Inter-participant variability data in characterization of anthropomorphicity of prosthetic feet fitted to bone-anchored transtibial prosthesis

The data in this paper are related to the research article entitled “Automated characterization of anthropomorphicity of prosthetic feet fitted to bone-anchored transtibial prosthesis” (Frossard et al., 2019: DOI: 10.1109/TBME.2019.2904713). This article contains the individual angles of dorsiflexion and bending moments generated while walking with transtibial bone-anchored prostheses including prosthetic feet with different index of anthropomorphicity. Inter-participant variability were presented for the (A) position of the load cell measuring directly to the bending moments, (B) patterns of angles of dorsiflexion and bending moment as well as moment-angle curves and (C) variations of magnitude of angles of dorsiflexion as well as the raw and bodyweight-normalized bending moments between toe contact and heel off. These initial inter-participant variability benchmark datasets are critical to design future automated algorithms and clinical trials. Online repository contains the files: https://eprints.qut.edu.au/127745/1/127745.pdf.

Surgical treatment of radial head isolated Mason III fractures

INTRODUCTION

In this retrospective study we have analyzed a consecutive series of patients affected by isolated radial head Mason III fractures and treated with bone resection or prosthesis.

PATIENTS AND METHODS

This study includes 24 patients affected by fractures mentioned above and treated between July 2009 and November 2015. 15 patients (average age 48 y.o.) have been treated with prosthesis. The remaining 9 (average age 573) have been treated with a capitellectomy instead. From a clinical point of view, we have evaluated the patients according to main performance indicators such as range of motion, pain, instability and Mayo Elbow Performance Score as parameters.

RESULTS

We have found similar results in both group, with an average MEPS value of 95 in the prosthesis group and 966 in the radial head resection group. The range of motion was similar too: between 1,3° and 1203° in the first group and between 4,4° and 120° in the second one. No significant complication has detected in any patient.

DISCUSSION

According to most recent literature, it is not precisely defined how to treat isolated Mason III fractures, contrary to what is defined in more complex pattern, in which prosthesis are now evaluated as the best indication. Due to radial head limited contribution to elbow stability, in absence of other bony or ligamentous lesions both capitellectomy and prosthesis can be good treatment in this kind of fracture.

CONCLUSION

According to our experience and to the most recent literature, we recommend prosthesis in patient younger than 50 y.o., high demanding or manual worker, while in other cases we think that radial head resection can be the treatment of choice.

Effects of upper limb loss and prosthesis use on proactive mechanisms of locomotor stability

Persons with upper limb loss (ULL) experience a high prevalence of falls, with the majority of falls occurring when walking. This issue may be related to altered arm dynamics, which play an important role in proactive mechanisms of locomotor stability. This study investigated effects of ULL and prosthesis use on proactive stability mechanisms, particularly if matching the mass and inertia of the impaired limb to the sound limb would enhance locomotor stability. Gait data were collected on adults with unilateral ULL during level walking while: (1) not wearing a prosthesis, (2) wearing their customary prosthesis, (3) wearing a mock prosthesis that matched the sound limb mass and inertia. Main and interaction effects of limb side and condition on trunk rotations, arm swing, step width, free vertical moment, and margin-of-stability were analyzed. Across conditions, arm swing, free vertical moment, and margin-of-stability were 2.27, 1.13, and 1.20 times greater, respectively, on the sound limb side than the impaired limb side. Persons with ULL display asymmetry in proactive mechanisms of locomotor stability with potentially greater medial-lateral stability on the sound limb side irrespective of prosthesis use, but heavier prostheses reduced the walking base of support. This bias may enhance fall risk on the impaired side if the prosthetic limb is used inappropriately to regain balance following a disturbance. Research is warranted to explore the consequences of this asymmetry on perturbation response.

