Original article
Interlimb Muscle and Fat Comparisons in Persons With Lower-Limb Amputation

https://doi.org/10.1016/j.apmr.2010.04.008Get rights and content

Abstract

Sherk VD, Bemben MG, Bemben DA. Interlimb muscle and fat comparisons in persons with lower-limb amputation.

Objectives

To investigate differences in muscle and fat tissue between amputated and intact limbs in subjects with transfemoral and transtibial amputations and to determine the effect of amputation level on limb differences. We hypothesized that the amputated limb would have a higher relative amount of fat than the intact limb, and transfemoral amputees would have greater limb differences in muscle size than transtibial amputees.

Design

Cross-sectional, repeated-measures design.

Setting

Laboratory.

Participants

Subjects included persons with unilateral transfemoral (TF) (n=5) and transtibial (TT) (n=7) amputations and age- and sex-matched nonamputation controls (n=12).

Interventions

Not applicable.

Main Outcome Measures

Muscle cross-sectional areas and fat cross-sectional areas of the end of residual limbs were compared with similar cross-sectional sites of the intact limb by using peripheral quantitative computed tomography scans. Thigh and lower-leg fat mass (FM) and bone-free lean body mass were measured by dual-energy x-ray absorptiometry.

Results

There was a 93% to 117% difference between limbs in muscle cross-sectional areas for TF and TT. TT had a between-limb difference of 39% for fat cross-sectional areas. Thigh bone-free lean body masses and FM were significantly (P<.05) lower for the amputated limb for both TF and TT. Thigh percent fat was significantly (P<.05) higher in the amputated thigh for TF and TT, but limb differences were greater in TF.

Conclusions

Muscle atrophy was prevalent in the residual limb with larger relative amounts of fat in the thighs, especially in TF subjects.

Section snippets

Study Design

This study is a cross-sectional, repeated-measures design comparing absolute and relative amounts of bone-free lean and fat tissue, and muscle and fat areas in the lower limbs of persons with unilateral TF and TT amputations. Furthermore, persons without amputations were tested as control participants, primarily to show interlimb variations in soft tissue not attributable to amputation. Thigh muscle volume and area data from previous amputee studies7, 8 resulted in large effect sizes, creating

Results

Table 1 shows participant characteristics. Subjects ranged in age from 23.2 to 62.9 years. There were no significant differences in whole-body composition characteristics between groups. Table 2 shows results of the soft-tissue analyses from pQCT (MCSA and fat cross-sectional area) and DXA (bone-free lean body mass and FM). MCSA values were significantly lower (F1,12=28.7–30.0, ηp2=.71; F1,8= 62.5–68.9, ηp2=.89–.90, P<.01) on the amputated limb for TF and TT groups, and the amputated limb

Discussion

To our knowledge, this is the first study that has quantified leg composition at the end of the residual limb. The MCSA was smaller, and relative FM was higher in the amputated limb compared with the intact limb. Qualitatively, pQCT analyses showed that the ends of residual limbs had noticeable amounts of intermuscular fatty tissue. Although the mean percent difference in the fat cross-sectional area between limbs for the TT group was much greater than for the TF group, the lack of significance

Conclusions

Muscle losses in the thigh muscles of TF and TT amputated limbs were evident. Also, there were large amounts of intermuscular adipose tissue at the end of residual limbs. Studies are needed to determine the uniformity of muscle and fat changes in the distal segments of residual limbs.

Acknowledgments

We thank Hanger Prosthetics and Orthotics, Inc and Kyle Sherk, CPO, for assistance with subject recruitment.

References (21)

There are more references available in the full text version of this article.

Cited by (52)

  • Biomechanical factors affecting individuals with lower limb amputations running using running-specific prostheses: A systematic review

    2022, Gait and Posture
    Citation Excerpt :

    Given the small sample size in each of the aforementioned studies, it remains inconclusive whether the magnitude of loading asymmetry is speed dependent. The lower prosthetic limb vertical GRFs can be attributed to physiological alterations to the musculoskeletal system [49] and side-effects such as muscular atrophy [51] and performance limitations of RSP designs [50,52]. In addition, it has been suggested that the asymmetry in average vertical GRF [8] and peak vertical GRF [7] between the intact limb and the prosthetic limb could be related to leg length discrepancy.

  • Circumference Method Estimates Percent Body Fat in Male US Service Members with Lower Limb Loss

    2021, Journal of the Academy of Nutrition and Dietetics
    Citation Excerpt :

    This may suggest that the method may be useful in individuals with limb loss but should be used in the context of clinical judgment because of the potential variability in measurement. Previous studies determining %BF in participants with limb loss have included a variety of body composition techniques, including skinfold thickness, DXA, and hydrostatic weighing.12,14,22 However, there is no standardized reference or validation data for body composition techniques in individuals with limb loss with which to compare our findings.

  • Non-amputated limb muscle coordination of unilateral transfemoral amputees

    2021, Journal of Biomechanics
    Citation Excerpt :

    It is commonly suggested that unilateral transfemoral amputees are more likely to have muscle hypertrophy on the non-amputated side than the able-bodied persons; however, our study presents another possibility. Sherk et al. found that the muscles of non-amputated limbs undergo atrophy during on-bed rehabilitation, whereas hypertrophy occurred when the amputee was re-learning bipedal locomotion (Sherk et al., 2010). However, the cross-sectional study conducted by Sherk et al. did not consider the variation of muscle volume change in time among amputees.

View all citing articles on Scopus

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

View full text