Prosthetic loading during kneeling of persons with transfemoral amputation

Abstract--Observations in the field of lower limb prosthetic rehabilitation have shown that several transfemoral prostheses show signs of wear on some components of the knee unit. This is thought to be a result of severe loading developed during activities associated with kneeling. Some prostheses may have failed due to repetitive action of such loading. In order to determine the nature and magnitude of the loads developed during kneeling by persons with transfemoral amputation, and to investigate the influence of various prosthetic parameters, an analysis of the results of 162 tests in prosthetic knee hyperflexion was undertaken. The services of four males with amputation were enlisted. The measurements involved simultaneous use of two Kistler force platforms, a six-channel strain gauge transducer mounted on the prosthetic shank, and a data acquisition system. The critical loads for this configuration were found to be the shear force on the knee hinge, the shear force imposed by the knee chassis on the shin, and the bending moment tending to hyperflex the knee. These loads ranged from 0.6 to 6.2 kN, 0.9 to 6.7 kN, and from 18.3 to 155.7 Nm, respectively. To achieve a comfortable kneeling position, some prostheses permit foot rotation about the pylon axis of 90 ° to allow the shank to be approximately parallel to the ground. Tests were also conducted with the prostheses in this configuration and the most influential prosthetic parameter was found to be the external rotation of the foot (toe-out angle). During kneeling, it was found that the loading was dependent upon the position of the torso relative to the prosthesis, but loads were much higher than those developed during level walking