The effect of prosthetic alignment on lower limb kinetics in people with a transtibial bone-anchored prosthesis: An experimental within-subject study

Alyssa M.G. Groeneveld; Niels Jonkergouw; Sjoerd M. Bruijn; Han Houdijk; Vera G.M. Kooiman; Ruud A. Leijendekkers; Maarten R. Prins

doi:10.1016/j.gaitpost.2025.01.010

The effect of prosthetic alignment on lower limb kinetics in people with a transtibial bone-anchored prosthesis: An experimental within-subject study

Alyssa M.G. Groeneveld
, Niels Jonkergouw^*
, Sjoerd M. Bruijn
, Han Houdijk
, Vera G.M. Kooiman
, Ruud A. Leijendekkers
, Maarten R. Prins

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

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Abstract

Background: The alignment of a bone-anchored prosthesis has consequences for the external moments around the residual joints and implant, and these external moments can lead to serious negative long-term effects. A clear understanding of the relationship between transtibial prosthetic alignment and external joint and implant moment for bone-anchored prosthetic users is still lacking.

Research question: What is the effect of systematic frontal plane prosthetic alignment changes on lower limb external joint moments in people with a transtibial bone-anchored prosthesis?

Methods: Participants underwent gait analysis on an instrumented dual belt treadmill. Between analyses, frontal-plane alignment adjustments were made, shifting the prosthetic foot 2, 4, and 6 mm medial and lateral in relation to the residual limb. The effect of alignment changes on frontal- and sagittal plane external joint moments during the stance phase of gait were assessed at the hip, knee, and implant level, using statistical parametric mapping regression analyses.

Results: Twenty-seven unilateral transtibial bone-anchored prosthesis users were included. Alignment changes had a significant effect on external frontal plane knee and implant moments on the prosthetic side, with the largest effect at the level of the implant. Incremental medial and lateral displacements resulted in a progressive increase or decrease of the external adduction moments, respectively. Alignment changes did not significantly affect external moments around the prosthetic hip, non-prosthetic joints in the frontal plane or in any of the evaluated joints or implant in the sagittal plane.

Significance: Mediolateral foot alignment changes have a considerable effect on the frontal plane external knee and implant moments at the prosthetic side of a transtibial bone-anchored prosthesis. The findings of this study can help prosthetists to anticipate and adjust alignment changes for transtibial BAP users to minimize joint moments before issues arise.

Original language	English
Pages (from-to)	274-282
Number of pages	9
Journal	Gait and Posture
Volume	117
Early online date	14 Jan 2025
DOIs	https://doi.org/10.1016/j.gaitpost.2025.01.010
Publication status	Published - Mar 2025

Bibliographical note

Publisher Copyright:
© 2025 Elsevier B.V.

Funding

This work was supported by the Dutch Army Health Insurance Foundation: “Stichting ZiektenkostenVerzekering Krijgsmacht” (SZVK) (Grandnr. 21-038, September 2021). The SZVK did not have any involvement with the study design, collection, analysis, and interpretation of the data and/or writing of the manuscript. The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Ministry of Defense, Military Health Care Organization, the Dutch Government, or that of the Radboud University Medical Center. This work was supported by the Dutch Army Health Insurance Foundation: “Stichting ZiektenkostenVerzekering Krijgsmacht” (SZVK) (Grandnr. 21-038, September 2021). The SZVK did not have any involvement with the study design, collection, analysis, and interpretation of the data and/or writing of the manuscript.

Funders	Funder number
Radboud Universitair Medisch Centrum
Military Health Care Organization
Ministry of Defence
Dutch Army Health Insurance Foundation	21-038

Keywords

Bone-Anchored Prosthesis
Gait
Moments
Prosthesis Alignment
Rehabilitation

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10.1016/j.gaitpost.2025.01.010

The effect of prosthetic alignment on lower limb kinetics in people with a transtibial bone-anchored prosthesisFinal published version, 4.29 MBLicence: Article 25fa Dutch Copyright Act

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@article{34a714ac5ef944aaadc10c93c6e96b97,

title = "The effect of prosthetic alignment on lower limb kinetics in people with a transtibial bone-anchored prosthesis: An experimental within-subject study",

abstract = "Background: The alignment of a bone-anchored prosthesis has consequences for the external moments around the residual joints and implant, and these external moments can lead to serious negative long-term effects. A clear understanding of the relationship between transtibial prosthetic alignment and external joint and implant moment for bone-anchored prosthetic users is still lacking.Research question: What is the effect of systematic frontal plane prosthetic alignment changes on lower limb external joint moments in people with a transtibial bone-anchored prosthesis?Methods: Participants underwent gait analysis on an instrumented dual belt treadmill. Between analyses, frontal-plane alignment adjustments were made, shifting the prosthetic foot 2, 4, and 6 mm medial and lateral in relation to the residual limb. The effect of alignment changes on frontal- and sagittal plane external joint moments during the stance phase of gait were assessed at the hip, knee, and implant level, using statistical parametric mapping regression analyses.Results: Twenty-seven unilateral transtibial bone-anchored prosthesis users were included. Alignment changes had a significant effect on external frontal plane knee and implant moments on the prosthetic side, with the largest effect at the level of the implant. Incremental medial and lateral displacements resulted in a progressive increase or decrease of the external adduction moments, respectively. Alignment changes did not significantly affect external moments around the prosthetic hip, non-prosthetic joints in the frontal plane or in any of the evaluated joints or implant in the sagittal plane.Significance: Mediolateral foot alignment changes have a considerable effect on the frontal plane external knee and implant moments at the prosthetic side of a transtibial bone-anchored prosthesis. The findings of this study can help prosthetists to anticipate and adjust alignment changes for transtibial BAP users to minimize joint moments before issues arise.",

