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



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).


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).


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.


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.


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


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.


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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

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