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Vilela M, Hochberg LR. Applications of brain-computer interfaces to the control of robotic and prosthetic arms. HANDBOOK OF CLINICAL NEUROLOGY 2020; 168:87-99. [PMID: 32164870 DOI: 10.1016/b978-0-444-63934-9.00008-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Brain-computer interfaces (BCIs) have the potential to improve the quality of life of individuals with severe motor disabilities. BCIs capture the user's brain activity and translate it into commands for the control of an effector, such as a computer cursor, robotic limb, or functional electrical stimulation device. Full dexterous manipulation of robotic and prosthetic arms via a BCI system has been a challenge because of the inherent need to decode high dimensional and preferably real-time control commands from the user's neural activity. Nevertheless, such functionality is fundamental if BCI-controlled robotic or prosthetic limbs are to be used for daily activities. In this chapter, we review how this challenge has been addressed by BCI researchers and how new solutions may improve the BCI user experience with robotic effectors.
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Wang Z, Fang Y, Zhou D, Li K, Cointet C, Liu H. Ultrasonography and electromyography based hand motion intention recognition for a trans-radial amputee: A case study. Med Eng Phys 2019; 75:45-48. [PMID: 31866120 DOI: 10.1016/j.medengphy.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/25/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022]
Abstract
Surface electromyography (sEMG) has dominated upper-limb prosthesis control for decades due to its simplicity and effectiveness [1-3]. However, the inherent variability of EMG signal hinders the flexible and accurate control of advanced multi-functional prosthesis. This study is an attempt to use ultrasonography (US) as an alternative for prosthetic hand control. A type of multi-sensory module, comprising a single-element ultrasound channel and one sEMG bipolar channel, is customised to ensure a fair comparison between these two modalities. Three machine-learning-oriented approaches were adopted to evaluate the performance in motion classification based on datasets captured from a trans-radial amputee. The experimental results demonstrated that the ultrasound outperformed the sEMG in random (98.9% vs 70.4%) and enhanced-trial-wise (74.10% vs 61.83%) cross-validation, but fell behind the sEMG in trial-wise (39.47% vs 58.04%) validation that is the closest comparison to a real life prosthetic control. This study preliminarily implies that 1) A-mode ultrasound signal can be more stable than the sEMG with minimum electrode shift, but more sensitive to external interference than the sEMG; and 2) to maintain high classification accuracy, US approach may require harsher electrode fixing mechanism or advanced on-line calibration approach.
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Brunelli S, Sancesario A, Iosa M, Delussu A, Gentileschi N, Bonanni C, Foti C, Traballesi M. Which is the Best Way to Perform the Physiological Cost Index in Active Individuals With Unilateral Trans-Tibial Amputation? CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2019; 2:32953. [PMID: 37614807 PMCID: PMC10443476 DOI: 10.33137/cpoj.v2i1.32953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Physiological Cost Index (PCI) is a simple method used to estimate energy expenditure during walking. It is based on a ratio between heart rate and self-selected walking speed. Previous studies reported that PCI is reliable in individuals with lower limb amputation but only if there is an important walking impairment. No previous studies have investigated the correlation of PCI with the Energy Cost Walking (ECW) in active individuals with traumatic unilateral trans-tibial amputation, considering that this particular category of amputees has an ECW quite similar to healthy individual without lower limb amputation. Moreover, it is important to determine if PCI is also correlated to ECW in the treadmill test so as to have an alternative to over-ground test. OBJECTIVES The aim of this study was to evaluate the correlation between PCI and ECW in active individuals with traumatic trans-tibial amputation in different walking conditions. The secondary aim was to evaluate if this correlation permits to determine ECW from PCI values. METHODOLOGY Ninety traumatic amputees were enrolled. Metabolic data, heart rate and walking speed for the calculation of ECW and for PCI were computed over-ground and on a treadmill with 0% and 12% slopes during a 6-minute walking test. FINDINGS There is a significant correlation between ECW and PCI walking over-ground (p=0.003; R2=0.10) and on treadmill with 12% slopes (p=0.001; R2=0.11) but there is only a poor to moderate correlation around the trendline. No significant correlation was found walking on treadmill with 0% slope. The Bland-Altman plot analysis suggests that is not possible to evaluate ECW directly from PCI. CONCLUSIONS PCI is a reliable alternative measure of energy expenditure during walking in active individuals with trans-tibial amputation when performing over-ground or at high intensity effort on treadmill. PCI is therefore useful only for monitoring a within subject assessment.
