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9
th
 Australasian Biomechanics Conference, University of Wollongong, Australia, 30 Nov – 2 Dec 2014 
 
 
REPEATABILITY OF STATIC LOAD BEARING EXERCISES DURING REHABILITATION OF INDIVIDUALS WITH TRANSFEMORAL 
AMPUTATION FITTED WITH OSSEOINTEGRATED IMPLANT  
Sofie Vertriest
1
, Laurent Frossard
2,3
 
1 
Ghent University Hospital, Belgium 
2 
University of the Sunshine Coast, Maroochydore, QLD, Australia 
3 
Queensland University of Technology, Brisbane, QLD, Australia 
email: sofie.vertriest@uzgent.be 
 
 
Vertriest S, Frossard L. Repeatability of static load bearing exercises during rehabilitation of individuals with 
transfemoral amputation fitted with osseointegrated implant . IX Australasian Biomechanics Conference (ABC9). 2014. 
Wollongong, Australia. p 79 
 
 
INTRODUCTION 
Bone-anchored prostheses, relying on implants to 
attach the prosthesis directly to the residual skeleton, are 
the ultimate resort for patients with transfemoral 
amputations (TFA) experiencing severe socket discomfort. 
The first patient receiving a bone-anchored prosthesis 
underwent the surgery in 1990 in the Sahlgrenska 
University Hospital (Sweden).  
To date, there are two commercially available 
implants: OPRA (Integrum, Sweden) and ILP 
(Orthodynamics, Germany).
[1, 2]
 The key to success to this 
technique is a firm bone-implant bonding, depending on 
increasing mechanical stress applied daily during load 
bearing exercises (LBE). The loading data could be 
analysed through different biomechanical variables.
[3-6]
 
The intra-tester reliability of these exercises will be 
presented here.  
Moreover the effect of increase of loading, axes of 
application of the load and body weight as well as the 
difference between force and moment variables will be 
discussed.  
 
METHODS 
Eleven individuals with unilateral transfemoral 
amputation fitted with an OPRA osseointegrated implant 
participated in this study. They performed five trials in 
four loading conditions (10kg, 20kg, 40 kg and a maximum 
depending on the body weight).
[7, 8]
   
The forces and moments on the three axes of the 
implant were measured directly with a six-channel 
commercial transducer embedded in a short pylon (Figure 
1). 
[7-19]
 
Patients monitor the load applied by looking at a 
bathroom scale, getting information only on the load 
applied on the vertical axis.  
Reliability of the loading variables was assessed 
using intraclass correlation coefficients (ICCs), standard 
error of measurement values (SEMs) and %SEM values. 
 
RESULTS 
The ICCs of all variables ranged between 0.947 and 1 and 
the %SEM values ranged between 0 and 87.07%. 
 
The lowest ICC values and the highest %SEM values were 
found for the MLG and MML for the higher loads.  
 
 
Figure 1: Overview of the apparatus used to monitor the 
load prescribed including the single-axis strain gauge (A) 
that was embedded in a support frame (B) and connected 
to a LCD display (C). 
 
DISCUSSION 
The %SEM is slightly higher for the moments than for the 
forces, especially for the MLG and MML in the higher 
loads (40kg and max load) indicating a slight decrease in 
the reliability for the moment on the long and 
mediolateral axis for the higher loads. Apart from these 
exceptions, the progression of the load prescribed, the 
axes of application and the body weight did have only 
limited impact on the reliability 
 
CONCLUSIONS 
The results indicate an overall high reliability between the 
loading conditions with little to no impact of the 
progression of the load prescribed, the axes of application 
and the body weight.  
 
