Transfemoral Amputations: The Effect of Residual Limb Length and Orientation on Gait Analysis Outcome Measures

Background: The level of function achieved following a transfemoral amputation is believed to be affected by surgical attachment of the remaining musculature, resulting orientation of the femur, residual limb length, and eventual prosthetic fit. Methods: Twenty-six subjects underwent gait analysis testing in the current preferred prosthesis more than twenty-four months postamputation. The femoral length and orientation angles of each subject were measured from standing postoperative radiographic scanograms. The subjects were separated into groups for analysis on the basis of the femoral shaft angles and the residual limb length ratios. Gait analysis was performed to collect kinematic and temporospatial parameters. Results: A good correlation was observed between residual femoral length and trunk with regard to forward lean (r = -0.683) and lateral flexion (r = -0.628). A good correlation was also observed between residual femoral length and pelvic motion with regard to pelvic tilt (r = -0.691) and obliquity (r = -0.398). A moderate correlation was observed with speed (r = 0.550), indicating that subjects with shorter residual limbs experienced a greater excursion in the torso and pelvis, while walking at a slower self-selected pace. A significant correlation (r = 0.721, p < 0.001) was observed between the femoral shaft abduction angle and the residual femoral length; the shorter the residual limb, the more abducted it was. Conclusions: The length of the residual femur substantially influences temporospatial and kinematic gait outcomes following transfemoral amputation, and appears to be more important than femoral orientation with regard to these parameters.