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Updated: Jul 2, 2026
Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers
Published on: October 29, 2021
Muscle morphology and function following a transfemoral amputation: A systematic review
C M Kroes1,2, R Schelhaas3,4, R Dekker3
1Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Background:
Restoring function and mobility after transfemoral amputation (TFA) is crucial for prosthesis use and heavily relies on muscle morphology and function in the residual limb. After amputation, the loss of distal muscle insertions alters morphology and might impair (muscle) functioning.
Objective:
To provide a comprehensive and critically appraised overview of the existing evidence on muscle morphology and function of the residual limb following TFA.
Methodology:
A literature search was conducted in PubMed, Embase, and CINAHL, including articles published up to September 15, 2025. Language was restricted to English, Dutch and German. Articles were eligible if they included individuals with a TFA and objectively measured outcomes related to muscle morphology and/or function. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklist and the review followed the PRISMA guidelines.
Results:
Out of 1832 identified articles, 24 met the inclusion criteria. Eight articles reported outcomes related to muscle morphology while sixteen articles reported outcomes on muscle function. All articles assessing muscle volume and cross-sectional area reported reductions in most residual-limb muscle groups compared to the intact limb. Across articles assessing muscle function, the residual limb generated reduced hip flexion, extension, and abduction torques compared to the intact and/or control limb, while adduction torque diminished only at lower isokinetic speeds. The magnitude of alterations varied greatly between articles. No article investigated both muscle morphology and function. Therefore, the interrelationship between these outcomes could not be determined.
Conclusion:
The literature shows that muscle morphology and function are significantly altered in the residual limb following TFA, although reported effects vary across articles and muscle groups. Study heterogeneity limited exploration of factors that could account for this variation. This needs future study. Future research also should combine assessments of muscle morphology and function to better understand these variations.