Gait biomechanics and energy cost of walking after rotationplasty: A systematic review and meta-analysis compared to above-knee amputation and healthy participants.

Abstract

To provide insight into rotationplasty, we reviewed walking oxygen/energy cost and gait biomechanics, comparing it to above-knee amputation patients(AKA) (to inform clinical decision-making), and to healthy individuals (to assess deviation from normal). A literature search was conducted on September 30, 2024, using terms: rotationplasty, oxygen/energy cost of walking, and gait biomechanics. Small case reports were excluded. Methodological quality was assessed and meta-analyses (random-effects model, including heterogeneity assessment) with forest plots were performed for walking speed, cadence, stride length, and energy cost, while gait biomechanics outcomes were described qualitatively. Fifteen studies (225 rotationplasty patients) were included. Oxygen/energy cost of walking was 12.5 % lower for rotationplasty patients compared to AKA (SMD:0.57,p = 0.01), while was 34.5 % higher compared to healthy participants (SMD:2.55,p < 0.001). Gait biomechanics were like AKA, except for reduced compensatory knee power on the unaffected side in rotationplasty patients. Compared to healthy participants, rotationplasty patients had lower walking speed (18.1 %,p < 0.001), reduced cadence (6.8 %,p < 0.05), shorter stride length (9.5 %,p < 0.05), longer double support time, more lateral trunk and pelvic tilt, reduced knee flexion in loading response and swing, and a greater compensatory joint power with a 13.9 % higher vertical ground reaction force in the unaffected leg. This systematic review showed that rotationplasty is energetically preferable compared to AKA as oxygen/energy cost of walking was moderately lower compared to AKA, with reduced compensatory knee and hip power on the unaffected side. Walking energy cost was higher, and gait biomechanics more deviant in rotationplasty patients compared to healthy participants.