Dynamic alignment using external socket reaction moments in trans-tibial amputees

Background: Prosthetic alignment is used to optimize prosthetic functioning and comfort. Spatio-temporal and kinematic gait parameters are generally observed to guide this process. However, they have been shown to be influenced by compensations, which reduces their sensitivity to changes in alignment. Alternatively, the use of moments working at the base of the prosthetic socket, external socket reaction moments (ESRM), has been proposed to quantify prosthetic alignment. Research question: To investigate if a predetermined kinetic alignment criterion, 0Nm averaged over the stance phase, can be used to fine-tune prosthetic alignment. Methods: 10 transtibial amputees were included in this intervention study. Firstly, their prostheses were aligned using conventional alignment procedures. Kinetic parameters and Socket Comfort Score (SCS) were measured in this initial alignment (IA) condition. Subsequently, the coronal plane ESRM during gait was presented to the prosthetist in real time using a Gait Real-time Analysis Interactive Lab. The prosthetist iteratively adapted the prosthetic alignment towards a predetermined average ESRM during the stance phase of 0 Nm. At the Final Alignment (FA), kinetic parameters and SCS were measured again and a paired sample t-test was performed to compare ESRMs and SCSs between alignments. Results: A significant (p < 0.001) change was found in the absolute coronal plane ESRM (mean ± SD) from IA (|0.104| ± 0.058 Nm/kg) to FA (|0.012| ± 0.015 Nm/kg). In addition a significant (p < 0.001) change of the external coronal adduction knee moments was observed from IA (−0,127 ± 0.079 Nm/kg) to FA (−0.055 ± 0.089 Nm/kg), however this change was more variable among participants. On average, no significant (p = 0.37) change in the SCS was observed. Significance: While this study shows the potential of quantifying and guiding alignment with the assistance of kinetic criteria, it also suggests that a sole reliance on the ESRM as a single alignment criterion might be too simple