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Farmakis IIK, Potsika VT, Smyris AF, Gelalis ID, Fotiadis DI, Pakos EE. A biomechanical study of the effect of weight loading conditions on the mechanical environment of the hip joint endo prosthesis. Clin Biomech (Bristol, Avon) 2019; 70:197-202. [PMID: 31655450 DOI: 10.1016/j.clinbiomech.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total hip arthroplasty is one of the most successful orthopedic surgical procedures aiming to eliminate pain related to several types of hip arthritis and restore mobility. Obesity has been associated with an increased risk of complications after a total hip arthroplasty such as poor wound healing, periprosthetic joint infection, instability, and aseptic loosening. METHODS This paper presents an in-vitro study on composite femoral models to investigate the impact of different weight loading conditions on the mechanical environment of the hip joint endoprosthesis considering normal-weight and overweight individuals from 70 to 110 kg. The micro strains on the femur during single-leg stance of gait were measured on critical stress points based on the Gruen femoral zones. FINDINGS The micro strains increase as the weight increases implying that the displacement in the hip joint endoprosthesis is higher for overweight subjects enhancing the risk of failure. The highest increase was measured in Gruen zone 1 by 5.60% indicating that the great trochanter is subjected to higher stress shielding with increasing the weight. Also, the statistically significant increase of the micro strain values with increasing the weight in Gruen Zones 3 (2.91%), 5 (1.56%), and 11 (1.75%) may enhance the risk for a periprosthetic fracture at the lower region of the prosthesis. INTERPRETATION This is the first biomechanical study which quantifies the effect of increasing weight loading conditions on the mechanical environment of the hip joint endoprosthesis considering different positions of evaluation.
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Xu J, Rao Y, Wu X, Jiang J, Yu M, Chen X, Wang H. The osteoinductive effect of nano-nacre particles on MC-3T3 E1 preosteoblast through controlled release of water soluble matrix and calciumions. Dent Mater J 2019; 38:981-986. [PMID: 31178546 DOI: 10.4012/dmj.2018-270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prostheses and implants have been widely utilized in the orthopedic and dental fields. Nowadays, significant advances have been made in the structural and functional connection between living bone and prostheses, especially in the presence of compromised bone quantity/quality. Despite improvement in the treatment outcomes after augmentation, there are still challenges to meet the clinical demands due to limited materials available. In the current study, we investigated the effects of nano-nacre particles as an alternative material on stimulating bone cell differentiation and formation. Mouse osteoblastic cells (MC3T3-E1) were cultured on nano-nacre/type I collagen composite scaffold (NN-ICS) and type I collagen scaffold (ICS). Generated nano-nacre particles showed controlled release of protein and calcium for a period of 36 days. NN-ICS significantly contributed to the proliferation and differentiation of preosteoblasts compared to ICS controls. Our data showed that nano-nacre particles could serve as a candidate of bone substitution material, which potentially contributed to treatment outcomes in cases with compromised bone quality and/or quality.
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Chang HW, Kim WS, Ahn JH, Carriere KC, Jeong DS, Cho YH, Sung K, Park PW. Late clinical outcomes of aortic valve replacement with Carpentier-Edwards pericardial valves. J Thorac Dis 2019; 11:5372-5381. [PMID: 32030255 DOI: 10.21037/jtd.2019.11.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The present study aimed to compare the long-term clinical and hemodynamic outcomes of aortic valve replacement using Carpentier-Edwards Perimount (Perimount) or Perimount Magna (Magna) valves. Methods We enrolled 430 patients who underwent aortic valve replacements with Perimount (n=58) or Magna (n=372) valves [1998-2013]. Multivariable and inverse probability of treatment weight (IPTW) analyses were performed. Results Before IPTW analysis, the overall 8-year survival rate differed significantly between the groups [Perimount 90%±4% vs. Magna 76%±4%; P=0.02; hazard ratio (HR): 0.37 for the Perimount group; 95% confidence interval (CI): 0.17-0.83]. Multivariable analysis of the overall survival identified Perimount valve use as a protective factor (P=0.009; HR: 0.32; 95% CI: 0.14-0.75). Independent risk factors of overall survival were older age, male sex, higher preoperative left ventricular mass index, lower ejection fraction, lower aortic valve pressure gradient, and lower haemoglobin. After applying IPTW, overall survival was again found to be significantly longer in the Perimount group (P=0.04; HR: 0.43; 95% CI: 0.20-0.93). Event-free survival was also better in the Perimount group (P=0.006; HR: 0.38; 95% CI: 0.19-0.75). However, the Magna group had significantly lower aortic valve pressure gradients at one year and five years postoperative. Conclusions Although Magna use led to decreased aortic valve pressure gradients at follow-up, overall and event-free survival rates were significantly better with use of the Perimount valve. Additional and larger studies are needed to confirm these results.
