Limb Salvage With Intrepid Dynamic Exoskeleton Orthosis Versus Transtibial Amputation: A Comparison of Functional Gait Outcomes

OBJECTIVES:To determine if there is a difference in functional gait outcomes between patients with limb injuries treated with either transtibial amputation or limb preservation with Intrepid Dynamic Exoskeletal Orthosis (IDEO). DESIGN:Retrospective prognostic study. SETTING:Tertiary referral military hospital. PATIENTS:This study included 10 transtibial amputees and ten limb preservation patients using the IDEO who were matched by body mass index after excluding for non-traumatic, proximal ipsilateral, contralateral, spine or traumatic brain injuries. Transtibial amputation patients were also excluded if they did not have a gait study between 6 and 12 months after independent ambulation and limb preservation were excluded if they did not complete the “Return to Run” program. INTERVENTIONS:An observational study of functional outcomes utilizing instrumented gait analysis. OUTCOME MEASURES:Spatiotemporal, kinetic (vertical ground reaction force), unified deformable (UD) power, work, and efficiency. RESULTS:Limb preservation patients walked with a significantly slower cadence (p=0.036) and spent less time on their affected limb in stance (p=0.045), and longer in swing (p=0.019). Amputees had significantly increased maximum positive power in both limbs (p=0.004 and p= 0.029) and increased maximum negative power on the unaffected limb (p= 0.035). Amputees had significantly increased positive and negative work in the affected limb (p=0.0009 and p=0.014) and positive work in the unaffected limb (p=0.042).There was no significant difference in the kinetic data or efficiency. CONCLUSIONS:Limb preservation patients spend less time on their affected limb as a percentage of the gait cycle. The UD power demonstrated more dynamic gait in amputees, with peak values closer to normative data. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.