Fully functional leg prosthesis from a third/second century BC grave in Turfan, China
  • View of the flexed ankylosed left knee of the prosthesis owner. A, X-ray radiographic image. B, photograph of the knee. © DAI.
  • Pathological bone changes indicative of tuberculosis. A, periosteal lesions on the seventh left rib. B, necrotic lesions in combination with new bone formations on the distal surface of the fifth cervical vertebra (circa 50–65-year-old male individual). C, periostitis on the visceral surface of the third and D, fourth left rib (circa 19–20-year-old female individual). © DAI.
  • View of leg prosthesis and its details. A, drawing of the inner face (attached to the body). B, photograph of the outer face. C, detail showing the shiny outline of the knee. D, detail showing thinning of the thigh plate by rubbing over a long period. E, detail showing fastening of the hoof with a leather strap penetrating the horn tip. © DAI.
  • Reconstruction of leg prosthesis and its owner. © DAI.
  • Table 1. © DAI.
  • Table 2. © DAI.

Xiao Li 1,5, Mayke Wagner 2*, Xiaohong Wu 3, Pavel Tarasov 4, Yongbin Zhang 5, Arno Schmidt 6, Julia Gresky 2


1School of Chinese Classics Renmin University of China, 59 Zhongguancun St., Haidian District, Beijing 100872, P. R. China

2German Archaeological Institute, Im Dol 2-6, 14195 Berlin, Germany

3School of Archaeology and Museology, Peking University, 5 Baiyi Rd., Haidian District, Beijing 100871, P. R. China

4Institute of Geological Sciences, Free University, 12249 Berlin, Germany

5Turfan Academy, 224 Gaochang Rd., Turfan 838000, P. R. China

6Otto Bock HealthCare, Max-Naeder-Str. 15, 37115 Duderstadt, Germany


* Author for correspondence: Tel. 49 (030) 187711312; fax: 49 (030) 187711313.

E-mail address: mayke [dot] wagner [at] zedat [dot] fu-berlin [dot] de



‘Standing on one’s own feet’ is synonymous for self-sufficiency. An individual whose foot or lower leg is disabled or lost due to accident or disease ultimately needs cultural intervention for survival. Walking sticks or crutches are the simplest supporting tools helping to regain mobility but keeping hands occupied. The use of a functional artificial shank allows the person to lead a close-to-normal life. Therefore, the invention of a prosthesis was a great advance in medical engineering. Indirect textual evidences, e.g. the Hegesistratus story recorded by Herodotus (484–425 BC) about an artificial wooden foot1,2, suggest that foot prostheses were already known in the Graeco-Roman world in the fifth century BC3. The oldest prosthesis of a big toe was found in Thebes, Egypt and dated around 950–710 BC.4

So far the oldest preserved leg-prosthesis assigned to a man’s skeleton with his right leg missing from the mid-calf was discovered in Capua, Italy, in 1885 and dated to circa 300 BC.1 The ‘Capua leg’ had a wooden core and luxurious bronze sheeting, indicating the owner’s wealthy status. Its functionality has remained uncertain, as the device was lost during the Second World War.1,2

In China, historical texts report foot or leg amputation as one of the “five punishments” from the late second millennium BC onwards and bronze figurines of an invalid with an amputated lower limb are dated to circa 900 BC.5 However, neither depictions nor preserved examples of prosthetic devices or skeletons with healed amputations have been reported to date.

Midway between the Graeco-Roman and Chinese worlds a wooden peg-leg was excavated near Turfan in the Uygur Autonomous Region Xinjiang, China. The current study discusses the construction details, wear, and absolute age of the prosthesis and pathological changes in the skeletal remains of its user.


Grave setting and archaeological context

The Shengjindian graveyard is situated about 35 km east of modern Turfan city on the upper terrace, which belongs to the valley crossing the ‘Flame Mountains’ in the eastern part of Tian Shan. In total, 31 tombs were excavated there in 2006-2008. The current study is focused on the tomb 2007TSM2 (M2), which contained the wooden peg-leg and the well preserved skeleton of its user found in a side chamber. Another well preserved skeleton was found in a 110 cm deep vertical shaft. Based on the morphology of skull and pelvis6 these two individuals were a man and a woman. Signs of a secondary opening indicate that the tomb was constructed primarily for the man, and the woman was interred later. Partially displaced or missing small bones of the man’s skeleton likely resulted from this later opening. Construction of the tomb and grave goods match the general features of the whole graveyard and indicate its commoner status.

