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Clinical Orthopaedics and Related Research®

, Volume 472, Issue 10, pp 3093–3101 | Cite as

Does a Microprocessor-controlled Prosthetic Knee Affect Stair Ascent Strategies in Persons With Transfemoral Amputation?

  • Jennifer M. Aldridge Whitehead
  • Erik J. Wolf
  • Charles R. Scoville
  • Jason M. Wilken
Symposium: Recent Advances in Amputation Surgery and Rehabilitation

Abstract

Background

Stair ascent can be difficult for individuals with transfemoral amputation because of the loss of knee function. Most individuals with transfemoral amputation use either a step-to-step (nonreciprocal, advancing one stair at a time) or skip-step strategy (nonreciprocal, advancing two stairs at a time), rather than a step-over-step (reciprocal) strategy, because step-to-step and skip-step allow the leading intact limb to do the majority of work. A new microprocessor-controlled knee (Ottobock X2®) uses flexion/extension resistance to allow step-over-step stair ascent.

Questions/Purposes

We compared self-selected stair ascent strategies between conventional and X2® prosthetic knees, examined between-limb differences, and differentiated stair ascent mechanics between X2® users and individuals without amputation. We also determined which factors are associated with differences in knee position during initial contact and swing within X2® users.

Methods

Fourteen individuals with transfemoral amputation participated in stair ascent sessions while using conventional and X2® knees. Ten individuals without amputation also completed a stair ascent session. Lower-extremity stair ascent joint angles, moment, and powers and ground reaction forces were calculated using inverse dynamics during self-selected strategy and cadence and controlled cadence using a step-over-step strategy.

Results

One individual with amputation self-selected a step-over-step strategy while using a conventional knee, while 10 individuals self-selected a step-over-step strategy while using X2® knees. Individuals with amputation used greater prosthetic knee flexion during initial contact (32.5°, p = 0.003) and swing (68.2°, p = 0.001) with higher intersubject variability while using X2® knees compared to conventional knees (initial contact: 1.6°, swing: 6.2°). The increased prosthetic knee flexion while using X2® knees normalized knee kinematics to individuals without amputation during swing (88.4°, p = 0.179) but not during initial contact (65.7°, p = 0.002). Prosthetic knee flexion during initial contact and swing were positively correlated with prosthetic limb hip power during pull-up (r = 0.641, p = 0.046) and push-up/early swing (r = 0.993, p < 0.001), respectively.

Conclusions

Participants with transfemoral amputation were more likely to self-select a step-over-step strategy similar to individuals without amputation while using X2® knees than conventional prostheses. Additionally, the increased prosthetic knee flexion used with X2® knees placed large power demands on the hip during pull-up and push-up/early swing. A modified strategy that uses less knee flexion can be used to allow step-over-step ascent in individuals with less hip strength.

Level of Evidence

Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Keywords

Knee Flexion Knee Flexion Angle Prosthetic Limb Peak Knee Flexion Stair Ascent 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Elizabeth Nottingham BS and Alison Linberg DPT for their help with data collection and processing.

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Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Jennifer M. Aldridge Whitehead
    • 1
  • Erik J. Wolf
    • 2
  • Charles R. Scoville
    • 3
  • Jason M. Wilken
    • 1
  1. 1.DOD-VA Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Department of Orthopaedics and RehabilitationBrooke Army Medical CenterFt Sam HoustonUSA
  2. 2.DOD-VA Extremity Trauma and Amputation Center of Excellence, Department of RehabilitationWalter Reed National Military Medical CenterBethesdaUSA
  3. 3.Department of RehabilitationWalter Reed National Military Medical CenterBethesdaUSA

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