Table 1.
Summary of Included Studies
| Author, Year | Title | Participants With Amputation | Methods | Time Points | Comparison | |
|---|---|---|---|---|---|---|
| Skeletal | Bemben et al. (2017) | Acute bone changes after lower limb amputation resulting from traumatic injury | 8 TT; Mean age 35.4 (SD 11.1); All traumatic etiologies | DXA measured BMD for total body, lumbar spine, femoral neck, proximal femur; pQCT measured residual limb volumetric BMD, stress-strain index, and muscle cross-sectional area | Prior to prosthesis fitting; 6 months post-prosthesis; 12 months post-prosthesis; additional blood draw occurred at time of surgery | Amputated vs intact limbs; over time points |
| Cavedon et al. (2021) | Body composition and bone mineral density in athletes with a physical impairment | 18 total 7 TT and 11 TF Mean age 34.4; All athletes of at least two years in adaptive sports | DXA measured whole-body and regional: total mass, lean mass, fat mass, % fat mass, fat mass/lean mass, BMC, and BMD | Cross-sectional; inclusion stated all athletes of at least two years in adaptive sports | Amputated vs intact limbs; amputee group vs spinal cord injury group vs control group | |
| Haket et al. (2017) | Periprosthetic cortical bone remodeling in patients with an osseointegrated leg prosthesis | 27 TF with osseointegration; 21 males, 6 females Mean age 48 (range 23-68); Mean TSA 18 years (range 2-45) | DXA measured BMD at the femoral neck (DXA only included 24 patients); X-ray measured periprosthetic cortical thickness; | Immediately post-op; 1 year post-op; 2 years post-op | Amputated vs intact; time points | |
| Hansen et al. (2019) | Changes in periprosthetic bone mineral density and bone turnover markers after osseointegrated implant surgery: A cohort study of 20 transfemoral amputees with 30-month follow-up | 19 TF with osseointegration; 12 males, 7 females; Mean age 49 (SD 11.17) | DXA measured BMD in lumbar spine, proximal femur and seven periprosthetic regions (zones 1-7 may or may not be similar to other studies) | Pre-op (2-21 days before surgery), and 1, 3, 6, 7, 9, 12, 18, 24 and 30 months after the S1 surgery or until implant was removed | Amputees vs controls; removed OI implant over nonremoved OI implant; over time points | |
| Hoyt et al. (2021) | Femoral Neck Hounsfield Units as an Adjunct for Bone Mineral Density After Combat-Related Lower Extremity Amputation | 26 individuals with 30 amputations total; 17 TT amputations and 13 TF amputations; All males; Mean age 26.4 (range 22-29); All traumatic etiologies | DXA measured BMD at femoral neck; CT measured Hounsfield units at femoral neck | Cross-sectional; inclusion criteria stated DXA and CT scans within 6 months of each other; DXA scans taken 5-11 months post-injury (mean 6 months) | Correlation b/t hounsfield units from CT scans and BMD from DXA scans | |
| Ramírez et al. (2011) | Analysis of bone demineralization due to the use of exoprosthesis by comparing Young’s modulus of the femur in unilateral transfemoral amputees | 20 TF; 3 females and 17 males; Mean age 44.6 (range 23–71); Mean TSA 10.9 years; All used SACH foot and mechanical monocentric knee | CT measured Young’s Modulus (no BMD data presented- just correlations) | Cross-sectional; no inclusion criteria stated | Amputated vs intact proximal femur at three locations= femoral neck, metaphysis just below lesser trochanter, and proximal quarter of the diaphysis | |
| Royer and Koenig (2005) | Joint loading and bone mineral density in persons with unilateral, trans-tibial amputation | 9 TT; 8 male 1 female; Mean age 41.7 (SD 10.6); Mean TSA 16.7 years (STD 10.9); All used ESAR feet; 4 traumatic etiologies, 1 diabetic, 2 congenital, 1 blood clot, 1 infection; | DXA measured BMD in proximal femur and tibia | Cross-sectional | Amputated vs intact vs averaged matched control limb value | |
| Rush et al. (1994) | Osteopenia in patients with above knee amputation | 16 TF; All male; Mean age 48 range (23-66) All ischial weight bearing sockets; 9 suction sockets and 7 silesian belt suspension; 8 traumatic etiologies, 6 cancer, 2 vascular | DXA measured BMD for L2 and femoral neck | Cross-sectional; inclusion says prosthesis users for over 5 years | Amputated vs intact; amputee group vs controls | |
