Microprocessor knees with ‘standing support’ and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing

INTRODUCTION: Trans-femoral amputees are at risk of musculoskeletal problems that are in part caused by loading asymmetry during activities, such as prolonged standing, particularly on uneven or sloped ground. METHODS: Four prosthetic conditions were tested; microprocessor knee ‘standing support’ mode activated (ON) and deactivated (OFF), combined with a rigidly attached foot (RA) and with an articulating, hydraulic ankle-foot (HA). Five trans-femoral amputees and five able-bodied controls were measured using a motion capture system and a force plate while standing, facing down a 5° slope. Ground reaction force distributions and centre-of-pressure root-mean-square (COP RMS) were calculated as outcome measures. RESULTS: Compensatory kinematic adjustments were observed for RA conditions but not for HA conditions. HA-OFF reduced ground reaction force degree-of-asymmetry for all five amputees, compared to RA-OFF. RA-ON reduced ground reaction force degree-of-asymmetry for four amputees, compared to RA-OFF. In terms of balance, the HA conditions reduced the mean inter-limb COP RMS by 24–25% compared to equivalent RA conditions, while ON conditions reduced it by 9–11%, compared to equivalent OFF conditions. CONCLUSIONS: It is important to consider both prosthetic knee and ankle technologies when prescribing devices to trans-femoral amputees. The combination of hydraulic ankle and knee standing support technologies produced outcomes closest to normal biomechanics.