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Cui H, Zhang L, Wei S, Jiang S. Early clinical outcomes of simple pannus removal for mechanical aortic valve stenosis. J Cardiothorac Surg 2019; 14:203. [PMID: 31775823 PMCID: PMC6880563 DOI: 10.1186/s13019-019-1022-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study aimed to confirm the safety and feasibility of simple pannus removal in patients with mechanical aortic valve dysfunction for pannus overgrowth by evaluating its early clinical outcomes. METHODS From March 2015 to April 2019, 24 consecutive patients with mechanical aortic valve dysfunction due to subaortic pannus underwent reoperation. In 12 patients the repeat aortic valve replacement (AVR) was performed, and 12 received the simple pannus removal to preserve the previously implanted prosthesis. RESULTS There was only 1 in-hospital death in simple pannus removal group. Significant differences were obtained between procedures in cardiopulmonary bypass (CPB) and aortic cross-clamp time (128.7 vs 179.7 and 74.2 vs 132.7 mins, respectively, P < 0.05). The C-reactive protein (CRP) in simple pannus removal group was lower on the first day (0.13 ± 0.09 vs 0.31 ± 0.22 mg/dl, P < 0.05) and continued to be lower within 1 week after operation. There was no significant difference between procedures in aortic transvalvular peak velocity and transvalvular mean pressure gradient (TMPG) (2.6 ± 0.4 vs 2.5 ± 0.4 m/s and 13.2 ± 3.6 vs 11.6 ± 2.6 mmHg, respectively, P > 0.05) in echocardiography 1 week after operation. In addition, the aortic transvalvular peak velocity and TMPG in echocardiography 1 week after operation in pannus removal group between the repeat and initial surgery were not statistically significant (2.6 ± 0.4 vs. 2.5 ± 0.3 m/s, 13.2 ± 3.6 vs. 13.0 ± 3.5 mmHg, P > 0.05). CONCLUSIONS Simple pannus removal was a safe and effective procedure with satisfied early clinical outcomes for pannus overgrowth in mechanical aortic valve. However, further randomized and long-term follow-up studies were warranted to determine the clinical effects of the simple aortic pannus removal.
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Realizing Efficient EMG-Based Prosthetic Control Strategy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019. [PMID: 31729675 DOI: 10.1007/978-981-13-2050-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
As an integral part of the body, the limb poses dexterous and fine motor grasping and sensing capabilities that enable humans to effectively communicate with their environment during activities of daily living (ADL). Hence, limb loss severely limits individuals' ability especially when they need to perform tasks requiring their limb functions during ADL, thus leading to decreased quality of life. To effectively restore limb functions in amputees, the advanced prostheses that are controlled by electromyography (EMG) signal have been widely investigated and used. Since EMG signals reflect neural activity, they would contain information on the muscle activation related to limb motions. Pattern recognition-based myoelectric control is an important branch of the EMG-based prosthetic control. And the EMG-based prosthetic control theoretically supports multiple degrees of freedom movements that allows amputees to intuitively manipulate the device. This chapter focuses on EMG-based prosthetic control strategy that involves utilizing intelligent computational technique to decode upper limb movement intentions from which control commands are derived. Additionally, different techniques/methods for improving the overall performance of EMG-based prostheses control strategy were introduced and discussed in this chapter.
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Milazzo M, Muyshondt PGG, Carstensen J, Dirckx JJJ, Danti S, Buehler MJ. De novo topology optimization of total ossicular replacement prostheses. J Mech Behav Biomed Mater 2019; 103:103541. [PMID: 31786510 DOI: 10.1016/j.jmbbm.2019.103541] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022]
Abstract
Conductive hearing loss, due to middle ear pathologies or traumas, affects more than 5% of the population worldwide. Passive prostheses to replace the ossicular chain mainly rely on piston-like titanium and/or hydroxyapatite devices, which in the long term suffer from extrusion. Although the basic shape of such devices always consists of a base for contact with the eardrum and a stem to have mechanical connection with the residual bony structures, a plethora of topologies have been proposed, mainly to help surgical positioning. In this work, we optimize the topology of a total ossicular replacement prosthesis, by maximizing the global stiffness and under the smallest possible volume constraint that ensures material continuity. This investigation optimizes the prosthesis topology in response to static displacement loads with amplitudes that normally occur during sound stimulation in a frequency range between 100 Hz and 10 kHz. Following earlier studies, we discuss how the presence and arrangement of holes on the surface of the prosthesis plate in contact with the umbo affect the overall geometry. Finally, we validate the designs through a finite-element model, in which we assess the prosthesis performance upon dynamic sound pressure loads by considering four different constitutive materials: titanium, cortical bone, silk, and collagen/hydroxyapatite. The results show that the selected prostheses present, almost independently of their constitutive material, a vibroacustic behavior close to that of the native ossicular chain, with a slight almost constant positive shift that reaches a maximum of ≈5 dB close to 1 kHz. This work represents a reference for the development of a new generation of middle ear prostheses with non-conventional topologies for fabrication via additive manufacturing technologies or ultraprecision machining in order to create patient-specific devices to recover from conductive hearing loss.
