Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review

Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.