Advertisement

Structural changes in the thigh muscles following trans-femoral amputation

  • C. PutzEmail author
  • J. Block
  • S. Gantz
  • D. W. W. Heitzmann
  • T. Dreher
  • B. Lehner
  • M. Alimusaj
  • S. I. Wolf
  • S. Müller
Original Article • LOWER LIMB - TUMORS

Abstract

Introduction

Early ambulation is the principal objective in trans-femoral amputees. Postamputation modifications complicate the rehabilitation process due to a reduced control at the interface between stump and prosthesis. The aim of this study is to determine whether magnetic resonance imaging depicts the amount of fatty degeneration of the thigh muscles after trans-femoral amputation (TFA).

Methods

A total of 12 patients following a TFA on the basis of a bone neoplasm or metastasis with an evaluable postoperative MRI were identified. Using the Goutallier classification, the fatty degeneration of the thigh muscles was analyzed in the middle (M) and at the distal end (E) of the residual limb at T1 (10.6 months) and T2 (25.6 months).

Results

Analysis at two different levels showed different grades of fatty degeneration of thigh muscles after TFA at T1 and T2. Comparing fatty degeneration at both levels of the stump, the quadriceps femoris revealed a significant change (p = 0.01) at T1 and M. sartorius and adductor (p = 0.02) at T2.

Conclusions

MRI is an excellent diagnostic tool to evaluate fatty degeneration after TFA. The highest amount of fatty degeneration of the quadriceps muscle was monitored within the first 10 months. Early physiotherapy is important to strengthen the remaining stump muscles during rehabilitation.

Keywords

Trans-femoral amputation Magnetic resonance imaging Goutallier classification intramuscular fatty degeneration Thigh muscles 

