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Hirschhorn A1,2, Dale M2, Wynne C1,2, Dean B1,2, Bloomfield A1, Lai B2, McColl-Green M2, Al Muderis M3
1Macquarie University, MQ Health Physiotherapy, Sydney, Australia, 2Macquarie University, Department of Health Professions, Sydney, Australia, 3Osseointegration Group of Australia, Sydney, Australia
Background: Patients with lower limb amputation frequently present with gait disturbances, fitting of an appropriate socket prosthesis notwithstanding. Osseointegration (OI) is an innovative approach to lower limb amputation and prosthesis fitting that involves implantation of a titanium prosthesis into the residual femur or tibia. By enabling direct fitting of an external prosthesis, OI has the potential to mitigate gait disturbances associated with socket prostheses. Data have been published on macroscopic indicators of walking function late after OI; there are limited data however examining spatiotemporal characteristics of gait early after OI.
Purpose: A focus of physiotherapy care for patients having OI is gait retraining, i.e. teaching patients to walk with an osseointegrated prosthesis. Patients having OI at Macquarie University Hospital, Sydney routinely undergo real-time assessment/analysis of spatiotemporal characteristics of gait using the GaitRite gait analysis system, a portable walkway incorporating pressure sensors. This analysis is used by physiotherapists to provide feedback to patients at the time of consultation. This study aimed to describe novel data on spatiotemporal characteristics of gait for patients having OI. Said data might provide indications of commonly encountered gait patterns early after OI, that may inform future clinical physiotherapy practice.
Methods: Patients undergoing OI at Macquarie University Hospital, Sydney performed as clinically feasible four walking trials of the GaitRite walkway at a self-selected comfortable walking speed on three occasions: at preoperative assessment; when first able to walk independently with an osseointegrated prosthesis (early postoperative); and at the time of transfer-of-care to home-based rehabilitation (late postoperative). Spatial (step length, stride length, foot rotation angle) and temporal (walking speed, cadence) data were retrospectively analysed.
Results: Four patients (2M:2F, age 49±12 years) all having unilateral transfemoral OI participated in the study. Time since/reason for initial amputation was:
Patient A: 6 years/vascular disease;
Patient B: 2 years/trauma;
Patient C: 2 years/trauma;
Patient D: 26 years/malignancy.
Only Patient B performed preoperative assessment,
Patients A, B, C and D performed early postoperative assessment (17±11 days postoperative), and
Patients A, B and D performed late postoperative assessment (37±13 days postoperative). Reasons for non-performance included unavailability of prosthesis (preoperative) and pain (postoperative). Patients demonstrated variable asymmetries in step length and foot rotation angle across the perioperative period. Mean walking speed was unchanged from early to late postoperative for Patient A (0.30m.s-1) and increased from early to late postoperative for Patients B (0.54m.s-1 to 0.80m.s-1) and D (0.35m.s-1 to 0.52m.s-1). Increases in mean walking speed for Patients B and D were a function of increases in both stride length and cadence.
Conclusion(s): Assessment of gait in the acute perioperative period of OI is complicated by factors including postoperative pain. Early changes in spatiotemporal characteristics suggest normalisation of gait (increased speed/cadence/step length) with postoperative time. Further research might seek to assess longer-term changes in gait characteristics after OI.
Implications: Patients having OI demonstrate both variable gait and progression thereof. Analysis of the spatiotemporal aspects of gait in the acute perioperative period may help guide physiotherapy interventions to improve gait speed and symmetry.
Keywords: Osseointegration, Amputee, Rehabilitation
Funding acknowledgements: Nil
Purpose: A focus of physiotherapy care for patients having OI is gait retraining, i.e. teaching patients to walk with an osseointegrated prosthesis. Patients having OI at Macquarie University Hospital, Sydney routinely undergo real-time assessment/analysis of spatiotemporal characteristics of gait using the GaitRite gait analysis system, a portable walkway incorporating pressure sensors. This analysis is used by physiotherapists to provide feedback to patients at the time of consultation. This study aimed to describe novel data on spatiotemporal characteristics of gait for patients having OI. Said data might provide indications of commonly encountered gait patterns early after OI, that may inform future clinical physiotherapy practice.
Methods: Patients undergoing OI at Macquarie University Hospital, Sydney performed as clinically feasible four walking trials of the GaitRite walkway at a self-selected comfortable walking speed on three occasions: at preoperative assessment; when first able to walk independently with an osseointegrated prosthesis (early postoperative); and at the time of transfer-of-care to home-based rehabilitation (late postoperative). Spatial (step length, stride length, foot rotation angle) and temporal (walking speed, cadence) data were retrospectively analysed.
Results: Four patients (2M:2F, age 49±12 years) all having unilateral transfemoral OI participated in the study. Time since/reason for initial amputation was:
Patient A: 6 years/vascular disease;
Patient B: 2 years/trauma;
Patient C: 2 years/trauma;
Patient D: 26 years/malignancy.
Only Patient B performed preoperative assessment,
Patients A, B, C and D performed early postoperative assessment (17±11 days postoperative), and
Patients A, B and D performed late postoperative assessment (37±13 days postoperative). Reasons for non-performance included unavailability of prosthesis (preoperative) and pain (postoperative). Patients demonstrated variable asymmetries in step length and foot rotation angle across the perioperative period. Mean walking speed was unchanged from early to late postoperative for Patient A (0.30m.s-1) and increased from early to late postoperative for Patients B (0.54m.s-1 to 0.80m.s-1) and D (0.35m.s-1 to 0.52m.s-1). Increases in mean walking speed for Patients B and D were a function of increases in both stride length and cadence.
Conclusion(s): Assessment of gait in the acute perioperative period of OI is complicated by factors including postoperative pain. Early changes in spatiotemporal characteristics suggest normalisation of gait (increased speed/cadence/step length) with postoperative time. Further research might seek to assess longer-term changes in gait characteristics after OI.
Implications: Patients having OI demonstrate both variable gait and progression thereof. Analysis of the spatiotemporal aspects of gait in the acute perioperative period may help guide physiotherapy interventions to improve gait speed and symmetry.
Keywords: Osseointegration, Amputee, Rehabilitation
Funding acknowledgements: Nil
Topic: Disability & rehabilitation; Human movement analysis; Orthopaedics
Ethics approval required: Yes
Institution: Macquarie University
Ethics committee: Macquarie University Human Research Ethics Committee
Ethics number: 5201700910
All authors, affiliations and abstracts have been published as submitted.
