Amputation Level Affects Energy Expenditure in Children

Energy expenditure higher in above-knee amputations than in below-knee amputations

FRIDAY, Jan. 21 (HealthDay News) -- Children with a below-knee amputation are able to maintain normal walking speed without significantly increasing their energy cost, whereas those with above-knee amputations walk slower and expend more energy, according to a study published in the Jan. 5 issue of The Journal of Bone & Joint Surgery.

Kelly A. Jeans, of the Texas Scottish Rite Hospital for Children in Dallas, and colleagues evaluated 73 children who had had an amputation, as they walked at a self-selected speed. Children were grouped according to the level of amputation and compared to controls. Five children had below-knee bilateral amputation, and they were considered separately. Resting and walking oxygen consumption, resting and walking heart rate, and walking velocity were measured.

The researchers found that children with a Syme amputation, transtibial amputation, or knee disarticulation walked with the same speed and oxygen cost as did able-bodied children. Unilateral transfemoral and hip disarticulation amputations resulted in significantly reduced walking speed (80 and 72 percent of normal, respectively) and increased VO2 cost (151 and 161 percent of normal, respectively). Children with bilateral amputation walked significantly slower (87 percent of normal), with an elevated heart rate (119 percent of normal), but an energy cost similar to controls.

"Children with an amputation through the knee or distal to the knee were able to maintain a normal walking speed without significantly increasing their energy cost. Only when the amputation is above the knee do children walk significantly slower and with an increased energy cost," the authors write.

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