{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:03:15Z","timestamp":1791576195449,"version":"4.3.4"},"reference-count":58,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100006965","name":"Telemedicine & Advanced Technology Research Center","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006965","id-type":"DOI","asserted-by":"crossref"}]},{"name":"DoD-VA Extremity Trauma and Amputation Center of Excellence"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      In transtibial limb loss, computer simulations suggest that the maintenance of muscle strength between pre- and post-limb loss can maintain the pre-limb loss metabolic cost. These results are consistent with comparable costs found experimentally in select cases of high functioning military service members with transtibial limb loss. It is unlikely that similar results would be found with transfemoral limb loss, although the theoretical limits are not known. Here we performed optimal control simulations of walking with and without an above-knee prosthesis to determine if transfemoral limb loss\n                      <jats:italic>per se<\/jats:italic>\n                      increases the metabolic cost of walking.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      OpenSim Moco was used to generate optimal control simulations of walking in 15 virtual \u201csubjects\u201d that minimized the weighted sum of (i) deviations from average able-bodied gait mechanics and (ii) the gross metabolic cost of walking, pre-limb loss in models with two intact biological limbs, and post-limb loss with one of the limbs replaced by a prosthetic knee and foot. No other changes were made to the model. Metabolic cost was compared between pre- and post-limb loss simulations in paired\n                      <jats:italic>t<\/jats:italic>\n                      -tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Metabolic cost post-limb loss increased by 0.7\u20139.3% (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01) depending on whether cost was scaled by total body mass or biological body mass and on whether the prosthetic knee was passive or non-passive.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Given that the post-limb loss model had numerous features that predisposed it to low metabolic cost, these results suggest transfemoral limb loss\n                      <jats:italic>per se<\/jats:italic>\n                      increases the metabolic cost of walking. However, the large differences above able-bodied peers of \u223c20\u201345% in most gait analysis experiments may be avoidable, even when minimizing deviations from able-bodied gait mechanics. Portions of this text were previously published as part of a preprint (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.biorxiv.org\/content\/10.1101\/2023.06.26.546515v2.full.pdf\">https:\/\/www.biorxiv.org\/content\/10.1101\/2023.06.26.546515v2.full.pdf<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.16756","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T03:10:27Z","timestamp":1704769827000},"page":"e16756","source":"Crossref","is-referenced-by-count":13,"title":["Transfemoral limb loss modestly increases the metabolic cost of optimal control simulations of walking"],"prefix":"10.7717","volume":"12","author":[{"given":"Ross H.","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Kinesiology, University of Maryland at College Park, College Park, MD,  United 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Center, Tacoma, WA, United States of America"},{"name":"Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences,  Bethesda, MD, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"10.7717\/peerj.16756\/ref-1","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1080\/02640419308730011","article-title":"Deformation characteristics of the heel region of the shod foot during a simulated heel strike: the effect of varying midsole hardness","volume":"11","author":"Aerts","year":"1993","journal-title":"Journal of Sports Sciences"},{"key":"10.7717\/peerj.16756\/ref-2","article-title":"A dynamic optimization solution for a complete cycle of normal gait","author":"Anderson","year":"1999","journal-title":"Doctoral 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