keywords = "Bone-Anchored Prosthesis, Gait, Moments, Prosthesis Alignment, Rehabilitation",

author = "Groeneveld, \{Alyssa M.G.\} and Niels Jonkergouw and Bruijn, \{Sjoerd M.\} and Han Houdijk and Kooiman, \{Vera G.M.\} and Leijendekkers, \{Ruud A.\} and Prins, \{Maarten R.\}",

note = "Publisher Copyright: {\textcopyright} 2025 Elsevier B.V.",

year = "2025",

month = mar,

doi = "10.1016/j.gaitpost.2025.01.010",

language = "English",

volume = "117",

pages = "274--282",

journal = "Gait and Posture",

issn = "0966-6362",

publisher = "Elsevier B.V.",

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TY - JOUR

T1 - The effect of prosthetic alignment on lower limb kinetics in people with a transtibial bone-anchored prosthesis

T2 - An experimental within-subject study

AU - Groeneveld, Alyssa M.G.

AU - Jonkergouw, Niels

AU - Bruijn, Sjoerd M.

AU - Houdijk, Han

AU - Kooiman, Vera G.M.

AU - Leijendekkers, Ruud A.

AU - Prins, Maarten R.

PY - 2025/3

Y1 - 2025/3

N2 - Background: The alignment of a bone-anchored prosthesis has consequences for the external moments around the residual joints and implant, and these external moments can lead to serious negative long-term effects. A clear understanding of the relationship between transtibial prosthetic alignment and external joint and implant moment for bone-anchored prosthetic users is still lacking.Research question: What is the effect of systematic frontal plane prosthetic alignment changes on lower limb external joint moments in people with a transtibial bone-anchored prosthesis?Methods: Participants underwent gait analysis on an instrumented dual belt treadmill. Between analyses, frontal-plane alignment adjustments were made, shifting the prosthetic foot 2, 4, and 6 mm medial and lateral in relation to the residual limb. The effect of alignment changes on frontal- and sagittal plane external joint moments during the stance phase of gait were assessed at the hip, knee, and implant level, using statistical parametric mapping regression analyses.Results: Twenty-seven unilateral transtibial bone-anchored prosthesis users were included. Alignment changes had a significant effect on external frontal plane knee and implant moments on the prosthetic side, with the largest effect at the level of the implant. Incremental medial and lateral displacements resulted in a progressive increase or decrease of the external adduction moments, respectively. Alignment changes did not significantly affect external moments around the prosthetic hip, non-prosthetic joints in the frontal plane or in any of the evaluated joints or implant in the sagittal plane.Significance: Mediolateral foot alignment changes have a considerable effect on the frontal plane external knee and implant moments at the prosthetic side of a transtibial bone-anchored prosthesis. The findings of this study can help prosthetists to anticipate and adjust alignment changes for transtibial BAP users to minimize joint moments before issues arise.

AB - Background: The alignment of a bone-anchored prosthesis has consequences for the external moments around the residual joints and implant, and these external moments can lead to serious negative long-term effects. A clear understanding of the relationship between transtibial prosthetic alignment and external joint and implant moment for bone-anchored prosthetic users is still lacking.Research question: What is the effect of systematic frontal plane prosthetic alignment changes on lower limb external joint moments in people with a transtibial bone-anchored prosthesis?Methods: Participants underwent gait analysis on an instrumented dual belt treadmill. Between analyses, frontal-plane alignment adjustments were made, shifting the prosthetic foot 2, 4, and 6 mm medial and lateral in relation to the residual limb. The effect of alignment changes on frontal- and sagittal plane external joint moments during the stance phase of gait were assessed at the hip, knee, and implant level, using statistical parametric mapping regression analyses.Results: Twenty-seven unilateral transtibial bone-anchored prosthesis users were included. Alignment changes had a significant effect on external frontal plane knee and implant moments on the prosthetic side, with the largest effect at the level of the implant. Incremental medial and lateral displacements resulted in a progressive increase or decrease of the external adduction moments, respectively. Alignment changes did not significantly affect external moments around the prosthetic hip, non-prosthetic joints in the frontal plane or in any of the evaluated joints or implant in the sagittal plane.Significance: Mediolateral foot alignment changes have a considerable effect on the frontal plane external knee and implant moments at the prosthetic side of a transtibial bone-anchored prosthesis. The findings of this study can help prosthetists to anticipate and adjust alignment changes for transtibial BAP users to minimize joint moments before issues arise.

KW - Bone-Anchored Prosthesis

KW - Gait

KW - Moments

KW - Prosthesis Alignment

KW - Rehabilitation

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UR - https://www.scopus.com/pages/publications/85215392556#tab=citedBy

U2 - 10.1016/j.gaitpost.2025.01.010

DO - 10.1016/j.gaitpost.2025.01.010

M3 - Article

AN - SCOPUS:85215392556

SN - 0966-6362

VL - 117

SP - 274

EP - 282

JO - Gait and Posture

JF - Gait and Posture

ER -

The effect of prosthetic alignment on lower limb kinetics in people with a transtibial bone-anchored prosthesis: An experimental within-subject study

Abstract

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Keywords

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