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Transfemoral Amputations: The Effect of Residual Limb Length and Orientation on Gait Analysis Outcome Measures
Johanna C. Bell, MSE1; Erik J. Wolf, PhD1; Barri L. Schnall, MPT1; John E. Tis, MD2; Laurie L. Tis, PhD3; MAJ Benjamin K. Potter, MD1
1 Center for Performance & Clinical Research, Walter Reed National Military Medical Center, America Building (#19), B-322, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600. E-mail address for J.C. Bell: Johanna.Bell@us.army.mil
2 Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, 733 North Broadway #100, Baltimore, MD 21205-1832
3 Wellstar College of Health and Human Services, Kennesaw State University, 1000 Chastain Road Northwest, Kennesaw, GA 30144
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Investigation performed at Walter Reed Army Medical Center, Washington, D.C.

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, the Department of the Navy, the Department of Defense, or the United States Government.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Mar 06;95(5):408-414. doi: 10.2106/JBJS.K.01446
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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.


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.


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.


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.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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