Is Socket Flexion Alignment Associated With Changes in Gait Parameters in Individuals With an Above-knee Amputation and a Hip Flexion Contracture?

IF 4.2 2区 医学 Q1 ORTHOPEDICS
Kevin Arribart, Valentin Peryoitte, Anton Kaniewski, Xavier Bonnet, Hélène Pillet
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To our knowledge, little is known about how or whether these compensations relate to the socket's flexion alignment.</p><p><strong>Questions/purposes: </strong>(1) Is the presence of HFC associated with modifications of spatiotemporal and kinematic parameters during gait in patients with an above-knee amputation? (2) Is there a correlation between the socket flexion angle and the spatiotemporal and kinematic parameters during gait in patients with an above-knee amputation with and without HFC?</p><p><strong>Methods: </strong>A comparative observational study was conducted between February 2022 and June 2023. Thirty-two participants with unilateral above-knee amputations who had undergone amputation at least 1 year prior and had a minimum of 1 month of experience with their current prostheses were eligible for consideration and included in the study. After the trial, 1 of 32 participants was excluded due to other impairments affecting gait, and 9% (3 of 32) were excluded because of pain or discomfort during data acquisition on their gait, leaving 88% (28 of 32) of participants included in the analysis. The median (IQR) age of participants in the HFC group (n = 13) was 50 years (26 to 56); 85% (11) were male and 15% (2) were female. The median (IQR) age of participants in the noHFC group (n = 15) was 41 years (32 to 56), and 100% were male. Time since amputation was similar between groups (HFC median 8 years [IQR 3 to 21], noHFC median 6 years [IQR 1 to 9], difference of medians 2; p = 0.31). Thirty-two percent (9 of 28) of patients were classified according to the Medicare Functional Classification Level system as K4 (exceeding basic ambulation skills) and 68% (19 of 28) were classified as K3 (ability to walk with variable cadence and traverse most environmental barriers). Clinical and prosthetic measurements were made, which comprised measurement of the HFC using a hand-held goniometer with the patient in the modified Thomas test position, the socket flexion alignment, and the difference (δ) between the HFC and socket flexion alignment. A gait analysis was performed with an optoelectronic system equipped with six infrared cameras and two force plates to analyze the time-distance and kinematic parameters of gait. To answer our first question, we quantitively compared the gait spatiotemporal and kinematic parameters between groups, and for the second question, we evaluated the correlations between the same parameters and prosthesis alignment for both groups.</p><p><strong>Results: </strong>During gait, the HFC group exhibited reduced mean ± SD residual hip ROM in comparison with the noHFC group (35° ± 6° versus 44° ± 6°, mean difference -9° [95% CI -13° to -6°]; p < 0.001), increased pelvic tilt (11° ± 6° versus 7° ± 3°, mean difference 4° [95% CI 1° to 8°]; p = 0.02), increased pelvic rotation (12° ± 3° versus 9° ± 2°, mean difference 3° [95% CI 2° to 6°]; p < 0.001), and increased trunk rotation (15° ± 5° and 12° ± 2°, mean difference 3° [95% CI 0° to 6°]; p = 0.04). Greater δ correlated with decreased ROM in the contralateral hip (r = -0.71; p = 0.006), pelvis (r = -0.77; p = 0.002), and trunk (r = -0.58; p = 0.04) in the sagittal plane and with increased residual hip ROM (r = 0.62; p = 0.02). In terms of spatiotemporal gait parameters, in the HFC group, the δ correlated with an increase in contralateral step width (r = 0.58; p = 0.04) and a decrease in prosthetic step length (r = -0.65; p = 0.02).</p><p><strong>Conclusion: </strong>Our findings further suggest that physiotherapists should consider the pelvic and trunk compensations associated with HFC in their rehabilitation because of potential long-term effects, such as low back pain or osteoarthritis. In addition, the correlation between the socket flexion angle and the parameters involved may support prosthetists in their choices of prosthetic settings. For now, we cannot consider these compensations as an impaired gait syndrome, and future studies are needed to evaluate their impact on patients' quality of life.</p><p><strong>Level of evidence: </strong>Level III, therapeutic study.</p>","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Orthopaedics and Related Research®","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CORR.0000000000003288","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: A hip flexion contracture (HFC) results in an inability to extend the hip by reducing the ROM of the affected hip. The condition affects one in four patients with above-knee amputations on the amputation side. While HFC in other disorders is known to decrease hip ROM and increase pelvic tilt during gait, its impact on the gait of patients with above-knee amputations remains unexplored. Typically, prosthetists design the socket with a flexion angle matching the HFC, potentially leading to compensations during the posterior stance phase of the gait cycle. To our knowledge, little is known about how or whether these compensations relate to the socket's flexion alignment.

