Coronal plane socket stability during gait in persons with transfemoral amputation: Pilot study

• Published in: Journal of rehabilitation research and development Vol. 51; no. 8; pp. 1217 - 1228
• Main Authors: Fatone, Stefania, Dillon, Michael, Stine, Rebecca, Tillges, Robert
• Format: Journal Article
• Language: English
• Published: United States Department of Veterans Affairs 01.01.2014; Superintendent of Documents
• Subjects: Adaptation, Physiological; Adult; Aged; Aged, 80 and over; Amputation; Amputation - methods; Amputation - rehabilitation; Artificial Limbs; Design and construction; Female; Femur - surgery; Gait; Gait - physiology; Health aspects; Humans; Kidnapping; Leg; Male; Middle Aged; Orthopedic implants; Patient outcomes; Pilot Projects; Prostheses; Prosthesis Design; Studies; Walking; Marlo Anatomical Socket; socket comfort; amputation; ischial containment; socket design; coronal plane stability; gait; prosthesis; tissue loading; transfemoral prosthetic socket
• ISSN: 0748-7711; 1938-1352; 1938-1352
• DOI: 10.1682/JRRD.2014.01.0021

Little research describes which transfemoral socket design features are important for coronal plane stability, socket comfort, and gait. Our study objectives were to (1) relate socket comfort during gait to a rank order of changes in ischial containment (IC) and tissue loading and (2) compare socket comfort during gait when tissue loading and IC were systematically manipulated. Six randomly assigned socket conditions (IC and tissue compression) were assessed: (1) IC and high, (2) IC and medium, (3) IC and low, (4) no IC and high, (5) no IC and medium, and (6) no IC and low. For the six subjects in this study, there was a strong, negative relationship between comfort and changes in IC and tissue loading (rho = -0.89). With the ischium contained, tissue loading did not influence socket comfort (p = 0.47). With no IC, the socket was equally comfortable with high tissue loading (p = 0.36) but the medium (p = 0.04) and low (p = 0.02) tissue loading conditions decreased comfort significantly. Coronal plane hip moments, lateral trunk lean, step width, and walking speed were invariant to changes in IC and/or tissue loading. Our results suggest that in an IC socket, medial tissue loading mattered little in terms of comfort. Sockets without IC required high tissue loading to be as comfortable as those with IC, while suboptimal tissue loading compromised comfort.