Research Papers

Design and Preliminary Field Validation of a Fully Passive Prosthetic Knee Mechanism for Users With Transfemoral Amputation in India

[+] Author and Article Information
V. N. Murthy Arelekatti

Department of Mechanical Engineering,
Massachusetts Institute of Technology,
Cambridge, MA 02139
e-mail: murthya@mit.edu

Amos G. Winter, V

Department of Mechanical Engineering,
Massachusetts Institute of Technology,
Cambridge, MA 02139
e-mail: awinter@mit.edu

Contributed by the Mechanisms and Robotics Committee of ASME for publication in the JOURNAL OF MECHANISMS AND ROBOTICS. Manuscript received September 20, 2015; final manuscript received December 27, 2017; published online April 5, 2018. Assoc. Editor: James Schmiedeler.

J. Mechanisms Robotics 10(3), 031007 (Apr 05, 2018) (8 pages) Paper No: JMR-15-1274; doi: 10.1115/1.4039222 History: Received September 20, 2015; Revised December 27, 2017

An estimated 230,000 above-knee amputees in India are currently in need of prosthetic devices, a majority of them facing severe socio-economic constraints. However, only a few passive prosthetic knee devices in the market have been designed for facilitation of normative gait kinematics and for meeting the specific daily life needs of above-knee amputees in the developing world. Based on the results of our past studies, this paper establishes a framework for designing a potentially low-cost, fully passive prosthetic knee device, which aims to facilitate able-bodied kinematics at a low metabolic cost. Based on a comprehensive set of functional requirements and biomechanical analysis from our past work, we present an early prototype mechanism for the prosthetic knee joint that is primarily focused on enabling able-bodied kinematics. The mechanism is implemented using two functional modules: an automatic early stance lock for stability and a differential friction damping system for late stance and swing control. For preliminary, qualitative validation of the knee mechanism, we carried out a field trial on four above-knee amputees in India, which showed satisfactory performance of the early stance lock. The prototype enabled smooth stance-to-swing transition by timely initiation of late stance flexion. Possible methods of incorporating an additional spring module for further refinement of the design are also discussed, which can enable flexion-extension during the early-stance phase of the gait cycle and potentially reduce the metabolic energy expenditure of the user further.

Copyright © 2018 by ASME
Your Session has timed out. Please sign back in to continue.