Questions/purposes: (1) Is the presence of HFC associated with modifications of spatiotemporal and kinematic parameters during gait in patients with an above-knee amputation? (2) Is there a correlation between the socket flexion angle and the spatiotemporal and kinematic parameters during gait in patients with an above-knee amputation with and without HFC?

Methods: A comparative observational study was conducted between February 2022 and June 2023. Thirty-two participants with unilateral above-knee amputations who had undergone amputation at least 1 year prior and had a minimum of 1 month of experience with their current prostheses were eligible for consideration and included in the study. After the trial, 1 of 32 participants was excluded due to other impairments affecting gait, and 9% (3 of 32) were excluded because of pain or discomfort during data acquisition on their gait, leaving 88% (28 of 32) of participants included in the analysis. The median (IQR) age of participants in the HFC group (n = 13) was 50 years (26 to 56); 85% (11) were male and 15% (2) were female. The median (IQR) age of participants in the noHFC group (n = 15) was 41 years (32 to 56), and 100% were male. Time since amputation was similar between groups (HFC median 8 years [IQR 3 to 21], noHFC median 6 years [IQR 1 to 9], difference of medians 2; p = 0.31). Thirty-two percent (9 of 28) of patients were classified according to the Medicare Functional Classification Level system as K4 (exceeding basic ambulation skills) and 68% (19 of 28) were classified as K3 (ability to walk with variable cadence and traverse most environmental barriers). Clinical and prosthetic measurements were made, which comprised measurement of the HFC using a hand-held goniometer with the patient in the modified Thomas test position, the socket flexion alignment, and the difference (δ) between the HFC and socket flexion alignment. A gait analysis was performed with an optoelectronic system equipped with six infrared cameras and two force plates to analyze the time-distance and kinematic parameters of gait. To answer our first question, we quantitively compared the gait spatiotemporal and kinematic parameters between groups, and for the second question, we evaluated the correlations between the same parameters and prosthesis alignment for both groups.

Results: During gait, the HFC group exhibited reduced mean ± SD residual hip ROM in comparison with the noHFC group (35° ± 6° versus 44° ± 6°, mean difference -9° [95% CI -13° to -6°]; p < 0.001), increased pelvic tilt (11° ± 6° versus 7° ± 3°, mean difference 4° [95% CI 1° to 8°]; p = 0.02), increased pelvic rotation (12° ± 3° versus 9° ± 2°, mean difference 3° [95% CI 2° to 6°]; p < 0.001), and increased trunk rotation (15° ± 5° and 12° ± 2°, mean difference 3° [95% CI 0° to 6°]; p = 0.04). Greater δ correlated with decreased ROM in the contralateral hip (r = -0.71; p = 0.006), pelvis (r = -0.77; p = 0.002), and trunk (r = -0.58; p = 0.04) in the sagittal plane and with increased residual hip ROM (r = 0.62; p = 0.02). In terms of spatiotemporal gait parameters, in the HFC group, the δ correlated with an increase in contralateral step width (r = 0.58; p = 0.04) and a decrease in prosthetic step length (r = -0.65; p = 0.02).

Conclusion: Our findings further suggest that physiotherapists should consider the pelvic and trunk compensations associated with HFC in their rehabilitation because of potential long-term effects, such as low back pain or osteoarthritis. In addition, the correlation between the socket flexion angle and the parameters involved may support prosthetists in their choices of prosthetic settings. For now, we cannot consider these compensations as an impaired gait syndrome, and future studies are needed to evaluate their impact on patients' quality of life.

Level of evidence: Level III, therapeutic study.