The whole graveyard belongs to the Subeixi (Subeshi) culture, which is associated with the Cheshi (Chü-shih) state known from Chinese historical sources.7 Archaeological and historical data attest it as a complex society with a developed agro-pastoral economy, which existed in the Turfan Basin during the 1st millennium BC.8 For reliable age determination three samples from the peg-leg and six other wood and human bone samples representing tomb M2 were submitted to the Radiocarbon Dating Laboratory at Peking University. All dates overlap within a 95% confidence range from 2190 to 2130 BP, suggesting the tomb was most probably constructed circa 240–180 BC.


The peg-leg owner

Anthropological investigation of cranial sutures of the skull, symphyseal pubis morphology and tooth wear7 indicated a 50–65-year-old man, who was circa 170–178 cm tall, calculated from the length of his long bongs.9 His left knee joint (figure 1, A) showed complete bony fusion of femur, patella, fibula, and tibia, i.e. osseous ankylosis with fixation at 135° flexion and 11° internal rotation. Different causes like inflammation in or around the joint, rheumatism or trauma might have resulted in this pathological change. Inspection using X-ray images (figure 1, B) and computed tomography supported the elimination of fracture or other mechanical trauma. In the case of rheumatoid arthritis, more joints should be affected, but none of the others showed comparable lesions. Osseous ankylosis caused by inflammatory processes10,11 is often due to infection with either Mycobacterium tuberculosis or Mycobacterium bovis, both members of the M. tuberculosis complex.10,12 Apart from the ankylosed knee joint, periostitis on the visceral surface of the ribs as a palaeopathological indication of pulmonary tuberculosis13,14 has been observed on ribs two to eleven (figure 2, A). Necrotic lesions in combination with new bone formations between the fifth and sixth cervical vertebra (figure 2 B) probably indicate skeletal tuberculosis infection.16 Lesions of the left third and fourth among other ribs of the 19–20-year-old woman from the same grave (figure 2 C,D) suggest another possible case of tuberculosis.

The smooth surface of the bones affected by the ankylosis suggests the active inflammatory process stopped years before death. The measurements of the midshafts of femur and tibia16 show almost no bone loss on the affected side, suggesting that the invalidity most probably occurred when the man was 40–50 years old.

CT scans and radiograph allow the reconstruction of bone formation processes from bone remodelling within the inner structure of the bone, followed by depletion of the normal load lines of the bone and finally reduction of trabecular bone because the leg was not used for walking any more. The high degree of flexion of the lower limb made standing and walking on it unfeasible and horseback riding would have been greatly hindered due to the internal rotation. The wooden peg-leg supported walking and active lifestyle until death, as indicated by pronounced muscle attachment sites on all bones.


Characteristics of the peg-leg

The device (figure 3, A,B) consists of a flat, lateral thigh-plate stabilizer and a round distal peg made in one piece from soft wood; robust horn to reinforce the tip of the peg; and a hoof as sink resistance like a basket on ski poles. One side of the thigh plate clearly shows the outline of the knee (figure 3, C) and substantial thinning of the plate in its lower part (figure 3, D) as a result of long-term rubbing. The surface of the outer side is dark and rough except for the shiny top-end indicating covering by garment, indicating that the peg-leg was fastened to the outside of the left leg.

The top end of the thigh plate has two holes with straight upward friction grooves likely accommodating a waist strap. The other six lateral holes on each side served to fasten it around the thigh. Some holes show remains of chisel-cut marks smoothed over time by the leather straps. Preserved straps and deep downward friction marks on both the outer and inner faces allow the principal way of fastening to be reconstructed as follows. A single short strap was run through two neighbouring holes, both ends coming out on the inside of the plate. One end was sliced in two, the other had a cut eyelet and linked up with a strap or button fixed to a thigh casing. In this way the stabilizer was fastened to the thigh at six stable fixation points.

The distal peg end was forced into a straightened goat/sheep horn. Its pointed front side is bevelled from dragging over hard ground (figure 3, E). A horse/donkey hoof was pulled over the horn and secured in place with a leather strap run through a horizontally drilled hole penetrating the horn.



The shank of the man from Shengjindian was not amputated, but fully disabled. The peg-leg, which replaced the disabled limb, therefore deserves to be termed a ‘prosthesis’. The above mentioned Capua prosthesis was missing a thigh apparatus for secure fastening. Optically more than functionally it restored the user’s physical integrity when sitting on a chair or riding a horse.1 The prosthesis found in the commoner’s tomb from Shengjindian is neither elegant nor made of precious materials. However, it is unique in terms of technical design, robustness and functionality. Except that no stump was accommodated in the Turfan peg-leg and a horn plus horse/donkey shoe were used instead of iron for reinforcement of the tip, the ancient device resembles the industrially manufactured or home-made leg prosthetics used two thousand years later.2

The pathological changes in skeletal remains reported here add to our knowledge of tuberculosis history.15 Asian records of tuberculosis are still rare.17 Together with our results, M. tuberculosis DNA identified in adult and child skeletons from the wealthy graveyard (202 BC–200 AD) near Turfan18, the first century BC case of spinal tuberculosis from Korea19, and M. bovis identification in human remains from south Siberia dated to 360–170 BC20 show a wider frontier of disease. Known for the increase in residential mobility and the spread of complex pastoralism and mounted warfare in Eurasia, the first millennium BC therefore seems to be crucial for the spread of tuberculosis in East Asia.



