Research Article
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Analysis of static pelvic tilt variations in transfemoral prosthesis users: comparison of different socket designs with healthy controls

Year 2025, Volume: 8 Issue: 2, 210 - 214, 21.03.2025
https://doi.org/10.32322/jhsm.1607601

Abstract

Aims: The aim of this study was to investigate pelvic tilt angles in patients with transfemoral prosthesis, considering different socket designs, and to compare them with healthy controls.
Methods: In this cross-sectional study, 28 male participants were enrolled, including 14 unilateral transfemoral prosthesis users (prosthesis group) and 14 demographically similar healthy subjects (control group). Pelvic tilt angles in both sagittal and frontal planes were measured using a digital inclinometer mounted on a two-arm caliper.
Results: All participants had anterior pelvic tilt. Within the prosthesis group, there was no significant difference in anterior pelvic tilt and lateral pelvic tilt angles between the prosthetic side and the contralateral side (p=0.106, effect size (ES)=0.464; p=0.055, ES=-0.564, respectively). There was no significant difference in anterior pelvic tilt and lateral pelvic tilt angles between the prosthetic side and the contralateral side of the participants using both quadrilateral socket design and ischial containment socket designs (p=0.499, ES=-0.256; p=0.128, ES=-0.575; p=0.063, ES=-0.703; p=0.612, ES=-0.192, respectively). However, a significant difference was found in both the right and left anterior pelvic tilt angles and the lateral pelvic tilt angles between the prosthesis group and the control group (p=0.001, ES=-0.582; p<0.001, ES=-0.635; p<0.001, ES=-0.797, respectively).
Conclusion: The findings reveal that while anterior pelvic tilt is present in all participants, significant differences exist between prosthesis users and healthy individuals in both anterior and lateral pelvic tilt angles. These results underscore the importance of considering pelvic alignment in the design and fitting of prostheses, potentially in forming clinical practices to enhance the comfort and functionality for transfemoral prosthesis users.