WHO, 2005, Guidelines for Training Personnel in Developing Countries for Prosthetics and Orthotics Services, World Health Organization, Geneva, Switzerland.
WHO, 2011, World Report on Disability, World Health Organization, Geneva, Switzerland.
Hamner, S. R. , Narayan, V. G. , and Donaldson, K. M. , 2013, “ Designing for Scale: Development of the ReMotion Knee for Global Emerging Markets,” Ann. Biomed. Eng., 41(9), pp. 1851–1859. [CrossRef] [PubMed]
Narang, Y. S. , 2013, “ Identification of Design Requirements for a High-Performance, Low-Cost, Passive Prosthetic Knee Through User Analysis and Dynamic Simulation,” Master's thesis, Massachusetts Institute of Technology, Cambridge, MA.
Andrysek, J. , 2010, “ Lower-Limb Prosthetic Technologies in the Developing World: A Review of Literature From 1994–2010,” Prosthet. Orthotics Int., 34(4), pp. 378–398. [CrossRef]
Cummings, D. , 1996, “ Prosthetics in the Developing World: A Review of the Literature,” Prosthet. Orthotics Int., 20(1), pp. 51–60.
Mohan, D. , 1986, “ A Report on Amputees in India,” Orthotics Prosthet., 40(1), pp. 16–32.
Narang, I. C. , Mathur, B. P. , Singh, P. , and Jape, V. S. , 1984, “ Functional Capabilities of Lower Limb Amputees,” Prosthet. Orthotics Int., 8(1), pp. 43–51.
Horgan, O. , and MacLachlan, M. , 2004, “ Psychosocial Adjustment to Lower-Limb Amputation: A Review,” Disability Rehabil., 26(14–15), pp. 837–850. [CrossRef]
Rybarczyk, B. , Nyenhuis, D. L. , Nicholas, J. J. , Cash, S. M. , and Kaiser, J. , 1995, “ Body Image, Perceived Social Stigma, and the Prediction of Psychosocial Adjustment to Leg Amputation,” Rehabil. Psychol., 40(2), p. 95. [CrossRef]
Yinusa, W. , and Ugbeye, M. , 2003, “ Problems of Amputation Surgery in a Developing Country,” Int. Orthop., 27(2), pp. 121–124. [PubMed]
Ottobock, 2014, “ Reimbursement by Product,” Ottobock, Duderstadt, Germany, accessed May 19, 2014, https://professionals.ottobockus.com/Reimbursement-by-Product
Andrysek, J. , Klejman, S. , Torres-Moreno, R. , Heim, W. , Steinnagel, B. , and Glasford, S. , 2011, “ Mobility Function of a Prosthetic Knee Joint With an Automatic Stance Phase Lock,” Prosthet. Orthotics Int., 35(2), pp. 163–170. [CrossRef]
Narang, Y. S. , Arelekatti, V. M. , and Winter, A. G. , 2016, “ The Effects of the Inertial Properties of Above-Knee Prostheses on Optimal Stiffness, Damping, and Engagement Parameters of Passive Prosthetic Knees,” ASME J. Biomech. Eng., 138(12), p. 121002. [CrossRef]
Narang, Y. S. , Arelekatti, V. M. , and Winter, A. G. , 2016, “ The Effects of Prosthesis Inertial Properties on Prosthetic Knee Moment and Hip Energetics Required to Achieve Able-Bodied Kinematics,” IEEE Trans. Neural Syst. Rehabil. Eng., 24(7), pp. 754–763. [CrossRef] [PubMed]
Narang, Y. S. , and Winter, A. G. , 2014, “ Effects of Prosthesis Mass on Hip Energetics, Prosthetic Knee Torque, and Prosthetic Knee Stiffness and Damping Parameters Required for Transfemoral Amputees to Walk With Normative Kinematics,” ASME Paper No. DETC2014-35065
Perry, J. , and Burnfield, J. M. , 2010, Gait Analysis: Normal and Pathological Function, 2nd ed., SLACK Incorporated, Thorofare, NJ.
Inman, V. T. , Ralston, H. , and Todd, F. , 1981, Human Walking, Williams & Wilkins, Baltimore, MD.
Kuo, A. D. , 2007, “ The Six Determinants of Gait and the Inverted Pendulum Analogy: A Dynamic Walking Perspective,” Hum. Mov. Sci., 26(4), pp. 617–656. [CrossRef] [PubMed]
Baker, R. , 2013, Measuring Walking: A Handbook of Clinical Gait Analysis, Mac Keith Press, London.
Donelan, J. , Kram, R. , and Kuo, A. , 2002, “ Mechanical Work for Step-to-Step Transitions is a Major Determinant of the Metabolic Cost of Human Walking,” J. Exp. Biol., 205(23), pp. 3717–3727. [PubMed]
BMVSS, 2014, “ What We Do: Above Knee Prosthesis,” Bhagwan Mahaveer Viklang Sahayata Samiti, Jaipur, India, accessed May 19, 2014, http://jaipurfoot.org/what_we_do/prosthesis/above_knee_prosthesis.html
Radcliffe, C. W. , 1994, “ Four-Bar Linkage Prosthetic Knee Mechanisms: Kinematics, Alignment and Prescription Criteria,” Prosthet. Orthotics Int., 18(3), pp. 159–173.
Winter, D. A. , 2009, Biomechanics and Motor Control of Human Movement, 4th ed., Wiley, Hoboken, NJ. [CrossRef]
Martinez-Villalpando, E. C. , and Herr, H. , 2009, “ Agonist-Antagonist Active Knee Prosthesis: A Preliminary Study in Level-Ground Walking,” J. Rehabil. Res. Dev., 46(3), pp. 361–74. [CrossRef] [PubMed]
Sup, F. , Bohara, A. , and Goldfarb, M. , 2008, “ Design and Control of a Powered Transfemoral Prosthesis,” Int. J. Rob. Res., 27(2), pp. 263–273. [CrossRef] [PubMed]
Farber, B. S. , and Jacobson, J. S. , 1995, “ An Above-Knee Prosthesis With a System of Energy Recovery: A Technical Note,” J. Rehabil. Res. Dev., 32(4), pp. 337–348. [PubMed]
Wyss, D. , 2012, “ Evaluation and Design of a Globally Applicable Rear-Locking Prosthetic Knee Mechanism,” Master's thesis, University of Toronto, Toronto, ON, Canada.
Arelekatti, V. M. , and Winter, A. G. , 2015, “ Design of a Fully Passive Prosthetic Knee Mechanism for Transfemoral Amputees in India,” IEEE International Conference on Rehabilitation Robotics (ICORR) , Singapore, Aug. 11–14, pp. 350–356.
Furse, A. , Cleghorn, W. , and Andrysek, J. , 2011, “ Development of a Low-Technology Prosthetic Swing-Phase Mechanism,” J. Med. Biol. Eng., 31(2), pp. 145–150. [CrossRef]


