Hip muscle geometry and function following a transfemoral amputation - a cross-sectional study protocol
Main Article Content
Abstract
Background: Individuals with a transfemoral amputation often experience limited walking abilities and difficulties with balance. These difficulties may arise not only from the loss of a limb but also from changes in the muscles in the residual limb post-amputation, such as muscle atrophy, increased intermuscular fat, and alterations in muscle architecture. This can result in loss of muscle function. Individuals with a transfemoral amputation indeed show decreased muscle strength in the residual limb compared to the intact limb. Although research has shown that muscle strength deficits in individuals with a transfemoral amputation are associated with difficulties in daily functioning, residual limb control, and walking performance, the specific role of residual muscle adaptations in contributing to these strength deficits and functional challenges remains unclear. Therefore, this paper presents a cross-sectional study protocol to investigate hip muscle geometry and function following transfemoral amputation, with the goal of understanding muscle adaptations and their functional consequences. Additionally, the influence of various amputation related factors, including the surgical technique, will be investigated.
Methods: Individuals aged 18 years or older who have undergone a unilateral transfemoral amputation within the past 1-5 years and are actively using a prosthesis (K-level ≥ 2) will be recruited. Participant characteristics such as age, sex, weight, height, cause, and date of amputation will be collected via a questionnaire. Study measurements will include a 1,5T Magnetic Resource Imaging scan to gather data on muscle geometry and femur length for both the residual and intact limbs, and a dynamometer strength test (isokinetic and isometric) to assess the hip muscle strength for each muscle group. The L Test of Functional Mobility will be performed to evaluate physical function. If possible, participants will be grouped based on the surgical technique used (myodesis vs. myoplasty) to allow group comparisons. Within-subjects differences will be assessed as the differences between the intact and residual limb, and Pearson’s correlation coefficients will be used to examine the relationships between muscle geometry and hip muscle strength. Ethical approval has been obtained by the Medical Ethical committee of the University Medical Center Groningen (METc 2024/392).
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References
2. Azuma Y, Chin T, Miura Y. The relationship between balance ability and walking ability using the Berg Balance Scale in people with transfemoral amputation. Prosthet Orthot Int. 2019;43(4):396-401. doi:10.1177/0309364619846364
3. Jaegers SMHJ, Arendzen JH, De Jongh HJ. Changes in hip muscles after above-knee amputation. Clin Orthop Relat Res. 1995;319(319):276-284. doi:10.1097/00003086-199510000-00030
4. Putz C, Block J, Gantz S, et al. Structural changes in the thigh muscles following trans-femoral amputation. Eur J Orthop Surg Traumatol. 2017;27(6):829-835. doi:10.1007/s00590-017-1929-5
5. Roda GF, Awad ME, Melton DH, Christiansen CL, Stoneback JW, Gaffney BMM. The Amputated Limb Gluteus Medius is Biomechanically Disadvantaged in Patients with Unilateral Transfemoral Amputation. Ann Biomed Eng. 2024;52(3):565-574. doi:10.1007/s10439-023-03400-0
6. Henson DP, Edgar C, Ding Z, et al. Understanding lower limb muscle volume adaptations to amputation. J Biomech. 2021;125. doi:10.1016/j.jbiomech.2021.110599
7. Addison O, Marcus RL, Lastayo PC, Ryan AS. Intermuscular fat: A review of the consequences and causes. Int J Endocrinol. 2014;2014. doi:10.1155/2014/309570
8. Ranz EC, Wilken JM, Gajewski DA, Neptune RR. The influence of limb alignment and transfemoral amputation technique on muscle capacity during gait. Comput Methods Biomech Biomed Engin. 2017;20(11):1167-1174. doi:10.1080/10255842.2017.1340461
9. Gottschalk F. Transfemoral Amputation. Clin Orthop Relat Res. 1999;361(361):15-22. doi:10.1097/00003086-199904000-00003
10. Crozara LF, Marques NR, LaRoche DP, et al. Hip extension power and abduction power asymmetry as independent predictors of walking speed in individuals with unilateral lower-limb amputation. Gait Posture. 2019;70(March):383-388. doi:10.1016/j.gaitpost.2019.03.033
11. Rutkowska-Kucharska A, Kowal M, Winiarski S. Relationship between asymmetry of gait and muscle torque in patients after unilateral transfemoral amputation. Appl Bionics Biomech. 2018;2018. doi:10.1155/2018/5190816
12. Hewson A, Dent S, Sawers A. Strength deficits in lower limb prosthesis users: A scoping review. Prosthet Orthot Int. 2020;44(5):323-340. doi:10.1177/0309364620930176
13. Croisier JL, Maertens De Noordhout B, Maquet D, et al. Isokinetic Evaluation of Hip Strength Muscle Groups in Unilateral Lower Limb Amputees. Isokinet Exerc Sci. 2001;9:163–169.