| Sherk et al. (2008) | BMD and bone geometry in transtibial and transfemoral amputees | 14 total; 7 TT (5 males and 2 females); Mean age 43.4 (SD 6.0); 7 TF (6 males and 1 female); Mean age 45.7 (SD 5.7); TSA (14.7 TT and 15.5 TF), and hours/day of prosthesis wear (15 TT and 11 TF); 11 traumatic etiologies, 1 secondary to diabetes, 1 secondary to circulation issues, and 1 secondary to osteomyelitis; both groups had similar numbers of years wearing a prosthesis (14.4 TT and 15.4 TF), | DXA measured areal BMD of the dual proximal femur, lumbar spine, and total body; pQCT measured volumetric BMD and bone geometry at the distal ends of both limbs | Cross-sectional; inclusion stated ambulatory with a prosthesis for at least 6 months | Amputated vs intact limbs; group comparisons for both levels and two groups of nonamputee controls (one transtibial control group and one transfemoral control group) | |
| Smith et al. (2009) | A study of bone mineral density in adults with disability | 52 lower-limb amputees (no further details) | DXA measured BMD for total lumbar spine, femoral neck, total proximal femur | Cross-sectional; inclusion stated they had to have their disability for at least 3 months | Amputees vs other groups with musculoskeletal deficits (e.g. spinal cord injury) | |
| Smith et al. (2011) | A study of BMD in lower limb amputees at a national prosthetics center | 52 total; 24 TT; 19 TF; 8 bilateral; 1 hip disarticulation; 39 males and 13 females Mean age 61.9 (SD 12.8) | DXA measured BMD in lumbar spine, femoral neck, and proximal femur | Cross-sectional | Amputated vs intact; male vs female | |
| Thomson et al. (2019A) | Proximal Bone Remodeling in Lower Limb Amputees Reconstructed With an Osseointegrated Prosthesis | 48 total with osseointegration; 15 TT (12 males and 3 females) and 33 TF (22 males and 11 females); Mean age 51 (SD 13.5); TF group split into 2 groups depending on presence of femoral neck lag screw | DXA measured BMD at lumbar spine and femoral neck | Pre-op; 1 year post-op; and 3 years post-op | Amputated vs intact limbs; between amputation level/femoral neck screw groups; over time points | |
| Thomson et al. (2019B) | Radiographic Evaluation of Bone Remodeling Around Osseointegration Implants Among Transfemoral Amputees | 28 TF with osseointegration; 15 received integral leg prosthesis (10 male and 5 female) and 13 received osseointegration prosthetic limb type A (8 male and 5 female); Mean age 48 years (SD 12.4) | X-rays measured bone density, longitudinal bone coverage, and bone width | About 6 months post-op (0.4 with STD of 0.5 years); about 3 years post-op(3.0 with STD of 0.8 years) | 7 femoral (inverse Gruen) zones; between osseointegration implant groups; over time points | |
| Tugcu et al. (2009) | Muscle strength and bone mineral density in mine victims with transtibial amputation | 15 TT; All male; Mean age 26.2 (SD 3.9); Mean TSA 57.9 months (SD 47.5) All traumatic etiologies; All PTB sockets | DXA measured BMD at femoral neck, Ward’s triangle, total femur, and total tibia | Cross-sectional | Amputated vs intact | |
| Yazicioglu et al. (2008) | Osteoporosis: A factor on residual limb pain in traumatic trans-tibial amputations | 36 TT; All male; Mean age 26.8 (SD 3.5); Mean TSA 62.8 months (SD 37); All traumatic etiologies | DXA measured BMD for femoral neck, Ward’s triangle, total hip, and proximal tibia | Cross-sectional | Amputated vs intact | |
| Muscular | Bramley et al. (2021) | Changes in Tissue Composition and Load Response After Transtibial Amputation Indicate Biomechanical Adaptation | 10 TT; (6 males and 4 females); Mean age 41 (range 25-62); Mean TSA 7.5 years; 2 chronic regional pain disease etiologies, 2 congenital, 5 traumatic, 1 vascular; Mean daily socket use 12.5 hours (range 6-16) | MRI measured fatty infiltration of limbs | Cross-sectional | Amputated vs intact vs control |
| de Palma et al. (2011) | Involvement of the muscle-tendon junction in skeletal muscle atrophy: an ultrastructural study | 15 TT Group A= 12 elderly (mean age 79 years; range 65-85) 10 males and 2 females; 10 vascular etiologies, 1 osteomyelitis, 1 cancer Group B= 3 healthy young adults (mean age 32 range 25-35); All male; All traumatic etiologies | Histology measured fiber structures; EM measured base/perimeter ratio in musculotendinous junction | Cross-sectional | Group A vs B | |
| George et al. (2021) | Circumference Method Estimates Percent Body Fat in Males U.S. Service Members with Lower Limb Loss | 47 total; 23 unilateral TT; 4 bilateral TT; 14 unilateral TF; 3 bilateral TF; 3 TT/TF; Mean age 27.6 years (SD 5.7) | DXA measured percent body fat | Cross-sectional | Amputees vs controls | |
| Henson et al. (2021) | Understanding lower limb muscle volume adaptations to amputation | 12 total; 6 unilateral TT; mean age 33.7 years (SD 1.9); mean TSA 7.5 years 6 bilateral TF; mean age 31.8 years (SD 2.9); mean TSA 7.2 years; All male; All traumatic etiologies; All used dynamic response feet; All TF used MPKs | MRI measured gross skeletal measurements and muscle volume | Cross-sectional | Amputated vs intact (in TT) vs control | |
