Gait biomechanics and energy cost of walking after rotationplasty: A systematic review and meta-analysis compared to above-knee amputation and healthy participants

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-07-22 DOI:10.1016/j.clinbiomech.2025.106626

G.G.J. Krebbekx , N.F.J. Waterval , M.A. Brehm , G.M.M.J. Kerkhoffs , J.A.M. Bramer , F.G.M. Verspoor

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引用次数: 0

Abstract

Background

To provide insight into rotationplasty, we reviewed walking oxygen/energy cost and gait biomechanics, comparing it to above-knee amputation patients(AKA) (to inform clinical decision-making), and to healthy individuals (to assess deviation from normal).

Methods

A literature search was conducted on September 30, 2024, using terms: rotationplasty, oxygen/energy cost of walking, and gait biomechanics. Small case reports were excluded. Methodological quality was assessed and meta-analyses (random-effects model, including heterogeneity assessment) with forest plots were performed for walking speed, cadence, stride length, and energy cost, while gait biomechanics outcomes were described qualitatively.

Findings

Fifteen studies (225 rotationplasty patients) were included. Oxygen/energy cost of walking was 12.5 % lower for rotationplasty patients compared to AKA (SMD:0.57,p = 0.01), while was 34.5 % higher compared to healthy participants (SMD:2.55,p < 0.001). Gait biomechanics were like AKA, except for reduced compensatory knee power on the unaffected side in rotationplasty patients. Compared to healthy participants, rotationplasty patients had lower walking speed (18.1 %,p < 0.001), reduced cadence (6.8 %,p < 0.05), shorter stride length (9.5 %,p < 0.05), longer double support time, more lateral trunk and pelvic tilt, reduced knee flexion in loading response and swing, and a greater compensatory joint power with a 13.9 % higher vertical ground reaction force in the unaffected leg.

Interpretation

This systematic review showed that rotationplasty is energetically preferable compared to AKA as oxygen/energy cost of walking was moderately lower compared to AKA, with reduced compensatory knee and hip power on the unaffected side. Walking energy cost was higher, and gait biomechanics more deviant in rotationplasty patients compared to healthy participants.

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步态生物力学和旋转成形术后行走的能量消耗：一项比较膝上截肢和健康参与者的系统回顾和荟萃分析

为了深入了解旋转成形术，我们回顾了步行的氧气/能量消耗和步态生物力学，并将其与膝上截肢患者（AKA）（为临床决策提供信息）和健康个体（评估与正常的偏差）进行比较。方法于2024年9月30日进行文献检索，检索术语为：旋转成形术、步行氧/能量成本、步态生物力学。小病例报告被排除在外。对方法学质量进行了评估，并对步行速度、节奏、步幅和能量消耗进行了meta分析（随机效应模型，包括异质性评估），同时对步态生物力学结果进行了定性描述。结果纳入了15项研究（225例旋转成形术患者）。与AKA相比，旋转成形术患者的步行氧/能量成本低12.5% (SMD:0.57,p = 0.01)，而与健康参与者相比，高34.5% (SMD:2.55,p <；0.001)。步态生物力学与AKA相似，除了旋转成形术患者未受影响侧膝关节代偿力降低。与健康参与者相比，旋转成形术患者的步行速度较低(18.1%,p <；0.001)，节奏降低(6.8%,p <；0.05)，步幅较短(9.5%,p <；0.05)，更长的双支撑时间，更多的侧躯干和骨盆倾斜，减少膝关节在负荷响应和摆动中的屈曲，以及更大的代偿关节力量，未受影响的腿的垂直地面反作用力提高13.9%。本系统综述显示，与AKA相比，旋转成形术在能量上更可取，因为与AKA相比，行走的氧气/能量消耗适度降低，未受影响一侧的膝关节和髋关节代偿力降低。与健康参与者相比，旋转成形术患者的行走能量消耗更高，步态生物力学更偏离正常。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.