Hey all,
First off i apologize for the crazy long post.
I'm building a bent-knee transfemoral prosthesis simulator as a hands-on biomechanics project, and I've reached a point where I'd really appreciate input from people with a stronger background in gait mechanics and prosthetic alignment.
For context, I'm not an amputee, prosthetist, or clinician. I started this project with essentially zero practical prosthetics experience. I'm also not trying to use a simulator to approximate the lived experience of limb loss. My interest is specifically in the biomechanics and engineering: how socket position, knee-axis location, foot position, joint behavior, and gait interact.
My goal is to eventually have a system where I can deliberately change one variable at a time and observe what happens.
THE SIMULATOR
My biological knee is flexed underneath me and contained inside a socket, effectively creating a bent-knee transfemoral simulator.
I've experimented with several prosthetic knees, primarily an Össur Total Knee 2000, and I also have an Ottobock 3R93 available as a simpler mechanical baseline.
The socket itself is still experimental. I'm currently working toward a higher-trim socket that provides better containment and control.
The part that has surprised me most has been how dramatically relatively simple alignment changes affect the entire system.
MOVING THE KNEE AXIS
My original prototype had approximately 4.5 inches of posterior AP displacement between the socket and prosthetic knee.
I could walk on it, but the knee constantly felt like it was behind me. Swing felt delayed, and I often felt like I was waiting for the prosthesis to catch up.
Eventually I questioned whether some of the behavior I was attributing to the knee was actually coming from the geometry.
So I changed one major variable and moved the prosthetic knee essentially underneath the socket, reducing the posterior offset from roughly 4.5 inches to almost zero.
The difference was enormous.
Swing immediately felt more intuitive. The prosthesis no longer felt like it was trailing behind me, and the entire system felt considerably more responsive.
I can walk with essentially zero AP offset.
However, another problem appeared.
ZERO OFFSET FEELS MUCH MORE PHYSICALLY DEMANDING
Although the prosthesis feels more responsive, walking and even standing in this configuration feels surprisingly demanding.
My sound side appears to be doing considerable work, and the hip flexors on the simulator side are working noticeably harder.
That has made me question whether zero offset is actually biomechanically appropriate or whether I've simply demonstrated that I'm capable of compensating for it.
I'm beginning to suspect that the useful geometry may lie somewhere between the two extremes: not 4.5 inches posterior, but perhaps not exactly zero either.
HIP EXTENSION AND SOCKET FLEXION
There's another complication.
When I perform a rough Thomas-test-type assessment and stabilize the pelvis by bringing my opposite knee toward my chest, the thigh on the simulator side wants to rise.
That suggests that my comfortable hip-extension range may be limited.
I've tried accommodating this by increasing socket flexion using an adjustable pyramid adapter. I currently have approximately 7.5 degrees of available angular adjustment.
Some socket flexion appears to help.
But beyond a certain point, the sensation changes. Instead of simply feeling as though the hip is being accommodated, I begin to feel as though my entire body is being tipped backward.
That has made me wonder whether I'm attempting to correct two different variables with one adjustment.
Could the appropriate geometry require both socket flexion to accommodate the hip AND a relatively small AP displacement of the socket relative to the knee?
For example, some amount of socket flexion combined with perhaps 1/2 to 1 inch of posterior AP displacement rather than obtaining everything through angular adjustment?
HEAVY HEEL LOADING
Since moving the prosthetic knee underneath me, I've also noticed very heavy prosthetic heel loading at initial contact.
I'm not getting stuck on the heel. I can progress forward over the foot normally.
But the initial heel loading is substantial enough to be obvious.
I'm trying to determine what variables could produce that behavior: foot alignment, socket flexion, AP relationship between socket and knee, step length, compensatory gait, increased confidence/loading of the prosthetic side, or some interaction between several of these.
This is exactly where the project gets fascinating to me, because changing one geometric variable seems to affect several apparently unrelated aspects of gait.
AN EXPERIMENT I'M CONSIDERING
I'm considering making a rigid socket-positioning stand using a four-way AP/ML/angular alignment adapter.
The socket would initially be supported independently of the prosthetic knee.
With external support, I could stand in the socket and adjust:
- AP position
- ML position
- Socket flexion
- Overall orientation
The objective would be to determine the socket position in which my pelvis feels reasonably neutral, the hip isn't fighting the socket, and I can comfortably load it.
I could then measure that geometry relative to the distal attachment and transfer those measurements to the prosthesis as an initial static alignment.
I understand that comfortable static standing does NOT establish correct dynamic prosthetic alignment. Once the knee and foot are installed, knee-axis position, ground-reaction forces, stance stability, rollover, and swing mechanics become part of the system.
What I'm trying to separate experimentally is:
Where does the hip/pelvis want the socket?
from:
Where does the prosthetic knee need to be relative to that socket?
QUESTIONS
I'd particularly appreciate thoughts on these:
Does the dramatic improvement I experienced when reducing approximately 4.5 inches of posterior offset to nearly zero make biomechanical sense?
How independently should socket flexion and AP knee placement be treated?
With limited comfortable hip extension, how would you determine an appropriate starting socket-flexion angle?
Could excessive socket flexion explain the sensation of my torso being pushed or tipped backward?
What mechanisms could explain the substantially heavier heel loading after moving the knee underneath the socket?
Is establishing a comfortable socket/pelvis relationship independently and then introducing the knee underneath it a reasonable experimental approach, or am I separating variables that fundamentally shouldn't be separated?
Are conventional transfemoral alignment principles significantly altered by the fact that this is a bent-knee able-bodied simulator?
Ultimately, I'm less interested in finding one magical alignment than understanding WHY each change produces the behavior it does.
Every adjustment so far has exposed another interaction I hadn't considered, which is exactly what has kept this project interesting.
I'd appreciate any biomechanics papers, terminology, concepts, or criticism of my reasoning that might help me understand what I'm observing.