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Rattanaprichavej P, Laoruengthana A, Rasamimogkol S, Varakornpipat P, Reosanguanwong K, Pongpirul K. The Effect of Prosthesis Design on Blood Loss in Simultaneous Bilateral Total Knee Arthroplasty: Closed-Box versus Open-Box Prosthesis. Clin Orthop Surg 2019; 11:409-415. [PMID: 31788163 PMCID: PMC6867911 DOI: 10.4055/cios.2019.11.4.409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/25/2019] [Indexed: 01/13/2023] Open
Abstract
Background Various pre- and perioperative risk factors have been reported in association with blood loss in knee arthroplasty. However, the effect of the uncovered cancellous surface on blood loss in simultaneous bilateral total knee arthroplasty (SBTKA) by different prosthetic designs is not well elucidated. Therefore, this study aimed to compare the blood loss and transfusion rate between different knee prostheses in SBTKA and to identify risk factors that influence blood loss and transfusion after SBTKA. Methods Demographic and perioperative data of patients who underwent SBTKA using either a closed-box or an open-box femoral component of posterior-stabilized fixed-bearing (PS FB) knee system were retrospectively reviewed. The calculated blood loss (CBL) and blood transfusion rate were compared by using Student t-test and confirmed with multivariate regression analysis. Results There was no significant difference in preoperative parameters between 54 closed-box and 56 open-box PS FB TKAs. The CBL of the closed-box TKA group was 135.23 mL less (95% confidence interval [CI], −215.30 to −55.16; p = 0.001) than that of the open-box TKA group. However, the blood transfusion rates of the closed- and open-box TKA groups were not significantly different (24.1% and 38.5%, p = 0.11). For each additional minute of total operative time, 3.75 mL (95% CI, 1.75 to 5.76; p < 0.001) of blood loss was anticipated. For each additional mg/dL of preoperative hemoglobin, 71% (p < 0.001) reduction of blood transfusion probability was predicted. Conclusions The use of closed- and open-box knee prostheses resulted in a significant difference in blood loss in SBTKA. Prolonged operative time also significantly increased CBL. Therefore, strategies to control the bleeding surface and shorten operative duration may be considered if blood loss is of special concern. The preoperative hemoglobin was the only factor that affects the probability of blood transfusion in SBTKA.
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Alvial P, Bravo G, Bustos MP, Moreno G, Alfaro R, Cancino R, Zagal JC. Quantitative functional evaluation of a 3D-printed silicone-embedded prosthesis for partial hand amputation: A case report. J Hand Ther 2019; 31:129-136. [PMID: 29196160 DOI: 10.1016/j.jht.2017.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 08/29/2017] [Accepted: 10/03/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A male patient with partial hand amputation of his nondominant hand, with only stumps of the proximal phalanx of the first and fifth finger, was evaluated. The performance of using two alternative 3D printed silicone-embedded personalized prostheses was evaluated using the quantitative Jebsen Hand Function Test. INTRODUCTION Custom design and fabrication of 3D printed prostheses appears to be a good technique for improving the clinical treatment of patients with partial hand amputations. Despite its importance the literature shows an absence of studies reporting on quantitative functional evaluations of 3D printed hand prostheses. PURPOSE OF THE STUDY We aim at producing the first quantitative assessment of the impact of using 3D printed silicone-embedded prostheses that can be fabricated and customized within the clinical environment. METHODS Alginate molds and computed tomographic scans were taken from the patient's hand. Each candidate prosthesis was modeled in Computer Aided Design software and then fabricated using a combination of 3D printed parts and silicone-embedded components. DISCUSSION Incorporating the patient's feedback during the design loop was very important for obtaining a good aid on his work activities. Although the explored patient-centered design process still requires a multidisciplinary team, functional benefits are large. CONCLUSION(S) Quantitative data demonstrates better hand performance when using 3D printed silicone-embedded prosthesis vs not using any aid. The patient accomplished complex tasks such as driving a nail and opening plastic bags. This was impossible without the aid of produced prosthesis.
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Frossard L, Ferrada L, Berg D. Survey data on the quality of life of consumers fitted with osseointegrated fixation and bone-anchored limb prostheses provided by government organization. Data Brief 2019; 26:104536. [PMID: 31667297 PMCID: PMC6811965 DOI: 10.1016/j.dib.2019.104536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/21/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022] Open
Abstract
The data in this paper are related to the research article entitled “Development of a government continuous quality improvement procedure for assessing the provision of bone anchored limb prosthesis: A process re-design descriptive study” (Frossard et al., Canadian Prosthetics & Orthotics Journal, 2018. 1(2). p. 1–14). This article contains quality of life data experienced by individuals before and after implantation of a press-fit or screw-type osseointegrated fixation when fitted with conventional socket-suspended and bone-anchored limb prosthesis, respectively. This specifically-designed survey was developed and administered by Queensland Artificial Limb Services (QALS), an Australian State government organization. It was an integrated part of QALS′ continuous quality improvement procedure for assessing the provision of bone-anchored prosthesis. A total of 12 out of the 65 consumers completed to the survey, giving a return rate of 18%. This benchmark information can contribute to inform the design of (A) other patients' experience surveys including those built-in governmental continuous quality improvement procedure as well as (B) clinical trials looking at the overall effects of surgical implantation of ossoeintegrated fixation on patients' quality of life. Online repository contains the files: https://data.mendeley.com/datasets/bkbxxmrhfh/1.