9
th
 Australasian Biomechanics Conference, University of Wollongong, Australia, 30 Nov – 2 Dec 2014 
REFERENCES 
1. Hagberg, K. and R. Branemark, One hundred patients 
treated with osseointegrated transfemoral 
amputation prostheses-rehabilitation perspective. J 
Rehabil Res Dev, 2009. 46(3): p. 331-44. 
2. Aschoff, H.H., R.E. Kennon, J.M. Keggi, and L.E. Rubin, 
Transcutaneous, distal femoral, intramedullary 
attachment for above-the-knee prostheses: an 
endo-exo device. J Bone Joint Surg Am, 2010. 92 Suppl 
2(Supplement 2): p. 180-6. 
3. Beaulieu, P., S. Vertriest, and L. Frossard. Description 
of body posture during static load bearing exercises 
for individuals with transfemoral amputation fitted 
with bone-anchored prosthesis. in 2013 O&P World 
Congress. 2013. Orlando, USA. 
4. Vertriest, S., P. Coorevits, and L. Frossard. Static load 
bearing exercises during rehabilitation of individuals 
with transfemoral amputation fitted with 
osseointegrated implant: Load compliance. in 2013 
O&P World Congress. 2013. Orlando, USA. 
5. Vertriest, S., P. Coorevits, and L. Frossard. Static load 
bearing exercises during rehabilitation of individuals 
with transfemoral amputation fitted with 
osseointegrated implant: Kinetic analysis. in 14th 
World Congress of the International Society of 
Prosthetics and Orthotics (ISPO). 2013. Hyderabad, 
India. 
6. Vertriest, S., P. Coorevits, and L. Frossard. Load 
bearing exercises and functional outcome of 
individuals with transfemoral amputation fitted with 
OPRA fixation. in 4th international conference in 
Advances in Orthopaedic osseintegration - 
Orthopaedic Surgical Osseointegration Society. 2012. 
San Francisco, USA. 
7. Vertriest, S., P. Coorevits, K. Hagberg, R. Branemark, E. 
Haggstrom, G. Vanderstraeten, and L. Frossard, Static 
Load Bearing Exercises of Individuals With 
Transfemoral Amputation Fitted With an 
Osseointegrated Implant: Reliability of Kinetic Data. 
IEEE Trans Neural Syst Rehabil Eng, 2014. In press. 
8. Frossard, L., D.L. Gow, K. Hagberg, N. Cairns, B. 
Contoyannis, S. Gray, R. Branemark, and M. Pearcy, 
Apparatus for monitoring load bearing rehabilitation 
exercises of a transfemoral amputee fitted with an 
osseointegrated fixation: a proof-of-concept study. 
Gait Posture, 2010. 31(2): p. 223-8. 
9. Frossard, L., J. Beck, M. Dillon, M. Chappell, and J.H. 
Evans, Development and preliminary testing of a 
device for the direct measurement of forces and 
moments in the prosthetic limb of transfemoral 
amputees during activities of daily living. Journal of 
Prosthetics and Orthotics, 2003. 15(4): p. 135-142. 
10. Frossard, L., L. Cheze, and R. Dumas, Dynamic input to 
determine hip joint moments, power and work on the 
prosthetic limb of transfemoral amputees: ground 
reaction vs knee reaction. Prosthet Orthot Int, 2011. 
35(2): p. 140-9. 
11. Frossard, L., K. Hagberg, E. Haggstrom, and R. 
Branemark, Load-relief of walking aids on 
osseointegrated fixation: instrument for 
evidence-based practice. IEEE Trans Neural Syst 
Rehabil Eng, 2009. 17(1): p. 9-14. 
12. Frossard, L., K. Hagberg, E. Häggström, D.L. Gow, R. 
Brånemark, and M. Pearcy, Functional Outcome of 
Transfemoral Amputees Fitted With an 
Osseointegrated Fixation: Temporal Gait 
Characteristics. JPO Journal of Prosthetics and 
Orthotics, 2010. 22(1): p. 11-20. 
13. Frossard, L., E. Haggstrom, K. Hagberg, and P. 
Branemark, Load applied on a bone-anchored 
transfemoral prosthesis: characterisation of prosthetic 
components – A case study Journal of Rehabilitation 
Research & Development, 2013. 50(5): p. 619–634. 
14. Frossard, L., N. Stevenson, J. Smeathers, E. Haggstrom, 
K. Hagberg, J. Sullivan, D. Ewins, D.L. Gow, S. Gray, and 
R. Branemark, Monitoring of the load regime applied 
on the osseointegrated fixation of a trans-femoral 
amputee: a tool for evidence-based practice. Prosthet 
Orthot Int, 2008. 32(1): p. 68-78. 
15. Frossard, L., N. Stevenson, J. Sullivan, M. Uden, and M. 
Pearcy, Categorization of Activities of Daily Living of 
Lower Limb Amputees During Short-Term Use of a 
Portable Kinetic Recording System: A Preliminary 
Study. JPO Journal of Prosthetics and Orthotics, 2011. 
23(1): p. 2-11. 
16. Frossard, L., R. Tranberg, E. Haggstrom, M. Pearcy, and 
R. Branemark, Fall of a transfemoral amputee fitted 
with osseointegrated fixation: loading impact on 
residuum. Gait & Posture, 2009. 30(Supplement 2): p. 
S151-S152. 
17. Frossard, L.A., Load on osseointegrated fixation of a 
transfemoral amputee during a fall: Determination of 
the time and duration of descent. Prosthet Orthot Int, 
2010. 34(4): p. 472-87. 
18. Frossard, L.A., R. Tranberg, E. Haggstrom, M. Pearcy, 
and R. Branemark, Load on osseointegrated fixation of 
a transfemoral amputee during a fall: loading, descent, 
impact and recovery analysis. Prosthet Orthot Int, 
2010. 34(1): p. 85-97. 
19. Lee, W.C., L.A. Frossard, K. Hagberg, E. Haggstrom, D.L. 
Gow, S. Gray, and R. Branemark, Magnitude and 
variability of loading on the osseointegrated implant 
of transfemoral amputees during walking. Med Eng 
Phys, 2008. 30(7): p. 825-833. 
 
