University of Ottawa, School of Human Kinetics, Montpetit Hall, 125 University, room 232, Ottawa, ON, K1N 6N5, Canada.
Ottawa Hospital Research Institute, 505 Smyth Road, Ottawa, ON, K1H8M2, Canada.
J Neuroeng Rehabil. 2019 Mar 12;16(1):37. doi: 10.1186/s12984-019-0509-9.
Osteoarthritis (OA) is a degenerative disease caused by the wearing of joint cartilage and bone. Literature has established that a prosthesis user's intact limb is at greater risk of developing OA. This study analyzed the effect of commonly encountered surface inclinations on knee joint loading measures in able-bodied and transtibial prosthesis users.
12 transtibial prosthesis users and 12 able-bodied participants walked across level ground, up slope, down slope, and cross slope (further divided into top and bottom slope depending on the location of the limb being analyzed). First and second peak external knee adduction moment (KAM), external knee adduction moment rate, and external knee adduction moment impulse were extracted from the stance phase of gait. Mixed ANOVA statistics with Bonferonni post hoc analyses were performed.
Significant limb differences were only found for KAM rate and first peak KAM. When compared to all other surfaces up slope had the significantly lowest KAM rate and was not significantly lower for all other tested variables. Down slope had significantly greater KAM rate than all surfaces except bottom slope. KAM second peak and KAM impulse analysis resulted in no significant differences.
Individuals at risk for developing, or currently dealing with, knee OA could avoid walking for extended periods on down slope. Walking up moderate slopes may be considered as a complementary activity to level walking for rehabilitation and delaying OA progression. The lack of significant limb differences suggests that second peak KAM and KAM impulse may not be appropriate load-related indicators of OA initiation among prosthesis users without OA. KAM rate was the most sensitive joint loading variable and therefore should be investigated further as an appropriate variable for identifying OA risk in individuals with transtibial amputations.
骨关节炎（OA）是一种由关节软骨和骨骼磨损引起的退行性疾病。文献已经确定，假肢使用者的完整肢体发生 OA 的风险更高。本研究分析了常见表面倾斜度对健全人和胫骨截肢者膝关节加载测量的影响。
12 名胫骨截肢者和 12 名健全参与者在水平地面、上坡、下坡和横坡（根据分析肢体的位置进一步分为上坡和下坡）上行走。从步态的站立阶段提取第一和第二峰值膝关节外展力矩（KAM）、膝关节外展力矩率和膝关节外展力矩冲量。采用混合方差分析统计和 Bonferroni 事后分析。
仅发现 KAM 率和第一峰值 KAM 存在显著的肢体差异。与所有其他表面相比，上坡的 KAM 率明显最低，对于所有其他测试变量都没有明显降低。下坡的 KAM 率明显高于除下坡外的所有表面。KAM 第二峰值和 KAM 冲量分析没有产生显著差异。
有发展或正在应对膝关节 OA 风险的个体可能应避免在下坡上长时间行走。在适度斜坡上行走可能被认为是与水平行走相结合的康复活动，可延迟 OA 进展。没有显著的肢体差异表明，对于没有 OA 的假肢使用者，第二峰值 KAM 和 KAM 冲量可能不是 OA 起始的合适负荷相关指标。KAM 率是最敏感的关节加载变量，因此应进一步研究其作为识别胫骨截肢者中 OA 风险的合适变量。