Evaluating shear and normal force with the use of an instrumented transtibial socket: A case study

Patients with transtibial amputation experience ulcers on their residual limb. The loading between the device and underlying material plays a role in loads transmitted to the skin. The objective was to evaluate normal and shear forces at the socket/liner interface during walking. A 53 year old male (85.45 kg and 177.8 cm) with a transtibial amputation participated in this case study. A transtibial prosthesis was instrumented with a load cell to measure normal and shear forces at the socket interface. Three conditions were evaluated during walking: gel liner, additional three ply sock and a hole in the gel liner. Shear and normal forces were highest with the addition of a three ply. Longitudinal shear stresses ranged from 0.4-7.66 kPa, transverse shear stresses ranged from 0.01-7.79 kPa and normal stresses ranged from 2.7-61.9 kPa. Increased shear and normal forces can cause a significant decrease in blood perfusion, linked to an increased risk of ulcer formation. Experimental force results are also important for future work involving finite element modeling of the skin/liner/device interface.

Four Extremity Amputation and Bionic Prosthesis Supply after Disseminated Intravascular Coagulation: A Follow-Up on Functionality and Quality of Life after Bionic Prosthesis Supply

BACKGROUND

Disseminated intravascular coagulopathy (DIC) is a rare symptom complex that causes embolisms within the microvasculature and extensive necrosis of the skin and the acres. During surgical decision-making, preserving functionally important structures must be weighed against radical debridement. The aim was to analyze functional recovery and quality of life of patients sustaining amputations from disseminated intravascular coagulopathy and supplied with bionic prostheses.

METHODS

A monocentric, retrospective review of patients with disseminated intravascular coagulopathy after sepsis was conducted from 2016 to 2018. After initial reconstruction and intensive care treatment, patients were provided with bionic prosthetic devices. A follow-up survey measuring function and quality of life was performed.

RESULTS

Three patients (mean: 45 years; median: 50 years) were analyzed. The first necrectomy and amputation were performed, on average, after >4 weeks post-symptom onset. All patients required re-amputation, averaging two or one re-amputations in the right or left upper extremity, respectively, and one in ​​the lower extremities. On average, 12 operations for reconstruction of skin defects were required (x͂=8). On average, patients tolerated their prostheses for 5.67 h per day. Satisfaction metrics were either sufficient (SF-36, x̅=69) or moderate (TAPES-R, x̅=4.7). Physical skills were rated poor to fair (average TAPES-R=2.67).

CONCLUSION

Supplying bionic prostheses after DIC yielded sufficient to moderate results. However, prothesis weight, signal transmission disorders, and repeated functional failures were suboptimal. For extensive stump scarring, implantable signal electrodes may improve signal transmission.

Management of Primary Testicular Tumor

In any man with a solid testicular mass, cancer should be considered until proven otherwise. Radical inguinal orchiectomy is the treatment of choice in patients with testis mass. Placement of a testicular prosthesis is safe with a very low complication rate and should be offered to all patients undergoing radical orchiectomy. In patients with widespread or life-threatening advanced disease, delayed orchiectomy following chemotherapy is recommended. Testis-sparing surgery can be performed in highly selected patients with solitary testicle mass, bilateral testicular tumors, or strong suspicion of a benign lesion.

Effect of iatrogenic factors on periodontal health: An epidemiological study

Introduction

Periodontitis is a multifactorial disease. Among conglomerate etiological factors, overhanging interproximal restorations are viewed as contributing factors causing gingival inflammation due to their retentive capacity for bacterial plaque leading to periodontal destruction. Hence this study is intended to determine the prevalence of overhanging restorations and its effect on periodontal status of the teeth and to assess the iatrogenic effects of overhanging margins on periodontal health.

Materials and methods

A total of 100 subjects of 15–65 years of age were recruited for this study. Dental restorations which affect periodontal health like amalgams, composite or glass ionomer restorations (overhanging margins proximally), fixed prosthesis, cervical abrasions, class V restorations extending sub-gingivally were included in the study. Patients with known systemic diseases, smokers, and on any medication in past 6 months were excluded from the study. Various parameters like bleeding on probing, probing depth, clinical attachment loss, biological width, gingival recession, duration of restoration were assessed according to the site of the restorations.

Statistical analysis

A commercially available SPSS version 20.0 Software, was used to perform the statistical analysis. The data were distributed normally and it was investigated using paired t-test. The prevalence of overhanging restorations was done through percentages comparison between restorative sites with non-restorative sites.