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Saint-Surin I, Roman T, Touzet-Roumazeille S, Ferri J, Lauwers L. Implant-borne rehabilitation for alveolar dental cleft: Retrospective analysis of thirty-nine cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:339-343. [PMID: 31672683 DOI: 10.1016/j.jormas.2019.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dental rehabilitation of patients with alveolar-dental cleft sequelae is a crucial issue in the final stages of functional and aesthetic management of these patients. The objectives of this study are to establish the success of implant-supported rehabilitations for patients with alveolar dental cleft sequelae followed in the Department of Maxillofacial Surgery and Stomatology of Lille University Hospital and the reasons for not using this type of rehabilitation for others. MATERIALS AND METHOD Patients treated between January 2009 and December 2018 with implant-supported prostheses at an alveolar dental cleft site were included. Dental implants were placed after a complementary alveolar bone graft. Clinical and radiological criteria regarding periodontal, occlusal and prosthetic status were studied. RESULTS A total of 12 implants in 8 patients were placed. One of these implants was lost, resulting in an implant survival rate of 91.7%. All patients were able to benefit from functional rehabilitation. DISCUSSION The present results demonstrate the interest and reliability of implant rehabilitation in these patients. They furthermore highlight financial factors as a barrier to using this solution among the majority of patients in care.
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Tartaglia GM, Farronato M, Sforza C, Bidra AS. Implant-Supported Immediately Loaded Complete Arch Rehabilitations with a Mean Follow-up of 10 Years: A Prospective Clinical Study. J Prosthodont 2019; 28:951-957. [PMID: 31630472 DOI: 10.1111/jopr.13116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the complication-free and failure-free survival rates of porcelain fused to zirconia (PFZ) and all-resin complete arch fixed implant-supported prostheses over a mean follow-up of 10 years. MATERIAL AND METHODS Subjects with either all-resin or PFZ complete arch fixed implant-supported prostheses on 4 or 6 implants were followed prospectively for 10 years. Cumulative survival rates of prostheses without any catastrophic mechanical complications (resolved without replacing the prosthesis) and free of prosthesis failure (requiring the replacement or removal of the prosthesis) were calculated using life table analysis for up to 10-year period. Additional descriptive variables for various prosthesis events were recorded, such as sex, smoking and drinking status of subjects. RESULTS A total of 36 subjects with a total of 68 prostheses (53 all-resin and 15 PFZ) were available for evaluation with a mean follow-up of 10 years (SD 1.47; range: 8-13 years). The study registered an overall 90% prostheses survival rate-78% for males and 94% for females; 91% for PFZ and 87% for all-resin; and a 31% complication-free prosthesis survival rate-13% for males and 38% for females; 29% for PFZ and 31% for all-resin at 10 years. A slight decrease in survival rate was identified in the first 3 years since the initial treatment (from 100% to 93%). The number of complications increased with time, especially after the 6th year after the initial treatment. CONCLUSION Despite the number of reparable mechanical complications, the results confirmed the long-lasting features of both PFZ and all-resin complete arch fixed implant-supported prostheses over a 10-year period. There was however an increased number of mechanical complications after 6 years which may entail additional treatment cost for patients.
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Devaraj H, Aw KC, McDaid AJ. Review of functional materials for potential use as wearable infection sensors in limb prostheses. Biomed Eng Lett 2019; 10:43-61. [PMID: 32175129 DOI: 10.1007/s13534-019-00132-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/30/2019] [Accepted: 09/17/2019] [Indexed: 12/31/2022] Open
Abstract
The fundamental goal of prosthesis is to achieve optimal levels of performance and enhance the quality of life of amputees. Socket type prostheses have been widely employed despite their known drawbacks. More recently, the advent of osseointegrated prostheses have demonstrated potential to be a better alternative to socket prosthesis eliminating most of the drawbacks of the latter. However, both socket and osseointegrated limb prostheses are prone to superficial infections during use. Infection prone skin lesions from frictional rubbing of the socket against the soft tissue are a known problem of socket type prosthesis. Osseointegration, on the other hand, results in an open wound at the implant-stump interface. The integration of infection sensors in prostheses to detect and prevent infections is proposed to enhance quality of life of amputees. Pathogenic volatiles having been identified to be a potent stimulus, this paper reviews the current techniques in the field of infection sensing, specifically focusing on identifying portable and flexible sensors with potential to be integrated into prosthesis designs. Various sensor architectures including but not limited to sensors fabricated from conducting polymers, carbon polymer composites, metal oxide semiconductors, metal organic frameworks, hydrogels and synthetic oligomers are reviewed. The challenges and their potential integration pathways that can enhance the possibilities of integrating these sensors into prosthesis designs are analysed.
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A Comparison of Mental Workload in Individuals with Transtibial and Transfemoral Lower Limb Loss during Dual-Task Walking under Varying Demand. J Int Neuropsychol Soc 2019; 25:985-997. [PMID: 31462338 DOI: 10.1017/s1355617719000602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to evaluate the influence of lower limb loss (LL) on mental workload by assessing neurocognitive measures in individuals with unilateral transtibial (TT) versus those with transfemoral (TF) LL while dual-task walking under varying cognitive demand. METHODS Electroencephalography (EEG) was recorded as participants performed a task of varying cognitive demand while being seated or walking (i.e., varying physical demand). RESULTS The findings revealed both groups of participants (TT LL vs. TF LL) exhibited a similar EEG theta synchrony response as either the cognitive or the physical demand increased. Also, while individuals with TT LL maintained similar performance on the cognitive task during seated and walking conditions, those with TF LL exhibited performance decrements (slower response times) on the cognitive task during the walking in comparison to the seated conditions. Furthermore, those with TF LL neither exhibited regional differences in EEG low-alpha power while walking, nor EEG high-alpha desynchrony as a function of cognitive task difficulty while walking. This lack of alpha modulation coincided with no elevation of theta/alpha ratio power as a function of cognitive task difficulty in the TF LL group. CONCLUSIONS This work suggests that both groups share some common but also different neurocognitive features during dual-task walking. Although all participants were able to recruit neural mechanisms critical for the maintenance of cognitive-motor performance under elevated cognitive or physical demands, the observed differences indicate that walking with a prosthesis, while concurrently performing a cognitive task, imposes additional cognitive demand in individuals with more proximal levels of amputation.