1          Bliquez L. Prosthetics in Classical Antiquity: Greek, Etruscan, and Roman Prosthetics. In: Haase W, ed. Rise and decline of the Roman world II. Berlin: Walter de Gruyter, 1996: 2640–76.

2          Knoche W. Prothesen der Unteren Extremität - Die Entwicklung vom Altertum bis 1930. Dortmund: Bundesfachschule für Orthopädie-Technik, 2006.

3          Finch J. The ancient origins of prosthetic medicine. Lancet 2011; 377: 548–49.

4          Nerlich AG, Zink A, Szeimies U, Hagedorn HG. Ancient Egyptian prosthesis of the big toe. Lancet 2000; 356: 2176–79.

5          Shaughnessy EL. Bronze fangding vessel. In: Yang XN, ed. The Golden Age of Chinese Archaeology. Washington: National Gallery of Art, 1999: 246–47.

6          Ferembach D, Schwidetzky I, Stloukal M. Recommendations for age and sex diagnosis of skeletons. J. Hum. Evol. 1980; 9: 517–49.

7          Sinor D, ed. The Cambridge History of Early Inner Asia. Cambridge: Cambridge University Press, 1990.

8          Mallory JP, Mair VH. The Tarim Mummies. London: Thames & Hudson, 2000.

9          Černý M, Komenda S. Reconstruction of body height based on humerus and femur lengths (material from Czech lands). Second Anthropological congress of Hrdlička A, ed. Praha: Univerzita Karlova, 1982: 475–79.

10        Kim YH, Kim JS, Cho SH. Total knee arthroplasty after spontaneous osseous ankylosis and takedown of formal knee fusion. J. Arthroplasty. 2000; 15: 453–60.

11        Bae DK, Yoon KH, Kim HS, Song SJ. Total knee arthroplasty in stiff knees after previous infection. J. Bone Joint Surg Br. 2005; 87: 333–36.

12        Teklali Y, El Alami ZF, El Madhi T, Gourinda H, Miri A. Peripheral osteoarticular tuberculosis in children: 106 case-reports. Joint Bone Spine 2003; 70: 282–86.

13        Pfeiffer S. Rib lesions and New World tuberculosis. Int. J. Osteoarch. 1991; 1: 191–98.

14       Roberts C, Boylston A, Buckley L, Chamberlain A, Murphy E. Rib lesions and tuberculosis: the palaeopathological evidence. Tuber Lung Dis 1998; 79: 55–60.

15        Pálfi G, Dutour O, Deák J, Hutás I, eds. Tuberculosis past and present. Budapest: Golden Books/Tuberculosis Foundation, 1999.

16        Martin R, Saller K. Lehrbuch der Anthropologie. Stuttgart: Gustav Fischer Verlag, 1957.

17        Pechenkina EA, Benfer RA Jr, Ma XL. Diet and Health in the Neolithic of the Wei and Middle Yellow River Basins, Northern China. In: Cohen MN, Crane-Kramer G, eds. Ancient health: Skeletal indicators of agricultural and economic intensification. Gainesville: University Press of Florida, 2007: 255-72.

18        Fusegawa H, Wang BH, Sakurai K, Nagasawa K, Okauchi M, Nagakura K. Outbreak of tuberculosis in a 2000-year-old Chinese population. Kansenshogaku Zasshi 2003; 77: 146-49.

19        Suzuki T, Fujita H, Choi JG. Brief communication: new evidence of tuberculosis from prehistoric Korea-Population movement and early evidence of tuberculosis in far East Asia. Am. J. Phys. Anthropol. 2008; 136: 357-60.

20        Taylor GM, Murphy E, Hopkins R, Rutland P, Chitov Y. First report of Mycobacterium bovis DNA in human remains from the Iron Age. Microbiol. 2007; 153: 1243–49.



For a more comprehensive version of this article see: doi:10.1016/j.quaint.2012.05.010


LI Xiao et al.

How to cite this page:

Bridging Eurasia , September 2014 , bridging-eurasia.org/en/node/337
Accessed:22 February, 2018 - 01:42