Results

The presence of sub-gingival restorations was greater in males than in females. This can be attributed to the oral hygiene maintenance of the subjects. The prevalence of sub-gingival restorations was more prevalent in the age groups between 35 and 45 years of age.

Conclusion

This study clearly identified a higher prevalence, 50.8% of sub-gingival restorations causing gingivitis and has shown significant influence on periodontal status of the tooth.

Quality of Life Associated Factors in a North African Sample of Lower Limbs Amputees

Objective

To study factors associated to the quality of life in a North African sample of lower limbs amputees.

Methods

We conducted a prospective study in the Department Physical Medicine and Rehabilitation, University Hospital of Monastit, Tunisia. A consecutive sample of patients with amputations of the lower limbs was included. The evaluated parameters were quality of life using the Short-Form quality-of-life questionnaire (SF-36), pain using a visual analog scale, function using, the perimeter of walking (PW), the Special Interest Group of the Amputee Medicine (SIGAM) and the Locomotion Capacities Index of the Prosthetic Profile of the Amputee (LCI), and psychological status thanks to the Hospital Anxiety and Depression scale. In the study, the patients were evaluated at the first consultation (T0) and again at 12 months (T1).

Results

We included 85 patients (age, 59.3±16.7 years) with a sex ratio of 3. The patient quality of life was positively correlated to distal type of amputation, traumatic origin, better LCI (p≤0.001, r=0.349), SIGAM (p=0.046) and PW. A negative correlation was noted with age (p=0.012, r=-0.483) and higher psychological scores (p=0.002, r=-0.321).

Conclusion

In our sample of North African lower limbs amputees the age and the functional status were the most important predictors of the quality of life.

Technique for secondary modification after maxillary resection and reconstruction for soft tissue flap fixation before prosthesis addition: a case report

Background

The removal of maxillary carcinoma causes various types of tissue defects, which can be corrected by free flap reconstruction. In flap reconstruction after maxillary cancer resection, ensuring prosthesis stability is frequently difficult owing to the flap’s weight. Therefore, a second modification technique is required for improvement of configuration. This case where flap suspension and flap modifying surgery were performed using anchor system for the extensive complete maxillectomy case.

Case presentation

The patient was a 56-year-old male, who underwent an extensive total maxillectomy and flap reconstruction using the rectus abdominus muscles in May 2005. Postoperatively, due to the difficulties of wearing a maxillary denture, he was transferred to our department with the chief complaint of morphological improvement. The maxillary bone had already been removed from the midline with the rectus abdominus muscle flap sutured directly to the soft palate without oral vestibule, and the flap margin was moving together with the surrounding soft tissue. The flap size was 70 × 50 mm, which was sagging due to its own weight and was in contact with mandibular molars, reducing the volume of the oral cavity without a denture being worn. Flap reduction and lifting the flap were performed under general anesthesia using 3 Mitek anchors implanted in the zygomatic bone, and the anchor suture was placed through the subcutaneous tissue to lift the flap. Postoperatively, the prosthesis was stable. No recurrence of flap sagging or wound infection was seen 3 years after surgery.

Conclusions

The second modification technique after maxillary cancer resection is useful for ensuring prosthesis stability. This method can be used before prosthesis addition. We could obtain remarkable denture stability by flap suspension using anchor system and a flap-modifying operation for the patient who had undergone maxilloecotomy. The denture was stabilized by using anchors for the elevated flap and flap loss technique and by performing vestibuloplasty for support.

