambulation questionnaire scores.

Three decades after surgery, rotationplasty survivors exhibit reduced gait stability characterized by higher step width variability, and reduced AP MoS versus the control group. Higher ML MoS likely reflects a compensatory balance strategy.