 
 
 REPEATABILITY OF STATIC LOAD BEARING EXERCISES DURING 
REHABILITATION OF INDIVIDUALS WITH TRANSFEMORAL 
AMPUTATION FITTED WITH OSSEOINTEGRATED IMPLANT  
 
Sofie Vertriest1, Laurent Frossard2,3 
 
1 Ghent University Hospital, Belgium,  
2 University of the Sunshine Coast, Maroochydore, QLD, Australia,  
3 Queensland University of Technology, Brisbane, QLD, Australia  
INTRODUCTION 
• Bone-anchored prostheses, relying on implants to attach the 
prosthesis directly to the residual skeleton, are the ultimate 
resort for patients with transfemoral amputations (TFA) 
experiencing severe socket discomfort. The first patient receiving 
a bone-anchored prosthesis underwent the surgery in 1990 in the 
Sahlgrenska University Hospital (Sweden).  
• To date, there are two commercially available implants: OPRA 
(Integrum, Sweden) and ILP (Orthodynamics, Germany). [1,2] The 
key to success to this technique is a firm bone-implant bonding, 
depending on increasing mechanical stress applied daily during 
load bearing exercises (LBE). The loading data could be analysed 
through different biomechanical variables. [3,4] The intra-tester 
reliability of these exercises will be presented here.  
• Moreover the effect of increase of loading, axes of application of 
the load and body weight as well as the difference between force 
and moment variables will be discussed. 
METHODS 
• Participants: Eleven individuals with unilateral transfemoral 
amputation fitted with an OPRA osseointegrated implant.  
 
• Trials: five trials in four loading conditions: 10kg, 20kg, 40 kg 
and a maximum depending on the body weight.  
 
• Measurements: 
o What: forces and moments on the three axes of the 
implant (FML, FAP , FLG ,MML, MAP , MLG ) 
o How: directly with a six-channel commercial 
transducer embedded in a short pylon (Figure 1).[5]  
o Control: Patients monitor the load applied by looking 
at a bathroom scale, gathering information only on the 
load applied on the vertical axis.  
 
• Statistical analysis: Reliability of the loading variables was 
assessed using intraclass correlation coefficients (ICCs), standard 
error of measurement values (SEMs) and %SEM values.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1: Overview of the apparatus used to monitor the load 
prescribed including the single-axis strain gauge (A) that was 
embedded in a support frame (B) and connected to a LCD display 
(C). 
RESULTS 
• Mean force applied was: 
o 79.03±57.54 N on the mediolateral axis, 
o 107.86±43.52 N on the anteroposterior axis, 
o 166.14±22.77 N on the long axis, 
o 223.97±26.19 N resultant. 
• ICCs of all variables ranged between 0.947 and 1.  
• SEM values ranged between 0 and 87.07%.  
• The lowest ICC values and the highest %SEM values were found 
for the MLG and MML for the higher loads.  
DISCUSSION 
• The %SEM is slightly higher for the moments than for the forces, 
especially for the MLG and MML in the higher loads (40kg and 
max load) indicating a slight decrease in the reliability for the 
moment on the long and mediolateral axis for the higher loads. 
• Apart from these exceptions, the progression of the load 
prescribed, the axes of application and the body weight did have 
only limited impact on the reliability. 
CONCLUSIONS 
• Overall high reliability between the loading conditions. 
• Little to no impact of:  
o  The progression of the load prescribed, 
o  The axes of application,  
o  The body weight. 
REFERENCES 
• [1] Hagberg K. and R. Brånemark. Journal of Rehabilitation 
Research & Development, 43(3): 331-344, 2009. 
• [2] Aschoff H. et al. The Journal of Bone & Joint Surgery, 92 
(Supplement 2): 180-186, 2010. 
• [3] Vertriest S., Coorevits P., Frossard L. XIVth World Congress of 
the ISPO, Hyderabad, India, 2013.  
• [4] Vertriest S., Coorevits P., Frossard L. OSOS, San Francisco, 
USA, 2012.  
• [5] Frossard. L. et al. Gait and Posture, 31(2): 223-228, 2010. 
TO KNOW MORE 
• Vertriest S, Coorevits P, Hagberg K, Brånemark R, Häggström E, 
Vanderstraeten G, Frossard L. Static load bearing exercises of 
individuals with transfemoral amputation fitted with an 
osseointegrated implant: Reliability of kinetic data. IEEE 
Transactions on Neural Systems and Rehabilitation Engineering. 
2014. Online First. DOI: 10.1109/TNSRE.2014.2337956  
• http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=685
6197  
SPEAKER’S INFORMATION 
Laurent Frossard (PhD) 
• Adjunct Professor at QUT and USC  
• Director at YourResearchProject 
• Laurentfrossard@yahoo.com.au 
• +61 (0)4 1379 5086  
• www.laurentfrossard.com