The use of labelled leucocyte scintigraphy to evaluate chronic periprosthetic joint infections: a retrospective multicentre study on 168 patients

Labelled leucocyte scintigraphy (LS) is regarded as helpful when exploring bone and joint infections. The aim of this study was to evaluate the utility of LS for the diagnosis of chronic periprosthetic joint infections (PJIs) in patients exhibiting arthroplastic loosening. One hundred sixty-eight patients were referred to centres for treatment of complex PJI. One hundred fifty underwent LS using ^99mTc-HMPAO (LLS); 18 also underwent anti-granulocyte scintigraphy (AGS) and 13 additional SPECT with tomodensitometry imaging (SPECT-CT). The LS results were compared with bone scan data. For all, the final diagnoses were determined microbiologically; perioperative samples were cultured. LS values were examined, as well as sensitivity by microorganism, anatomical sites, and injected activity. LS results were also evaluated according to the current use of antibiotics or not. The sensitivity, specificity, and positive predictive value of LLS were 72%, 60%, and 80%, respectively. LLS performed better than did AGS. SPECT-CT revealed the accurate locations of infections. The sensitivity of LS was not significantly affected by the causative pathogen or the injected activity. No correlation was evident between the current antibiotic treatment and the LS value. The test was more sensitive for knee (84%) than hip arthroplasty (57%) but was less specific for knee (52% vs. 75%). Sensitivity and specificity of LLS varied by the location of infection bone scan provide no additional value in PJI diagnosis. Current antibiotic treatment seems to have no influence on LS sensitivity as well as labelling leukocyte activity or pathogens responsible for chronic PJI.

Three-Level Lumbar En Bloc Spondylectomy with Three-Dimensional-Printed Vertebrae Reconstruction for Recurrent Giant Cell Tumor

BACKGROUND

Primary malignancies involving the mobile spine often require total en bloc spondylectomy with complex mechanical reconstruction, which can be augmented with novel application of the 3-dimensional (3D)-printing technique.

CASE DESCRIPTION

A 51-year-old man presented with a 12-month history of progressive thigh pain and lower limb motor function loss, 36 months after T12-L4 instrumentation and fusion for giant cell tumor (GCT) of the L2 vertebrae before referral. The patient subsequently underwent successful curative management of recurrent GCT through denosumab treatment, L1-L3 total en bloc spondylectomy (TES), and a novel lumbopelvic reconstruction method with a 3D-printed lumbar vertebrae and screw-rod system.

CONCLUSIONS

To our knowledge, this is the first reported case of multilevel lumbar TES for GCT reconstructed using a 3D-printed vertebrae. Although TES-specifically in the lumbosacral spine-remains challenging due to its unique anatomy and increased risk of neurologic insult, it is an effective option for curative management of GCTs.

Systematic Review and Meta-Analysis on the Management of Open Abdominal Aortic Graft Infections

OBJECTIVE

Aortic graft infection (AGI) is a disastrous complication with an incidence of 0.2-6% in operated patients. With little or no high quality evidence, the best treatment option remains unclear. Therefore, the literature on the management of open abdominal AGI was systematically reviewed to determine optimal treatment.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was conducted for AGI. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched. Methodological quality was assessed using the Methodological Index for Non-randomised Studies (MINORS) score. Primary outcomes were 30 day mortality and one year survival. Secondary outcomes were survival, infection recurrence, limb salvage, and graft patency.

RESULTS

Of 1574 studies identified, 32 papers were included in the study. The overall quality of the studies was moderate, with an average MINORS score of 11.9. Pooled overall 30 day mortality and one year survival were 13.5% (95% CI 10.5-16.4) and 73.6% (95% CI 68.8-78.4), respectively. The lowest 30 day mortality and highest one year survival were found for in situ repair compared with extra-anatomic repair and for prosthetic grafts compared with venous grafts or arterial allografts. The infection recurrence rate was highest for prosthetic grafts.

CONCLUSIONS

There is a lack of well designed, qualitative comparative studies making conclusive recommendations impossible. The current best available data suggests that partial graft removal should be avoided and the lowest 30 day mortality and best one year survival are achieved with in situ repair using prosthetic grafts. Initiatives such as the MAGIC database to collaboratively collect prospective data are an important step forward in obtaining more solid answers on this topic.

The NECK trial: Effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blinded randomized controlled trial

BACKGROUND

Motion preserving anterior cervical disc arthroplasty (ACDA) in patients with cervical radiculopathy was introduced to prevent symptomatic adjacent disc degeneration as compared with anterior cervical discectomy and fusion (ACDF). Prior reports suggest that ACDF is not more effective than anterior cervical discectomy (ACD) alone for the treatment of cervical radiculopathy.