References

  • Preece SJ, Willan P, Nester CJ, Graham-Smith P, Herrington L, Bowker P. Variation in pelvic morphology may prevent the identification of anterior pelvic tilt. J Man Manip Ther. 2008;16(2):113-117. doi:10.1179/ 106698108790818459
  • Suits WH. Clinical measures of pelvic tilt in physical therapy. Int J Sports Phys Ther. 2021;16(5):1366-1375. doi:10.26603/001c.27978
  • Herrington L. Assessment of the degree of pelvic tilt within a normal asymptomatic population. Man Ther. 2011;16(6):646-648. doi:10.1016/j.math.2011.04.006
  • Crossley KM, Schache AG, Ozturk H, Lentzos J, Munanto M, Pandy MG. Pelvic and hip kinematics during walking in people with patellofemoral joint osteoarthritis compared to healthy age-matched controls. Arthritis Care Res (Hoboken). 2018;70(2):309-314. doi:10.1002/acr.23261
  • Król A, Polak M, Szczygieł E, Wójcik P, Gleb K. Relationship between mechanical factors and pelvic tilt in adults with and without low back pain. J Back Musculoskelet Rehabil. 2017;30(4):699-705. doi:10.3233/BMR-140177
  • Kuwahara W, Kurumadani H, Tanaka N, et al. Correlation between spinal and pelvic movements during gait and aggravation of low back pain by gait loading in lumbar spinal stenosis patients. J Orthop Sci. 2019;24(2):207-213. doi:10.1016/j.jos.2018.09.002
  • Gailey R, Allen K, Castles J, Kucharik J, Roeder M. Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. J Rehabil Res Dev. 2008;45(1):15-29. doi:10.1682/jrrd.2006.11.0147
  • Kar Z, Kutlu A. Investigation of body ımage and quality of life of patients with lower limb amputation: problems experienced of patients. Niger J Clin Pract. 2023;26(11):1685-1695. doi:10.4103/njcp.njcp_307_23
  • 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):e0238093. doi:10.1371/journal.pone. 0238093
  • Long IA. Normal shape-normal alignment (NSNA) above-knee prosthesis. Clin Prosthet Orthot. 1985;9(4):9-14.
  • Sabolich J. Contoured Adducted Trochanteric-Controlled Alignment Method (CAT-CAM); introduction and basic princi ples. Clin Prosthet Orthot. 1985;9:15-26.
  • Hachisuka K, Umezu Y, Ogata H, Ohmine S, Shinkoda K, Arizono H. Subjective evaluations and objective measurements of the ischial-ramal containment prosthesis. J UOEH. 1999;21(2):107-118. doi:10.7888/juoeh. 21.107
  • Gailey RS, Lawrence D, Burditt C, Spyropoulos P, Newell C, Nash MS. The CAT-CAM socket and quadrilateral socket: a comparison of energy cost during ambulation. Prosthet Orthot Int. 1993;17(2):95-100. doi:10. 3109/03093649309164363
  • Flandry F, Beskin J, Chambers RB, Perry J, Waters RL, Chavez R. The effect of the CAT-CAM above-knee prosthesis on functional rehabilitation. Clin Orthop Relat Res (1976-2007). 1989;239:249-262.
  • Fairley M. MAS Socket: a transfemoral revolution. O&P Edge. 2004.
  • Goujon-Pillet H, Sapin E, Fodé P, Lavaste F. Three-dimensional motions of trunk and pelvis during transfemoral amputee gait. Arch Phys Med Rehabil. 2008;89(1):87-94. doi:10.1016/j.apmr.2007.08.136
  • Sjödahl C, Jarnlo GB, Söderberg B, Persson BM. Kinematic and kinetic gait analysis in the sagittal plane of trans-femoral amputees before and after special gait re-education. Prosthet Orthot Int. 2002;26(2):101-112. doi:10.1080/03093640208726632
  • Morino S, Ishihara M, Umezaki F, Hatanaka H, Yamashita M, Aoyama T. Pelvic alignment changes during the perinatal period. PLoS One. 2019; 14(10):e0223776. doi:10.1371/journal.pone.0223776
  • Azevedo DC, Santos H, Carneiro RL, Andrade GT. Reliability of sagittal pelvic position assessments in standing, sitting and during hip flexion using palpation meter. J Bodyw Mov Ther. 2014;18(2):210-214. doi:10. 1016/j.jbmt.2013.05.017
  • Gottschalk F. The importance of soft tissue stabilization in trans-femoral amputation : English version. Orthopade. 2016;45(Suppl 1):S1-S4. doi:10.1007/s00132-015-3098-8
  • Köhler TM, Blumentritt S, Braatz F, Bellmann M. The impact of transfemoral socket adduction on pelvic and trunk stabilization during level walking-a biomechanical study. Gait Posture. 2021;89:169-177. doi: 10.1016/j.gaitpost.2021.06.024
  • Gaunaurd I, Gailey R, Hafner BJ, Gomez-Marin O, Kirk-Sanchez N. Postural asymmetries in transfemoral amputees. Prosthet Orthot Int. 2011;35(2):171-180. doi:10.1177/0309364611407676
  • Ezhumalai K, Padhi A, Mohanty RK, Pradhan R, Mohanty P. Influence of femur length on asymmetry of prosthetic gait biomechanics in transfemoral amputation. J Mech Med Biol. 2024;24(05):2350099. doi: 10.1142/S0219519423500999
  • Michaud SB, Gard SA, Childress DS. A preliminary investigation of pelvic obliquity patterns during gait in persons with transtibial and transfemoral amputation. J Rehabil Res Dev. 2000;37(1):1-10.
  • Karimi MT, Kavyani M, Mehrvar A. Osseointegration: a new approach to improve functional performance of prostheses–a systematic review of the literature. Curr. Orthop. Pract. 2024;35(6):229-236. doi:10.1097/BCO.0000000000001275
  • Ravari R, Rehani M, Hebert JS. Biomechanical characteristics of transfemoral bone-anchored prostheses during gait: a review of literature. Prosthet Orthot Int. 2024;48(4):412-421. doi:10.1097/PXR. 0000000000000263

Statik pelvik tilt varyasyonlarının transfemoral protez kullanıcılarında analizi: farklı soket tasarımlarının sağlıklı kontrollerle karşılaştırılması

Year 2025, Volume: 8 Issue: 2, 210 - 214, 21.03.2025
https://doi.org/10.32322/jhsm.1607601