Grahic Jump Location
Fig. 1

Different Prosthetic knees available in the developing and developed world markets and their selling prices: (a) BMVSS (Jaipur-foot) manual-locking knee, shown fully extended and at full flexion [22]. (b) The International Committee of the Red Cross manual locking, single-axis knee, (c) Jaipur-Stanford four-bar knee joint, also used by BMVSS [3,22], (d) LCKnee designed by Andrysek et al. [13], with an automatic locking mechanism, and (e) the popular Ottobock range of quasi-passive and active, microprocessor-controlled prosthetic knees: C-leg and Genium Microprocessor-controlled knees have been widely adopted in the developed world markets and they can enable a wide range of activities and motions [12].

Grahic Jump Location
Fig. 2

Determination of optimal mechanical component coefficients for replicating able-bodied knee moment: (a) Narang et al. [15] used a rigid body model comprising the foot, ankle joint, lower leg, knee joint, and upper leg, (b) Using inverse dynamics, they predicted the spring stiffness coefficient (Kstance) and the frictional damping coefficients (Bflex and Bext) required at the knee joint for replicating able-bodied moment with R2 = 0.90 [14], and (c) the engagement-disengagement points during each gait cycle were also established as a part of this analysis for one spring and two friction dampers. Increase in the positive value of the knee angle denotes flexion (and decreasing positive value denotes extension).

Grahic Jump Location
Fig. 3

Relative position of the GRF vector and the knee. The GRF vector is posterior in early stance and late stance causing a flexion moment at the knee (clockwise direction, with respect to the upper leg frame). During mid-stance, the vector is anterior to the knee. The curved arrow depicts the direction of the net resultant moment at the knee during each stage because of the GRF vector, inertial forces, and the hip moment. The moment exerted by hip muscles and the inertial forces are not shown.

Grahic Jump Location
Fig. 4

Architecture and function of the prototype mechanism. During early stance, GRF direction (Fig. 3) causes a flexion moment at the locking axis while the lock is engaged. During mid-stance, the extension moment at the locking axis disengages the lock (as the locking element and rest of the lower leg assembly is mounted about the locking axis). During late stance, when the GRF vector passes posterior to the knee axis, late stance flexion at the unlocked knee joint can take place. During late stance flexion and early swing phase, the cam surface of the knee rotates about the knee axis and slips against the stationary brake lining, resulting in large damping torque (Bflex). During late swing extension, the brake, which is mounted on a one-way roller-clutch, also rotates along with the cam surface and provides a much lesser damping torque (Bext).

Grahic Jump Location
Fig. 5

Preliminary field evaluation: (a) subject 1 using the prototype for the 2 min walk test, (b) subject 2 during the 2 min walk test, late stance flexion of up to 40 deg can be seen, and (c) subject 2 walking comfortably outdoors on a relatively flat, muddy terrain

Grahic Jump Location
Fig. 6

The movement of the COP on the foot during stance phase of gait (as a function of time) has been determined in past studies [24]. The magnitude and direction of the GRF vector are also known through the stance phase [24]. This provides complete information about the physical location of the GRF vector as a function of time during stance phase of gait. The positioning of the locking axis (Fig. 4) is optimized in 2D space (the sagittal plane) to achieve the following: the GRF vector originating from the COP is posterior to the locking axis during early stance, keeping the knee locked. During mid-stance, the COP advances, moving the GRF vector anterior to the knee and locking axis, releasing the latch. During late stance just before toe off, the latch remains disengaged (Fig. 4), as the GRF vector moves posterior to the knee axis. This strategy can also be potentially used to enable ESF and extension.

Grahic Jump Location
Fig. 7

By incorporating an ESF axis, about which a spring is mounted for elastic early stance flexion–extension (Fig. 2), an additional module could be added to the proposed architecture of the prosthetic knee mechanism (Fig. 4). Illustration adapted with permission [29].




Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In