PURPOSE

To evaluate whether patients with cervical radiculopathy due to a herniated disc benefit more from undergoing ACDA, ACDF, or ACD in terms of clinical outcome measured by the neck disability index (NDI).

STUDY DESIGN

Double-blinded randomized controlled trial.

METHODS

One hundred-nine patients with one level herniated disc were randomized to one of the following treatments: ACDA, ACDF with intervertebral cage, ACD without fusion. Clinical and radiological outcome was measured by NDI, Visual Analogue Scale (VAS) neck pain, VAS arm pain, SF36, EQ-5D, patients' self-reported perceived recovery, radiographic cervical curvature, and adjacent segment degeneration parameters at baseline and until two years after surgery. BBraun Medical paid €298.837 to cover the costs for research nurses.

RESULTS

The NDI declined from 41 to 47 points at baseline to 19 ± 15 in the ACD group, 19 ± 18 in the ACDF group, and 20 ± 22 in the ACDA group after surgery (p=.929). VAS arm and neck pain declined to half its baseline value and decreased below the critical value of 40 mm. Quality of life, measured by the EQ-5D, increased in all three groups. Adjacent segment degeneration parameters were comparable in all three groups as well. No statistical differences were demonstrated between the treatment groups.

CONCLUSIONS

The hypothesis that ACDA would lead to superior clinical outcome in comparison to ACDF or ACD could not be confirmed during a 2-year follow-up time period. Single level ACD without implanting an intervertebral device may be a reasonable alternative to ACDF or ACDA.

[Evaluation of conjunctival inflammation among prosthesis wearers]

PURPOSE

To define the best methods of evaluating conjunctival inflammation in patients with ocular prostheses.

METHODS

The level of conjunctival inflammation and the patients' complaints were evaluated by several quantitative and qualitative methods : clinical grading, Schirmer's test, self-evaluation analogic scale of secretions, and a quality of life survey derived from the OSDI score (Ocular Surface Disease Index), initially designed for dry eye syndrome and modified to be relevant among this population. In order to test for consistency, the patients were re-evaluated for inflammation at the conclusion of 1 month of dexamethasone treatment, using the same methodology. The progression of each parameter under treatment was measured, searching for a correlation between improvement in the criteria and the patient's satisfaction.

RESULTS

Twenty five patients were evaluated. The Schirmer's test did not change significantly with treatment. The clinical inflammation grade decreased significantly with treatment (p<0.0001) but was not correlated with patient satisfaction (p=0.63). The modified OSDI score and the self-evaluation analogic scale of secretions were both significantly improved (p<0.0001) and correlated with patient satisfaction (p=0.0048 for the OSDI, p<0.0001 for the analog scale).

CONCLUSION

In our study, the most relevant tools to evaluate treatment efficacy for conjunctival inflammation in prosthetic eye wearers were the modified OSDI score and the self-evaluation analogic scale of secretions. The clinical grading scale is probably a good indicator for the biological effect of a treatment on the conjunctiva but may be unrelated to the patient's symptoms.

Functional plasticity of the ipsilateral primary sensorimotor cortex in an elite long jumper with below-knee amputation

Functional plasticity of the sensorimotor cortex occurs following motor practice, as well as after limb amputation. However, the joint effect of limb amputation and intensive, long-term motor practice on cortical plasticity remains unclear. Here, we recorded brain activity during unilateral contraction of the hip, knee, and ankle joint muscles from a long jump Paralympic gold medalist with a unilateral below-knee amputation (Amputee Long Jumper, ALJ). He used the amputated leg with a prosthesis for take-off. Under similar conditions to the ALJ, we also recorded brain activity from healthy long jumpers (HLJ) and non-athletes with a below-knee amputation. During a rhythmic isometric contraction of knee extensor muscles with the take-off/prosthetic leg, the ALJ activated not only the contralateral primary sensorimotor cortex (M1/S1), but also the ipsilateral M1/S1. In addition, this ipsilateral M1/S1 activation was significantly greater than that seen in the HLJ. However, we did not find any significant differences between the ALJ and HLJ in M1/S1 activation during knee muscle contraction in the non-take-off/intact leg, nor during hip muscle contraction on either side. Region of interest analysis revealed that the ALJ exhibited a greater difference in M1/S1 activity and activated areas ipsilateral to the movement side between the take-off/prosthetic and non-take-off/intact legs during knee muscle contraction compared with the other two groups. However, difference in activity in M1/S1 contralateral to the movement side did not differ across groups. These results suggest that a combination of below-knee amputation and intensive, prolonged long jump training using a prosthesis (i.e. fine knee joint control) induced an expansion of the functional representation of the take-off/prosthetic leg in the ipsilateral M1/S1 in a muscle-specific manner. These results provide novel insights into the potential for substantial cortical plasticity with an extensive motor rehabilitation program.