Abstract

Amaçlar: Bu çalışmanın amacı, transfemoral protez kullanan hastalarda pelvik tilt açılarını farklı soket tasarımlarına göre incelemek ve sağlıklı bireylerle karşılaştırmaktı.
Yöntemler: Bu kesitsel çalışmaya, 14 tek taraflı transfemoral protez kullanıcısı (protez grubu) ve 14 demografik olarak benzer sağlıklı birey (kontrol grubu) olmak üzere 28 erkek katılımcı dahil edildi. Sagittal ve frontal düzlemlerdeki pelvik tilt açıları, iki kollu bir kumpas üzerine monte edilen dijital inklinometre ile ölçüldü.
Bulgular: Tüm katılımcılarda anterior pelvik tilt vardı. Protez grubunda, protezli taraf ile kontralateral taraf arasında anterior pelvik tilt ve lateral pelvik tilt açılarında anlamlı bir fark yoktu (sırasıyla p=0.106, Etki Büyüklüğü (EB)=0.464; p=0.055, EB=-0.564). Hem quadrilateral soket tasarımı hem de ischial containment soket tasarımı kullanan katılımcıların protezli tarafları ile kontralateral tarafları arasında anterior pelvik tilt ve lateral pelvik tilt açılarında anlamlı bir fark yoktu (sırasıyla p=0.499, EB=-0.256; p=0.128, EB=-0.575; p=0.063, EB=-0.703; p=0.612, EB=-0.192). Bununla birlikte, protez grubu ile kontrol grubu arasında hem sağ ve sol anterior pelvik tilt açılarında hem de lateral pelvik tilt açılarında anlamlı bir fark bulundu (sırasıyla p=0.001, EB=-0.582; p<0.001, EB=-0.635; p<0.001, EB=-0.797).
Sonuç: Bulgular, anterior pelvik tiltin tüm katılımcılarda mevcut olmasına rağmen, protez kullanıcıları ile sağlıklı bireyler arasında hem anterior hem de lateral pelvik tilt açılarında önemli farklılıklar olduğunu ortaya koymaktadır. Bu sonuçlar, protezlerin tasarımında ve takılmasında pelvik hizalamanın dikkate alınmasının önemini vurgulamakta ve transfemoral protez kullanıcılarının konforunu ve işlevselliğini artırmak için klinik uygulamaları potansiyel olarak bilgilendirmektedir.

