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Gait Characteristics of a Soldier With a Traumatic Hip Disarticulation

BL Schnall, MPT, is Biomechanics Lab Physical Therapist, Center for Performance and Clinical Research, Military Advanced Training Center, Walter Reed Army Medical Center, Bldg 2A, Room 146, 6900 Georgia Ave NW, Washington, DC 20307 (USA)
BS Baum, MS, is Biomechanics Lab Engineer, Center for Performance and Clinical Research, Military Advanced Training Center, Walter Reed Army Medical Center
AM Andrews, PhD, RD, CSSD, is Chief, Education and Research Division, Nutrition Care Directorate, Walter Reed Army Medical Center

Address all correspondence to Ms Schnall at: barri.schnall{at}na.amedd.army.mil

Background and Purpose: No reports have analyzed the temporal-spatial, kinematic, or kinetic components of gait coupled with a metabolic analysis of patients with hip disarticulations. Most of the research on this population is based on older adults. As a result, guidelines for reasonable functional outcomes for patients with hip disarticulations who are young, premorbidly fit, and goal oriented are lacking. This report describes quantitative measures of energy cost and gait characteristics of a young soldier with a unilateral traumatic hip disarticulation.

Case Description: One patient, a soldier with a unilateral hip disarticulation, was evaluated in the Gait and Motion Analysis Laboratory at 3 months and 38 months postinjury.

Outcomes: The patient progressed from use of crutches at 3 months postinjury to independent ambulation at the follow-up visit at 38 months postinjury. At 38 months postinjury, he wore his prosthesis 12 hours per day and achieved step-length symmetry, and his oxygen consumption was 14.49 mL/kg/min at self-selected walking speed. Self-selected walking speed increased from 0.57 m/s at 3 months to 0.86 m/s at 38 months postinjury. During both visits, support time remained greater on the intact limb (72%) than the involved limb (57%), compensatory trunk and pelvic motions were used to advance the prosthetic limb, and the vertical ground reaction force profile was within 2 standard deviations of the data for an uninjured comparison group on the prosthetic side and plateaued on the sound limb.

Discussion: Young individuals with traumatic hip disarticulations can achieve and maintain functional independent ambulation with gait deviations. However, metabolic demands may not be as great as previously expected.

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