•

A Paralympic gold medalist with a unilateral below-knee amputation was recruited.

•

Brain activity during hip, knee, and ankle movements was recorded.

•

Brain activity was compared with healthy athletes and non-athletes with amputation.

•

Greater ipsilateral M1/S1 activity during knee movement was observed in the medalist.

•

Intensive motor practice and limb amputation would induce drastic neural plasticity.

Antibacterial coating of implants: are we missing something?

Implant-related infection is one of the leading reasons for failure in orthopaedics and trauma, and results in high social and economic costs. Various antibacterial coating technologies have proven to be safe and effective both in preclinical and clinical studies, with post-surgical implant-related infections reduced by 90% in some cases, depending on the type of coating and experimental setup used. Economic assessment may enable the cost-to-benefit profile of any given antibacterial coating to be defined, based on the expected infection rate with and without the coating, the cost of the infection management, and the cost of the coating. After reviewing the latest evidence on the available antibacterial coatings, we quantified the impact caused by delaying their large-scale application. Considering only joint arthroplasties, our calculations indicated that for an antibacterial coating, with a final user's cost price of €600 and able to reduce post-surgical infection by 80%, each year of delay to its large-scale application would cause an estimated 35 200 new cases of post-surgical infection in Europe, equating to additional hospital costs of approximately €440 million per year. An adequate reimbursement policy for antibacterial coatings may benefit patients, healthcare systems, and related research, as could faster and more affordable regulatory pathways for the technologies still in the pipeline. This could significantly reduce the social and economic burden of implant-related infections in orthopaedics and trauma. Cite this article: C. L. Romanò, H. Tsuchiya, I. Morelli, A. G. Battaglia, L. Drago. Antibacterial coating of implants: are we missing something? Bone Joint Res 2019;8:199-206. DOI: 10.1302/2046-3758.85.BJR-2018-0316.

Avian Skull Orthopedics

Because the avian skull is the reflection of the wide biodiversity of birds, many anatomic, morphologic, and functional variations are encountered. The main objectives of this article are to review the surgical considerations associated with the functional anatomy of the avian jaw apparatus and its variation among species, and to describe the general medical and surgical management of head traumatic and developmental disorders in birds.

Endovascular Repair of an Iliac Artery Pseudoaneurysm Using a Surgeon-Reconstructed Prosthetic Graft and a Bare Metal Stent

Iliac artery aneurysms are usually asymptomatic. Herein, we report a novel strategy for the repair of a pseudoaneurysm involving the external iliac artery using a conventional artificial graft and bare metal stent. A 76-year-old male patient presented with severe resting pain and right foot discoloration. Computed tomography angiography revealed a right distal external iliac artery pseudoaneurysm, with severe calcified occlusion at the right common and superficial femoral arteries. After exposing the right femoral artery, long-segment endarterectomy and patch angioplasty with the ipsilateral greater saphenous vein were performed. Before the completion of patch angioplasty, a surgeon-modified 8-mm expanded polytetrafluoroethylene (ePTFE) graft was inserted for complete pseudoaneurysm repair. If a commercial covered stent is not available, minimally invasive endovascular repair can be safely performed using a surgeon-modified ePTFE graft and bare metal stent.

