Bone and Muscle Changes After Transfemoral Amputation

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Abstract

Patients with transfemoral amputation (TFA) are more likely to develop hip osteoarthritis (OA) in either or both limbs compared to able-bodied individuals, primarily due to habitually altered joint loading caused by compensatory movement patterns. Changes in loading alter the mechanical stimulus applied to the musculoskeletal system, which is essential to both bone and muscle health. Although changes to both bone and muscle are separately known indicators for OA, they have not been rigorously investigated together in this population. This thesis investigated proximal femur morphology of the amputated limb and bilateral hip muscle differences of the gluteus maximus (GMAX), gluteus medius (GMED), and tensor fascia latae (TFL) in patients with unilateral TFA; which provides information on factors which could contribute to the limb-dependent etiology of hip OA.

The first goal of this project was to determine the differences in amputated limb proximal femur morphology in patients with TFA compared to controls. Retrospective computed tomography images were obtained for 31 patients with TFA and 29 patients in a control group and used to generate statistical shape models. The second goal of this project was to quantify bilateral hip muscle quality in patients with unilateral TFA. Quantitative magnetic resonance (MR) images were obtained from 8 patients with unilateral TFA. Using the MR images, volume and fatty infiltration were quantified for the GMAX, GMED, and TFL. Motion capture data was obtained for 6 patients and was used in tandem with MR data to create subject-specific musculoskeletal models. Abduction moment arm was calculated bilaterally for the GMED only.

The results from this project indicate altered loading from transfemoral prosthesis use changes proximal femur bony morphology and causes increased fatty infiltration and decreased volume of the amputated limb hip musculature compared to the intact limb. Furthermore, compared to the intact limb, the amputated limb GMED is biomechanically disadvantaged with a shorter abduction moment arm during overground walking. Thus, whether under- or overloading, this altered loading results in bony changes to the proximal femur and biomechanical disadvantages in the amputated limb hip musculature, which may contribute to the etiological progression and development of OA within this population.

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