| Jaegers et al. (1995) | Changes in hip muscles after above-knee amputation | 12 TF; Mean age 38.2 (SD of 18); TSA 3- 35 years (mean 9.4); 7 traumatic etiology and 5 osteosarcomic etiology | MRI measured femur and muscle volume | Cross-sectional; inclusion said at least 2 years post-amputation | Amputated vs intact vs control | |
| Onat et al. (2016) | Ultrasonographic assessment of the quadriceps muscle and femoral cartilage in transtibial amputees using different prostheses | 38 TT; 13 using vacuum suspension; 11 male and 2 female; Mean age 41.9 years with SD 11.8; TSA 10.8 years; Prosthesis use 5.6 years); 25 using pin-lock suspension; 20 males and 5 females; Mean age 40.6 years with SD 11.6; Mean TSA 16.3 years; prosthesis use 6.6 years) | Ultrasound of femoral cartilage thickness (intercondylar area, lateral femoral condyle, medial femoral condyle) and quadriceps muscle thickness (rectus femoris, vastus intermedius, vastus intermedius, and vastus medialis) | cross-sectional; inclusion states at least 6 months of prosthesis use | Amputated vs intact limbs; two suspension groups | |
| Putz et al. (2017) | Structural changes in the thigh muscles following trans-femoral amputation | 12 TF; 6 males and 6 females; Mean age 44.1 at amputation (range 21-69); All cancer | MRI measured fatty infiltration and degeneration at the middle and distal end of specific muscles within the residual limb | About 1 year post-op (avg 10.6 months SD 12.6); about 2 years post-op (avg 25.6 months SD 21.4); 12 patients included at time 1 but only 7 patients included at time 2 | Middle vs end of residual limb; time points | |
| Renström et al. (1983) | Thigh muscle atrophy in below-knee amputees | 10 TT; 8 males and 2 females; Mean age 56; 4 vascular etiologies, 2 infection, 4 trauma; Mean TSA 24 months (SD 37) | Histology measured fast and slow-twitch fibers, fiber sizes, and fiber area; CT measured mean fiber area of muscles in the thigh; measuring tape determined cross-sectional area of the thigh | Cross-sectional | Amputated vs intact; type 1 vs 2 fibers | |
| Schmalz et al. (2001) | Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study. | 17 TT; 15 male and 2 female; Mean age 47 (SD 18); 14 traumatic etiologies, 1 due to infection, 1 due to tumor, and 1 due to venous thrombosis; All had patellar tendon bearing prostheses | Ultrasound measured cross-sectional area and thickness of the quadriceps femoris, sartorius, gracillis, semitendinosus, and biceps femoris | Cross-sectional; demographics state at least 6 months of prosthesis use (range 0.5 - 19 years with median of 5 years) | Amputated vs intact vs control limb | |
| Sharma et al. (2019) | Fast and slow myosin as markers of muscle regeneration in mangled extremities: a pilot study | 15 lower-limb amputees (no level details); All trauma | Histology measured fast and slow myosin in residual limb | During amputation surgery, at 7 day follow-up | Fast vs slow myosin; time points | |
| Sherk et al. (2010) | Interlimb muscle and fat comparisons in persons with lower-limb amputation | 12 total 7 TT; Mean age 43.4 (SD 15.8) 5 TF; Mean age 38.5 (SD 10.6) | DXA measured thigh and lower-leg fat mass and bone-free lean body mass; qQCT measured muscle cross-sectional areas and fat cross-sectional areas of the end of residual and intact limbs with thresholding technique to determine the composition of fat vs muscle | Cross-sectional; inclusion states ambulatory for at least 6 months | Amputated vs intact limbs; amputee vs control groups | |
| Sibley et al. (2020) | The effects of long-term muscle disuse on neuromuscular function in unilateral transtibial amputees | 9 TT; All male; Mean age 40.3 (SD 8.5); All traumatic etiologies | Ultrasound of the vastus lateralis measured muscle thickness, pennation angle, and fascicle length | Cross-sectional; inclusion states amputation performed at least 6 months prior | Amputated vs intact vs control |
Studies are categorized by skeletal or muscular methodologies. All individuals with amputation were unilaterally affected unless otherwise specified. Mean age is in years unless otherwise specified. Abbreviations: TT= transtibial, TF= transfemoral, SD= standard deviation, TSA = time since amputation, DXA= Dual Energy X-ray Absorptiometry, pQCT= peripheral quantitative computed tomography, BMD= bone mineral density, CT= computed tomography, MRI= magnetic resonance imaging, MPKs= microprocessor knees.