Morphological Measurement of Supracondylar Femur Based on Digital Technology in Chinese Han Population

Objective

Relatively few studies have reported on the morphology of the supracondylar femur, which is a fundamental factor affecting prosthetic reconstruction. The objectives of the present study were to measure the morphological parameters of the supracondylar femur, to classify the supracondylar femur, and to provide theoretical guidance for the development of distal femoral prostheses.

Methods

The study consisted of 82 patients of Han Chinese nationality in North China. There were 57 men and 25 women included in the study, with an average age of 50.9 years (range, 18–87 years). Effective CT data should include a range of more than 10 cm for the distal femur. CT data for the right distal supracondylar femurs was obtained from DICOM files. Results for the cancellous bone and marrow cavity were retained, and information for the cortical bone was erased to obtain information of the lumen. Measurements of the intracortical cavity have not been reported previously. Lumen models were reconstructed with Mimics 17.0 software. The surfaces of the lumen models were smoothed with Geomagic studio 12.0 software. Using the Solidworks 2014 software, we established a 3‐D coordinate system, where variables of the lumen were examined. Correlations between the various measurements were calculated.

Results

The supracondylar region of the femur was divided into five levels, and the length, breadth, height, and angle values were measured at each level. There were strong correlations between the length indexes (transverse diameter [EF], medial anteroposterior diameter [AC], middle anteroposterior diameter [GH], and lateral anteroposterior diameter [BD]) and the volume index (V). There were also strong correlations among the length indicators (EF, AC, GH, and BD) in each layer. Angle γ was correlated with the lateral anteroposterior diameter (BD) at L2–L6 layers (r = −0.383, −0.385, −0.296, −0.258, −0.24; all P < 0.05) and with the height index (h) at L4–L6 layers (r = −0.244, −0.385, −0.506; all P < 0.05). The most representative parameters were the medial anteroposterior diameter (AC₂R₂ = 0.865; AC₆R₂ = 0.932), the coronal width ratio, and the sagittal width ratio with volume. The analysis found that the lumen shape of flower–top hat accounted for 81% at most.

Conclusions

The supracondylar femur has an asymmetrical structural area. The coronal plane is dominated by a flowerpot‐like morphology, and the sagittal plane is narrowest in the lateral 1/3 and resembles a top‐hat‐like morphology. Our results provide theoretical guidance for developing distal femoral prostheses and for their clinical application.

Management of Edentulous Patients

Edentulism, defined as the complete loss of all dentition, is a worldwide phenomenon. Edentulism occurs because of biologic disease processes, such as dental caries, periodontal diseases, trauma, and oral cancer. Edentulism is accompanied by several comorbidities that can significantly influence an individual. Although the rate of edentulism is declining, the number of edentulous patients continues to rise because of the increase in population. The management of edentulous patient has been addressed since the early days of dentistry. This article describes complete dentures and their maintenance, and advanced technology in complete dentures, and in implant-retained and implant-supported prosthesis.

Pelvic reconstruction following resection of tumour involving the whole ilium and acetabulum

Background

Functional reconstruction following resection of pelvic tumours with the ileum and the acetabulum involvement is challenging and demanding. The aim of this study was to evaluate the results of these patients receiving pelvic reconstruction with a femoral head autograft plus a hemipelvic prosthesis.

Methods

Eighteen patients receiving pelvic reconstruction with a femoral head autograft plus a hemipelvic prosthesis following resection of pelvic tumours involving the whole ileum and the acetabulum were included in this study from April 2006 to June 2014. Oncological status, functional results, and complications of these selected patients were analysed.

Results

The follow-up was 15–125 months (median 43). The functional MSTS-93 scores of the 18 patients available for the functional analysis were 37–87% (mean 60.7%). Complications occurred in seven patients (31.8%); dislocation in two (9%); and deep infection in three patients (13.6%) and two patients healed well following thorough debridement and antibiotic treatment. Five patients had local recurrence (22.7%). Lung metastases occurred in eight patients; seven died of disease and one lived after the metastasectomy. The 5-year overall Kaplan–Meier survival and disease-free survival rates were 61.7% and 50%, respectively.

Conclusions

The procedure of femoral head autograft plus hemipelvic prosthesis was an effective method to reconstruct the defect following the whole ileum and the acetabulum resection; the functional outcomes were satisfactory, and it had an acceptable complication rate.