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Migliorini F, Eschweiler J, Niewiera M, El Mansy Y, Tingart M, Rath B. Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg 2019; 139:1445-1454. [PMID: 31367842 DOI: 10.1007/s00402-019-03246-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a feasible and cost-effective procedure. However, resurfacing of the patella sparks a heated debate. Anterior knee pain after TKA was supposed to be correlated to the patellofemoral joint, and the resurface of the patella was believed to be effective to avoid this complication. AIM A meta-analysis was performed to update current evidence concerning the outcomes of patellar resurfacing versus retaining for total knee arthroplasty. The first outcomes of interest were to compare the rate of anterior knee pain and revision surgeries. MATERIAL AND METHODS This study was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). A comprehensive review of the literature was conducted accessing the main databases: Embase, Google Scholar, PubMed, Scopus. All the prospective clinical trials comparing the outcomes between patellar resurfacing versus retaining were included in this study. Only articles classified as level of evidence I to II were considered for inclusion. Only studies reporting a minimum 24 months follow-up were included. The following data were extracted: demographic baseline, anterior knee pain, reoperations, clinical scores (HSS, KSS and related subscales) and range of motion (ROM). Studies solely reporting quantitative data under the outcomes of interest were included. RESULTS In favor of the resurfacing group, we observed a statistically significant reduced rate of anterior knee pain (odd ratio 1.73) and reoperation (odd ratio 3.24). In the resurfacing group, a prevalence of anterior knee pain of 11.15% was detected, whereas in the retaining group it amounted to 17.39%. Furthermore, a greater KSS pain (+ 0.97%), KSS clinical (+ 0.23%), KSS functional (+ 2.44%), KSS overall (+ 2.47%) and HSS (+ 5.64%) were reported. In the retaining group, we found a better range of motion (+ 3.09°). CONCLUSION Based on the main findings of this meta-analysis, patellar resurfaced TKA was demonstrated to have performed superior overall. Patellar resurfacing detected a lower rate of postoperative anterior knee pain and reoperation. Moreover, the resurfacing group showed greater value of the HSS, KSS and related subscales. In favor of the retaining group, a slightly better ROM was evidenced. LEVEL OF EVIDENCE Level II, meta-analysis of prospective clinical trials.
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Bustamante Recuenco C, García-Quijada García J, Cendrero Martín M, Carabias Hernández A, Serantes Gómez A, Sanz Muñoz P, Delgado Millán MÁ, Jover Navalón JM. De Garengeot's hernia: Case report and literature review. Int J Surg Case Rep 2019; 64:58-61. [PMID: 31605980 PMCID: PMC6796716 DOI: 10.1016/j.ijscr.2019.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION De Garengeot's Hernia is a rare type of femoral hernia in which the appendix is located inside the herniated sac. Diagnosis of the condition is challenging and its treatment must be performed without delay. PRESENTATION OF CASE We present the case of a 75-year-old patient with a femoral hernia in which an appendix with signs of inflammation was found. An appendectomy followed by hernia repair was performed under an open preperitoneal approach according to Nyhus technique. The patient did not present any complications and was discharged on the second postoperative day. DISCUSSION This type of hernia is often unexpected and its preoperative diagnosis is difficult to perform. In most cases the clinical picture is indistinguishable from a common incarcerated hernia. Contrast-enhanced CT is the most useful complementary test, although it is not as accurate as desirable, so the diagnosis is frequently found intraoperatively. There is a wide variety of surgical options and there is no consensus on the most appropriate one. The preperitoneal approach enables the performance of an appendectomy and subsequent hernia reparation. The use of prosthesis should be considered if there are no signs of perforation or abscess. CONCLUSION De Garengeot's hernia is a very rare entity. The diagnosis and subsequent surgical treatment must be early to prevent the disease progression. The preperitoneal approach should be considered as the first choice technique, as it allows the exploration of the herniated sac and the performance of surgical procedures on its content.
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Frossard L, Leech B, Pitkin M. Inter-participant variability data in loading applied on osseointegrated implant by transtibial bone-anchored prostheses during daily activities. Data Brief 2019; 26:104510. [PMID: 31667273 PMCID: PMC6811920 DOI: 10.1016/j.dib.2019.104510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/19/2019] [Accepted: 09/05/2019] [Indexed: 10/31/2022] Open
Abstract
The data in this paper are related to the research article entitled "Loading applied on osseointegrated implant by transtibial bone-anchored prostheses during daily activities: Preliminary characterization of prosthetic feet" (Frossard et al., 2019: Accepted). This article contains the individual and grouped loading characteristics applied on transtibial osseointegrated implant generated while walking with bone-anchored prostheses including prosthetic feet with different index of anthropomorphicity. Inter-participant variability was presented for (A) the spatio-temporal characteristics, (B) the loading boundaries and (C) the loading local extremum during walking, ascending and descending ramp and stairs. These initial inter-participant variability benchmark datasets are critical to improve the efficacy and safety of prosthetic components for transtibial prostheses as well as the design of future automated algorithms and clinical trials. Online repository contains the files: https://doi.org/10.17632/vhc6sf7ngy.1.