膝上截肢和髋关节屈曲挛缩患者的步态参数变化是否与髋臼屈曲对齐有关?
背景:髋关节屈曲挛缩(HFC)会降低受影响髋关节的活动度,导致髋关节无法伸展。每四名膝上截肢患者中就有一人会出现这种情况。众所周知,HFC 在其他疾病中会降低髋关节的活动度,并在步态中增加骨盆倾斜度,但它对膝上截肢患者步态的影响仍有待研究。通常情况下,假肢制作者在设计插座时会考虑到与 HFC 相匹配的屈曲角度,这可能会导致在步态周期的后站立阶段出现代偿。问题/目的:(1)HFC 的存在是否与膝上截肢患者步态期间时空和运动参数的改变有关?(2)膝上截肢患者在步态过程中,髋臼屈曲角度与时空和运动学参数之间是否存在相关性?在 2022 年 2 月至 2023 年 6 月期间进行了一项对比观察研究。32名单侧膝上截肢的参与者至少在一年前接受过截肢手术,并且使用当前假肢至少有1个月的经验,他们符合条件并被纳入研究。试验结束后,32 名参与者中有 1 人因其他障碍影响步态而被排除,9% 的参与者(32 人中有 3 人)因步态数据采集过程中出现疼痛或不适而被排除,剩下 88% 的参与者(32 人中有 28 人)被纳入分析。HFC 组(13 人)参与者的年龄中位数(IQR)为 50 岁(26 至 56 岁);85%(11 人)为男性,15%(2 人)为女性。无 HFC 组(n = 15)参与者的年龄中位数(IQR)为 41 岁(32 至 56 岁),100% 为男性。两组患者截肢后的时间相似(HFC 中位数为 8 年 [IQR 3 至 21],noHFC 中位数为 6 年 [IQR 1 至 9],中位数相差 2;P = 0.31)。根据医疗保险功能分类级别系统,32%的患者(28 人中有 9 人)被归类为 K4(超过基本行走能力),68% 的患者(28 人中有 19 人)被归类为 K3(能够以不同的步速行走并穿越大多数环境障碍)。对患者进行了临床和假肢测量,包括使用手持式测角器测量患者在改良托马斯测试体位下的HFC、髋臼屈曲对齐度以及HFC和髋臼屈曲对齐度之间的差值(δ)。步态分析是通过配备有六个红外摄像头和两个测力板的光电系统进行的,以分析步态的时间-距离和运动学参数。为了回答第一个问题,我们对两组之间的步态时空参数和运动参数进行了量化比较;为了回答第二个问题,我们评估了两组相同参数与假体对位之间的相关性:结果:在步态过程中,与无 HFC 组相比,HFC 组表现出平均 ± SD 残余髋关节 ROM 减少(35° ± 6° 对 44° ± 6°,平均差异 -9° [95% CI -13° to -6°];p < 0.001)、骨盆倾斜增加(11° ± 6° 对 7° ± 3°,平均差异 4° [95% CI 1° to 8°];p = 0.02)、骨盆旋转增加(11° ± 6° 对 7° ± 3°,平均差异 4° [95% CI 1° to 8°];p = 0.001)。02)、骨盆旋转增加(12° ± 3° 与 9° ± 2°,平均相差 3° [95% CI 2° 至 6°];p < 0.001)和躯干旋转增加(15° ± 5° 与 12° ± 2°,平均相差 3° [95% CI 0° 至 6°];p = 0.04)。更大的δ与矢状面上对侧髋关节(r = -0.71;p = 0.006)、骨盆(r = -0.77;p = 0.002)和躯干(r = -0.58;p = 0.04)的 ROM 减少以及残余髋关节 ROM 增加相关(r = 0.62;p = 0.02)。就时空步态参数而言,在 HFC 组,δ 与对侧步幅的增加(r = 0.58;p = 0.04)和假肢步长的减少(r = -0.65;p = 0.02)相关:我们的研究结果进一步表明,物理治疗师在进行康复治疗时应考虑到与HFC相关的骨盆和躯干代偿,因为这可能会造成腰背痛或骨关节炎等长期影响。此外,髋臼屈曲角度与相关参数之间的相关性可能有助于假肢制作师选择假肢设置。目前,我们还不能将这些代偿视为步态受损综合症,未来还需要进行研究以评估它们对患者生活质量的影响:证据等级:三级,治疗性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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