References

  • Preece SJ, Willan P, Nester CJ, Graham-Smith P, Herrington L, Bowker P. Variation in pelvic morphology may prevent the identification of anterior pelvic tilt. J Man Manip Ther. 2008;16(2):113-117. doi:10.1179/ 106698108790818459
  • Suits WH. Clinical measures of pelvic tilt in physical therapy. Int J Sports Phys Ther. 2021;16(5):1366-1375. doi:10.26603/001c.27978
  • Herrington L. Assessment of the degree of pelvic tilt within a normal asymptomatic population. Man Ther. 2011;16(6):646-648. doi:10.1016/j.math.2011.04.006
  • Crossley KM, Schache AG, Ozturk H, Lentzos J, Munanto M, Pandy MG. Pelvic and hip kinematics during walking in people with patellofemoral joint osteoarthritis compared to healthy age-matched controls. Arthritis Care Res (Hoboken). 2018;70(2):309-314. doi:10.1002/acr.23261
  • Król A, Polak M, Szczygieł E, Wójcik P, Gleb K. Relationship between mechanical factors and pelvic tilt in adults with and without low back pain. J Back Musculoskelet Rehabil. 2017;30(4):699-705. doi:10.3233/BMR-140177
  • Kuwahara W, Kurumadani H, Tanaka N, et al. Correlation between spinal and pelvic movements during gait and aggravation of low back pain by gait loading in lumbar spinal stenosis patients. J Orthop Sci. 2019;24(2):207-213. doi:10.1016/j.jos.2018.09.002
  • Gailey R, Allen K, Castles J, Kucharik J, Roeder M. Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. J Rehabil Res Dev. 2008;45(1):15-29. doi:10.1682/jrrd.2006.11.0147
  • Kar Z, Kutlu A. Investigation of body ımage and quality of life of patients with lower limb amputation: problems experienced of patients. Niger J Clin Pract. 2023;26(11):1685-1695. doi:10.4103/njcp.njcp_307_23
  • 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):e0238093. doi:10.1371/journal.pone. 0238093
  • Long IA. Normal shape-normal alignment (NSNA) above-knee prosthesis. Clin Prosthet Orthot. 1985;9(4):9-14.
  • Sabolich J. Contoured Adducted Trochanteric-Controlled Alignment Method (CAT-CAM); introduction and basic princi ples. Clin Prosthet Orthot. 1985;9:15-26.
  • Hachisuka K, Umezu Y, Ogata H, Ohmine S, Shinkoda K, Arizono H. Subjective evaluations and objective measurements of the ischial-ramal containment prosthesis. J UOEH. 1999;21(2):107-118. doi:10.7888/juoeh. 21.107
  • Gailey RS, Lawrence D, Burditt C, Spyropoulos P, Newell C, Nash MS. The CAT-CAM socket and quadrilateral socket: a comparison of energy cost during ambulation. Prosthet Orthot Int. 1993;17(2):95-100. doi:10. 3109/03093649309164363
  • Flandry F, Beskin J, Chambers RB, Perry J, Waters RL, Chavez R. The effect of the CAT-CAM above-knee prosthesis on functional rehabilitation. Clin Orthop Relat Res (1976-2007). 1989;239:249-262.
  • Fairley M. MAS Socket: a transfemoral revolution. O&P Edge. 2004.
  • Goujon-Pillet H, Sapin E, Fodé P, Lavaste F. Three-dimensional motions of trunk and pelvis during transfemoral amputee gait. Arch Phys Med Rehabil. 2008;89(1):87-94. doi:10.1016/j.apmr.2007.08.136
  • Sjödahl C, Jarnlo GB, Söderberg B, Persson BM. Kinematic and kinetic gait analysis in the sagittal plane of trans-femoral amputees before and after special gait re-education. Prosthet Orthot Int. 2002;26(2):101-112. doi:10.1080/03093640208726632
  • Morino S, Ishihara M, Umezaki F, Hatanaka H, Yamashita M, Aoyama T. Pelvic alignment changes during the perinatal period. PLoS One. 2019; 14(10):e0223776. doi:10.1371/journal.pone.0223776
  • Azevedo DC, Santos H, Carneiro RL, Andrade GT. Reliability of sagittal pelvic position assessments in standing, sitting and during hip flexion using palpation meter. J Bodyw Mov Ther. 2014;18(2):210-214. doi:10. 1016/j.jbmt.2013.05.017
  • Gottschalk F. The importance of soft tissue stabilization in trans-femoral amputation : English version. Orthopade. 2016;45(Suppl 1):S1-S4. doi:10.1007/s00132-015-3098-8
  • Köhler TM, Blumentritt S, Braatz F, Bellmann M. The impact of transfemoral socket adduction on pelvic and trunk stabilization during level walking-a biomechanical study. Gait Posture. 2021;89:169-177. doi: 10.1016/j.gaitpost.2021.06.024
  • Gaunaurd I, Gailey R, Hafner BJ, Gomez-Marin O, Kirk-Sanchez N. Postural asymmetries in transfemoral amputees. Prosthet Orthot Int. 2011;35(2):171-180. doi:10.1177/0309364611407676
  • Ezhumalai K, Padhi A, Mohanty RK, Pradhan R, Mohanty P. Influence of femur length on asymmetry of prosthetic gait biomechanics in transfemoral amputation. J Mech Med Biol. 2024;24(05):2350099. doi: 10.1142/S0219519423500999
  • Michaud SB, Gard SA, Childress DS. A preliminary investigation of pelvic obliquity patterns during gait in persons with transtibial and transfemoral amputation. J Rehabil Res Dev. 2000;37(1):1-10.
  • Karimi MT, Kavyani M, Mehrvar A. Osseointegration: a new approach to improve functional performance of prostheses–a systematic review of the literature. Curr. Orthop. Pract. 2024;35(6):229-236. doi:10.1097/BCO.0000000000001275
  • Ravari R, Rehani M, Hebert JS. Biomechanical characteristics of transfemoral bone-anchored prostheses during gait: a review of literature. Prosthet Orthot Int. 2024;48(4):412-421. doi:10.1097/PXR. 0000000000000263
There are 26 citations in total.

Details

Primary Language English
Subjects Physiotherapy, Prosthetics and Orthotics
Journal Section Original Article
Authors

Kamil Yılmaz 0000-0002-5242-3094

Publication Date March 21, 2025
Submission Date December 26, 2024
Acceptance Date January 28, 2025
Published in Issue Year 2025 Volume: 8 Issue: 2

Cite

AMA Yılmaz K. Analysis of static pelvic tilt variations in transfemoral prosthesis users: comparison of different socket designs with healthy controls. J Health Sci Med / JHSM. March 2025;8(2):210-214. doi:10.32322/jhsm.1607601

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