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Claret CR, Herget GW, Kouba L, Wiest D, Adler J, von Tscharner V, Stieglitz T, Pasluosta C. Neuromuscular adaptations and sensorimotor integration following a unilateral transfemoral amputation. J Neuroeng Rehabil 2019; 16:115. [PMID: 31521190 PMCID: PMC6744715 DOI: 10.1186/s12984-019-0586-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/04/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Following an amputation, the human postural control system develops neuromuscular adaptations to regain an effective postural control. We investigated the compensatory mechanisms behind these adaptations and how sensorimotor integration is affected after a lower-limb transfemoral amputation. METHODS Center of pressure (CoP) data of 12 unilateral transfemoral amputees and 12 age-matched able-bodied subjects were recorded during quiet standing with eyes open (EO) and closed (EC). CoP adjustments under each leg were recorded to study their contribution to posture control. The spatial structure of the CoP displacements was characterized by measuring the mean distance, the mean velocity of the CoP adjustments, and the sway area. The Entropic Half-Life (EnHL) quantifies the temporal structure of the CoP adjustments and was used to infer disrupted sensory feedback loops in amputees. We expanded the analysis with measures of weight-bearing imbalance and asymmetry, and with two standardized balance assessments, the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG). RESULTS There was no difference in the EnHL values of amputees and controls when combining the contributions of both limbs (p = 0.754). However, amputees presented significant differences between the EnHL values of the intact and prosthetic limb (p < 0.001). Suppressing vision reduced the EnHL values of the intact (p = 0.001) and both legs (p = 0.028), but not in controls. Vision feedback in amputees also had a significant effect (increase) on the mean CoP distance (p < 0.001), CoP velocity (p < 0.001) and sway area (p = 0.007). Amputees presented an asymmetrical stance. The EnHL values of the intact limb in amputees were positively correlated to the BBS scores (EO: ρ = 0.43, EC: ρ = 0.44) and negatively correlated to the TUG times (EO: ρ = - 0.59, EC: ρ = - 0.69). CONCLUSION These results suggest that besides the asymmetry in load distribution, there exist neuromuscular adaptations after an amputation, possibly related to the loss of sensory feedback and an altered sensorimotor integration. The EnHL values suggest that the somatosensory system predominates in the control of the intact leg. Further, suppressing the visual system caused instability in amputees, but had a minimal impact on the CoP dynamics of controls. These findings points toward the importance of providing somatosensory feedback in lower-limb prosthesis to reestablish a normal postural control. TRIAL REGISTRATION DRKS00015254 , registered on September 20th, 2018.
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Frossard L. Loading characteristics data applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with basic components during daily activities. Data Brief 2019; 26:104492. [PMID: 31667256 PMCID: PMC6811875 DOI: 10.1016/j.dib.2019.104492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022] Open
Abstract
The data in this paper are related to the research articles entitled “Kinetics of transfemoral amputees with osseointegrated fixation performing common activities of daily living” (Lee et al., Clinical Biomechanics, 2007.22(6). p. 665–673) and “Magnitude and variability of loading on the osseointegrated implant of transfemoral amputees during walking” (Lee et al., Med Eng Phys, 2008.30(7). p. 825–833). This article contains the overall and individual loading characteristics applied on screw-type osseointegrated implant generated by transfemoral bone-anchored prostheses fitted with basic components during daily activities at self-selected comfortable pace. Overall and individual data was presented for the (A) spatio-temporal characteristics, (B) loading patterns, (C) loading boundaries and (D) the loading local extremum during level walking, ascending and descending ramp and stairs. Inter-participant variability of these new datasets with basic components is critical to improve the efficacy and safety of prosthetic components as well as the design of future automated algorithms and clinical trials. Online repository contains the files: https://data.mendeley.com/datasets/hh8rjjh73w/1.