Notes

Authors’ contribution

CP was involved in study design, analysis and interpretation of data and wrote the manuscript; JB, DWWH and SG were involved in analysis and interpretation of data; BL, MA and TD were involved in acquisition and analysis of data; SIW and SM were involved in study conception and critical review.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Eilber FR, Mirra JJ, Grant TT, Weisenburger T, Morton DL (1980) Is amputation necessary for sarcomas? A seven-year experience with limb salvage. Ann Surg 192(4):431–438CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sathishkumar S, Manigandan C, Asha T, Charles J, Poonoose PP (2004) A cost-effective, adjustable, femoral socket, temporary prosthesis for immediate rehabilitation of above-knee amputation. Int J Rehabil Res 27(1):71–74CrossRefPubMedGoogle Scholar
  3. 3.
    Fraisse N, Martinet N, Kpadonou TJ, Paysant J, Blum A, André JM (2008) Muscles of the below-knee amputees. Ann Readapt Med Phys 51(3):218–227CrossRefPubMedGoogle Scholar
  4. 4.
    Isakov E, Burger H, Gregoric M, Marincek C (1996) Stump length as related to atrophy and strength of the thigh muscles in trans-tibial amputees. Prosthet Orthot Int 20(2):96–100PubMedGoogle Scholar
  5. 5.
    Jaegers SM, Arendzen JH, de Jongh HJ (1995) Changes in hip muscles after above-knee amputation. Clin Orthop Relat Res 319:276–284Google Scholar
  6. 6.
    Degardin A, Morillon D, Lacour A, Cotten A, Vermersch P, Stojkovic T (2010) Morphologic imaging in muscular dystrophies and inflammatory myopathies. Skelet Radiol 39(12):1219–1227CrossRefGoogle Scholar
  7. 7.
    Engelken F, Wassilew GI, Kohlitz T, Brockhaus S, Hamm B, Perka C, Diederichs UG (2014) Assessment of fatty degeneration of the gluteal muscles in patients with THA using MRI: reliability and accuracy of the Goutallier and quartile classification systems. J Arthroplast 29(1):149–153CrossRefGoogle Scholar
  8. 8.
    Lachiewicz PF (2011) Abductor tendon tears of the hip: evaluation and management. J Am Acad Orthop Surg 19(7):385–391CrossRefPubMedGoogle Scholar
  9. 9.
    Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elb Surg 12(6):550–554CrossRefGoogle Scholar
  10. 10.
    Liem D, Lichtenberg S, Magosch P, Habermeyer P (2007) Magnetic resonance imaging of arthroscopic supraspinatus tendon repair. J Bone Joint Surg Am 89(8):1770–1776PubMedGoogle Scholar
  11. 11.
    Melis B, Nemoz C, Walch G (2009) Muscle fatty infiltration in rotator cuff tears: descriptive analysis of 1688 cases. Orthop Traumatol Surg Res 95(5):319–324CrossRefPubMedGoogle Scholar
  12. 12.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
  13. 13.
    Gottschalk F (1992) Transfemoral amputation. In: Atlas of limb prosthetics: prosthetic and rehabilitation principles, 2nd edn. Bowker JM, Michael JW.-St. Louis, Mosby: 501–507Google Scholar
  14. 14.
    Sanders JE, Cagle JC, Allyn KJ, Harrison DS, Ciol MA (2014) How do walking, standing, and resting influence transtibial amputee residual limb fluid volume? J Rehabil Res Dev 51(2):201–212CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Sherk VD, Bemben MG, Bemben DA (2010) Interlimb muscle and fat comparisons in persons with lower-limb amputation. Arch Phys Med Rehabil 91(7):1077–1081CrossRefPubMedGoogle Scholar
  16. 16.
    Reimers CD, Harder T, Saxe H (1998) Age-related muscle atrophy does not affect all muscles and can partly be compensated by physical activity: an ultrasound study. J Neurol Sci 159(1):60–66CrossRefPubMedGoogle Scholar
  17. 17.
    Moore CD, Craven BC, Thabane L, Laing AC, Frank-Wilson AW, Kontulainen SA, Papaioannou A, Adachi JD, Giangregorio L (2015) Lower-extremity muscle atrophy and fat infiltration after chronic spinal cord injury. J Musculoskelet Neuronal Interact 15(1):32–41PubMedPubMedCentralGoogle Scholar
  18. 18.
    Gorgey AS, Dudley GA (2007) Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury. Spinal Cord 45(4):304–309PubMedGoogle Scholar
  19. 19.
    Gorgey AS, Dudley GA (2008) Spasticity may defend skeletal muscle size and composition after incomplete spinal cord injury. Spinal Cord 46(2):96–102CrossRefPubMedGoogle Scholar
  20. 20.
    Gorgey AS, Dolbow DR, Cifu DX, Gater DR (2013) Neuromuscular electrical stimulation attenuates thigh skeletal muscles atrophy but not trunk muscles after spinal cord injury. J Electromyogr Kinesiol 23(4):977–984CrossRefPubMedGoogle Scholar
  21. 21.
    Schmalz T, Blumentritt S, Reimers CD (2001) Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study. Arch Orthop Trauma Surg 121(6):307–312CrossRefPubMedGoogle Scholar
  22. 22.
    Hogrel JY, Barnouin Y, Azzabou N, Butler-Browne G, Voit T, Moraux A, Leroux G, Behin A, McPhee JS, Carlier PG (2015) NMR imaging estimates of muscle volume and intramuscular fat infiltration in the thigh: variations with muscle, gender, and age. Age (Dordr) 37(3):9798CrossRefGoogle Scholar
  23. 23.
    Gottschalk FA, Stills M (1994) The biomechanics of trans-femoral amputation. Prosthet Orthot Int 18(1):12–17PubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • C. Putz
    • 1
    Email author
  • J. Block
    • 1
  • S. Gantz
    • 2
  • D. W. W. Heitzmann
    • 1
  • T. Dreher
    • 1
  • B. Lehner
    • 3
  • M. Alimusaj
    • 1
  • S. I. Wolf
    • 1
  • S. Müller
    • 1
  1. 1.Paediatric Orthopaedics and Foot Surgery, Center for Orthopaedic and Trauma SurgeryHeidelberg University HospitalHeidelbergGermany
  2. 2.Experimental Orthopaedics, Center for Orthopaedic and Trauma SurgeryHeidelberg University HospitalHeidelbergGermany
  3. 3.Tumour Orthopaedics, Center for Orthopaedic and Trauma SurgeryHeidelberg University HospitalHeidelbergGermany

Personalised recommendations