Does a Prosthetic Limb for Skiing Affect the Three-Dimensional Knee-Joint Kinematics of Unilateral Transfemoral Amputee Skiers: A Pilot Study

Background: Alpine skiing imposes high biomechanical demands on the lower limbs, which are further amplified in individuals with transfemoral amputation due to prosthetic constraints. This study aimed to quantify three-dimensional knee flexion asymmetries during alpine skiing turns in transfemoral amputee skiers compared with non-disabled controls. Methods: Five unilateral transfemoral amputee skiers (intervention group) and five non-disabled ski instructors (control group) performed six left and six right turns on a skiing simulator under laboratory conditions. Knee flexion angles at the apex of each turn were analyzed using three-dimensional motion capture. Intra-individual differences between the prosthetic and intact limbs were assessed using paired comparisons, and inter-individual differences between groups were evaluated using independent statistical tests (p < 0.05), performed in IBM SPSS Statistics. Results: Intra-individual analysis revealed significant knee flexion asymmetries (p < 0.05) in almost all amputee participants at the apex of both left (mean difference = 7.74°, 95% CI: 3.38–12.09) and right turns (mean difference = 4.36°, 95% CI: 2.66–6.06). In the control group, asymmetries were smaller and reached significance only for the inside leg in both turns (mean difference = 4.02°, 95% CI: 2.51–5.54). Inter-individual comparisons demonstrated significant differences between the groups for both turning directions. During left turns (prosthetic limb on the inside), the largest difference was observed for the inside leg (26.9°, p < 0.001), while the smallest difference occurred for the outside leg (12.1°, p = 0.013). During right turns (prosthetic limb on the outside), the largest difference was found for the outside leg (19.0°, p < 0.001), with a smaller but still significant difference for the inside leg (14.0°, p < 0.001). Conclusions: Transfemoral amputee skiers exhibit a turning strategy that is qualitatively comparable to that of non-disabled skiers; however, it is characterized by a reduced knee flexion range of motion. These limitations appear to be primarily influenced by prosthesis mechanics and user-specific skill levels rather than by a fundamentally different movement strategy.