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Li Z, Liu P, Ge J, Huang C, Chen G, Lu Y, Cai X, Xu F, Sun J, Li J, Wang Z. Kinematic parameter analysis and pilot clinical trial of dual-mobility semi-Knee prosthesis. Surg Oncol 2019; 30:13-21. [PMID: 31500776 DOI: 10.1016/j.suronc.2019.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 12/15/2018] [Accepted: 05/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND To address large tumor-related defects and lower limb-length discrepancies during limb-salvage surgery in children with malignant tumors in the distal femur, a new custom-made dual-mobility semi-knee prosthesis (DMK) was made. This study aimed to provide a theory and references for further clinical applications of this prosthesis. METHODS Based on computed tomography data from adult knee joint samples, we used Mimics/Geomagic/Pro-E software and computer numerical control milling technology to design and manufacture the DMK. An in vitro study was carried out to examine the related kinematic parameters in the normal knee, total knee arthroplasty and DMK groups of cadaveric specimens. Then, a pilot clinical trial was performed. RESULTS The in vitro study revealed that the kinematics of the novel custom-made DMK are more similar to those of the normal knee than the total knee prosthesis. The pilot clinical trial showed that patients recovered well, and postoperative serial X-ray films did not demonstrate any disfigurations, loosening, dislocations or breaks in the prosthesis after a follow-up period ranging from 11 months to 5 years. CONCLUSION The DMK is a novel concept and method for the treatment of malignant tumors in the distal femur in children, and the device used for ligament reattachment provides a solution for knee ligament reconstruction. However, DMK might be replaced by a total knee prosthesis after epiphyseal closure, because of incompatibility of tibial plateau with the prosthesis.
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Prosthetic restoration of the forefoot lever after Chopart amputation and its consequences onto the limb during gait. Gait Posture 2019; 73:1-7. [PMID: 31299498 DOI: 10.1016/j.gaitpost.2019.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/03/2019] [Accepted: 06/28/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In subjects with Chopart amputation the foot lever is clearly diminished. Usually high or low profile prostheses are routinely utilized to re-establish the lost forefoot lever. RESEARCH QUESTION The aim of this study was to investigate to what extent the proposed prostheses were able to replace the forefoot lever in chopart-amputees. METHODS An instrumented 3D gait analysis, including plantar and socket pressure measurements, was performed in thirteen subjects with Chopart amputation using a clamshell and/or a Bellmann prosthesis including an ankle foot orthosis during level ground walking. RESULTS The largest range of motion (p < 0.05) in the ankle joint was seen for the Bellmann prosthesis (32 ± 3°) followed by the Bellmann prosthesis with ankle-foot orthosis (22 ± 6°) whereas in the clamshell prosthesis (10 ± 4°) almost no ankle motion was seen. Conversely, the highest ankle joint moment (p < 0.05) was seen for the clamshell prosthesis (1.04 ± 0.24Nm/kg) followed by the Bellmann prosthesis with ankle-foot orthosis (0.66 ± 0.14Nm/kg) and, finally, the Bellmann (0.37 ± 0.11Nm/kg) alone offering the lowest joint moment. CONCLUSION High-profile prostheses with ventral shell are more suitable to reacquire the lost forefoot lever after Chopart amputation. However, the issue of restricted range of motion in the ankle joint with the clamshell prosthesis needs to be addressed.
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Full-mouth rehabilitation of an elderly patient with Sjogren's syndrome by using implant-supported fixed dental prostheses including CAD/CAM frameworks. J Dent Sci 2019; 14:428-429. [PMID: 31890134 PMCID: PMC6921124 DOI: 10.1016/j.jds.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 06/22/2019] [Indexed: 11/20/2022] Open
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Oltulu İ, Korkmaz Ö, Sarıoğlu E, Aydoğan M. A Retrospective Review of Radiographic and Clinical Findings from the M6 Cervical Prosthesis. Asian Spine J 2019; 13:913-919. [PMID: 31422645 PMCID: PMC6894978 DOI: 10.31616/asj.2018.0346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/26/2019] [Indexed: 12/20/2022] Open
Abstract
Study Design Retrospective clinical study. Purpose To evaluate clinical results of the M6 cervical prosthesis. Overview of Literature Cervical disk prostheses have been developed to preserve motion and reduce degeneration in adjacent segments in degenerative disk diseases. Methods A retrospective evaluation was performed on 43 patients who received the M6 cervical disk prosthesis between 2012 and 2016. Standard and dynamic radiographs, computed tomography, and magnetic resonance imaging were used to evaluate all the patients preoperatively and postoperatively. The Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores were examined in evaluating the clinical and functional results of patients with collapsed disk herniation who had received the M6 cervical prosthesis and to evaluate whether the core structure of the prosthesis protects motion. Results The mean follow-up period was 34.12±6.70 months. Radiologically, the preoperative cervical segment ROM was measured as a mean of 5.77°±2.19° preoperatively and 8.49°±2.37° at the inal postoperative follow-up examination. In the patients with a preoperative disk height of <4 mm, the segmental ROM increased from 4.53°±2.79° preoperatively to 7.2°±3.18° postoperatively. In the patients with a preoperative disk height of >4 mm, the cervical segment ROM increased from 6.4°±1.45° preoperatively to 8.6°±2.02° at the inal postoperative follow-up examination. The NDI scores reduced from 53.86±9.77 preoperatively to 22.69±7.26 postoperatively and the VAS scores reduced from 8.74±0.58 to 1.88±1.14. During follow-up in any patient, no collapse of the levels at which surgery was performed was observed. No heterotopic ossiication or implant failure was recorded in any patient during the follow-up period. Conclusions The M6 new-generation cervical disk prosthesis had few complications. No heterotopic ossiication was observed in any patient, and lexion-extension ROM was maintained in all the patients, indicating the M6 prosthesis as a promising alternative.
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