Temporal patterns of commonly used clinical outcome scales during a 5-year period after total knee arthroplasty

Background

It is not established beyond doubt whether improvements in functional outcome after total knee arthroplasty (TKA) are maintained in the long term. We therefore investigated the temporal patterns of functional outcome [using range of motion (ROM), American Knee Society (AKS) score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and 36-Item Short Form Health Survey (SF-36) score] over a 5-year period after uncomplicated TKA, and whether these patterns differed by implant type and patient age.

Materials and methods

This prospective study evaluated 138 patients who underwent unilateral TKA with either a mobile-bearing (MB) or fixed-bearing (FB) posterior-stabilized prosthesis. An independent investigator evaluated the functional outcome at five time points: preoperatively and at 6-month, 1-year, 2-year, and 5-year follow-up. Differences in functional outcomes between adjacent time points were evaluated by mixed-effect model repeat measurement (MMRM).

Results

The different functional outcome scores showed improvement till 6 months–2 years, followed by a variable decline. In patients aged ≥ 68 years with an MB implant, most of the functional outcome scores declined between 2 and 5 years after variable initial improvement till 6 months–2 years, whereas the parameters plateaued after 2 years in those aged < 68 years and in older patients with an FB implant.

Conclusions

A decline in function and pain relief occurs 2 years after TKA. This decline is more evident in older patients with an MB prosthesis. Based on these findings, we believe that use of MB implants in older patients (≥ 68 years) requires further investigation.

Level of evidence

Level 3.

Priorities for the design and control of upper limb prostheses: A focus group study

BACKGROUND

Common prosthetic options do not allow for enough independent control signals to control all the movements of the arm. Invasive approaches to obtain prosthetic control signals are being developed to provide people with upper limb loss improved prosthetic control and feedback.

OBJECTIVE/HYPOTHESIS

This study explored the prosthetic qualities that are important to users and examined the factors that play into the decision to consider invasive prosthetic interfaces that allow for enhanced prosthetic control.

METHODS

Individuals participated in semi-structured focus groups or in individual semi-structured interviews (N = 11). A semi-structured interview guide containing open-ended questions was used to learn about ideal prosthesis qualities and interest in prosthetic technology interfaces including targeted muscle reinnervation, peripheral nerve interface, and cortical interface. Qualitative content analysis with an inductive approach was used for transcript analysis.

RESULTS

Participants were most interested in improving the dexterity and durability of prosthetic options. Recovery time, anticipated risk, medical co-morbidities, and baseline functional status influenced willingness to consider invasive prosthetic interfaces. Participants were interested in learning more about all three invasive interfaces but had the most concerns about cortical interfaces.

CONCLUSIONS

Attitudes toward invasive control interfaces vary. Further education on invasive control interfaces and additional conversations between prosthetic developers and people with limb loss will help to develop effective prosthetic devices that potential consumers will use.

Quality of life of prosthetic and orthotic users in South India: a cross-sectional study

Background

The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education.

Methods

A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann–Whitney U and the Kruskal–Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment.

Results

Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment.

Conclusions

Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.

A review on the advancements in the field of upper limb prosthesis

Amputation is one of the serious issue across the globe which is mainly caused by trauma, medical illness or congenital condition. Because of steep increase in amputation incidences, the need for progress in technicality of prosthesis is becoming imperative. In this article, the journey of advancements in upper arm prosthesis has been discussed step by step. Moreover, it has also been enunciated that how from a simple replacement for an arm it now has reached the mark of giving a patient a fully functional limb with the help of sensors and myoelectric transducers that are able to translate the remaining muscle signals into full movement of the prosthesis. However, researches are still going on to make the design of the prosthetic more impressive having better range of movement, to establish its interface with brain more efficiently and to make the control of prosthetic more user friendly. In this review, a special emphasis has also been given to myoelectric prosthesis as this prosthetic system possesses a decisive influence on rehabilitation results. Moreover, this prosthetic system is extremely elegant and cutting-edge in both design and technology and offers a great wearer comfort.