Mechanical Work and Metabolic Cost of Walking with Knee-Foot Prostheses: A Study with a Prosthesis Simulator

Abstract

Background At equivalent speeds, above-knee amputee subjects have a higher metabolic cost than non-amputees. Following amputation, the ankle propulsion is reduced, and using other joints to compensate is mechanically less efficient. Objective This study investigated the link between mechanical work and metabolic cost in abled-bodied subjects using a prosthesis simulator, and the influence of foot energy restitution by comparing a foot with restitution to one without. Method Six volunteers fitted with an orthosis immobilising their ankle and knee, enabling the use of a prosthesis, carried out a gait analysis and an analysis of metabolic cost. The total lower limb mechanical work and works at the hip, knee and ankle were computed. Results With an almost twofold increase, metabolic cost and hip work were significantly higher in both configurations with prosthesis than without (p < 0.001 for both variables in both configurations), while total lower limb mechanical work showed no significant difference between configurations. No significant difference was observed between the two prosthetic feet in terms of metabolic cost nor mechanical work performed by the subject. Discussion Total lower limb mechanical work alone cannot explain the extra metabolic cost in subjects fitted with a knee-foot prosthesis simulator; internal inefficiencies exist. We also found that metabolic cost and hip work increase and decrease simultaneously, thus studying hip muscles work could be interesting. With no significant difference between the two feet, optimising ankle propulsion seems to be ineffective in improving metabolic cost. These findings should be evaluated in a sample of above-knee amputee subjects.