14. Sawers A, Fatone S. Normalization alters the interpretation of hip strength in established unilateral lower limb prosthesis users. Clin Biomech. 2022;97(June):105702. doi:10.1016/j.clinbiomech.2022.105702
15. Heitzmann DWW, Leboucher J, Block J, et al. The influence of hip muscle strength on gait in individuals with a unilateral transfemoral amputation. PLoS One. 2020;15(9 September):1-16. doi:10.1371/journal.pone.0238093
16. Bevacqua N, Dell Elce G, Intelangelo L. Assessing muscle strength of persons with transfemoral amputation with and without a prosthesis: A cross-sectional study. Prosthet Orthot Int. 2023;47(5):532-536. doi:10.1097/PXR.0000000000000228
17. Gottschalk F. Chapter 45: Transfemoral Amputation: Surgical Management. In: Krajbich JI, Pinzur MS, Stevens PM, Potter BK, eds. Atlas of Amputations and Limb Deficiencies : Surgical, Prosthetic, and Rehabilitation Principles. 4th ed. AAOS - American Academy of Orthopaedic Surgeons; 2016. ISBN: 978-1-62-552437-9
18. Fabre I, Thompson D, Gwilym B, et al. Surgical Techniques of, and Outcomes after, Distal Muscle Stabilization in Transfemoral Amputation: A Systematic Review and Narrative Synthesis. Ann Vasc Surg. 2024;98:182-193. doi:10.1016/j.avsg.2023.07.105
19. Gottschalk FA, Stills M. The biomechanics of trans-femoral amputation. Published online 1994:12-17.
20. Tintle SM, Keeling JJ, Shawen SB, Forsberg JA, Potter BK. Traumatic and trauma-related amputations: Part I: General principles and lower-extremity amputations. J Bone Jt Surg. 2010;92(17):2852-2868. doi:10.2106/JBJS.J.00257
21. Geertzen JHB, de Beus MC, Jutte PC, Otten E, Dekker R. What is the optimal femur length in a trans-femoral amputation? A mixed method study: Scoping review, expert opinions and biomechanical analysis. Med Hypotheses. 2019;129. doi:10.1016/j.mehy.2019.109238
22. Pons C, Borotikar B, Garetier M, et al. Quantifying skeletal muscle volume and shape in humans using MRI: A systematic review of validity and reliability. PLoS One. 2018;13(11). doi:10.1371/journal.pone.0207847
23. Leijendekkers RA, Marra MA, Ploegmakers MJM, et al. Magnetic-resonance-imaging-based three-dimensional muscle reconstruction of hip abductor muscle volume in a person with a transfemoral bone-anchored prosthesis: A feasibility study. Physiother Theory Pract. 2019;35(5):495-504. doi:10.1080/09593985.2018.1453902
24. Geertzen JHB, van der Schans SM, Jutte PC, Kraeima J, Otten E, Dekker R. Myodesis or myoplasty in trans-femoral amputations. What is the best option? An explorative study. Med Hypotheses. 2019;124(January):7-12. doi:10.1016/j.mehy.2019.01.008
25. Yun DH, Jung IY, Moon CW, Cho KH. Correlation of Femoral Muscle Volume Using Three-Dimensional Modeling and Locomotor Function After Unilateral Trans-femoral Amputation. Ann Rehabil Med. 2022;46(6):303-311. doi:10.5535/arm.22110
26. Deathe BA, Miller WC. The L Test of Functional Mobility: Measurement Properties of a Modified Version of the Timed “Up & Go” Test Designed for People with Lower-Limb Amputations. Phys Ther. 2005;85(7):626-635.
27. Huang Y, Yan J, Zhu H, et al. Low thigh muscle strength in relation to myosteatosis in patients with type 2 diabetes mellitus. Sci Rep. 2023;13(1). doi:10.1038/s41598-022-24002-1