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Characterizing loads at transfemoral osseointegrated implants. Med Eng Phys 2020; 84:103-114. [PMID: 32977907 DOI: 10.1016/j.medengphy.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/10/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022]
Abstract
Establishing normative and outlying loads on transfemoral osseointegrated devices will assist development of preclinical mechanical testing strategies to inform manufacturers and government regulators. Therefore, force and moment data from osseointegrated transfemoral transcutaneous implants were collated to better understand baseline load levels. Load data were also collected from other devices including transfemoral socket prostheses, instrumented hip stems, instrumented knee devices, instrumented limb salvage femoral endoprostheses, as well as estimated loads on transfemoral prostheses using data from able-bodied subjects. These additional data were assessed for their ability to bolster the limited osseointegrated device data. Several activities of daily living were investigated to characterize normative loading. Falling events were investigated to characterize outlying loads. Results revealed that limited loading data exist for osseointegrated devices. The most often reported activity was level walking. While these normative data may inform fatigue testing, they may not fully characterize fatigue loads during all activities of daily living. Socket prosthetics and able-bodied individuals may provide supplementary data, but significance is limited by sample sizes. Falling data are sparse, and insufficient data exist for characterizing adverse loads on osseointegrated devices. Future data collection should include more activities of daily living and adverse events to better define osseointegrated device loading profiles.
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Leardini A, Belvedere C, Nardini F, Sancisi N, Conconi M, Parenti-Castelli V. Kinematic models of lower limb joints for musculo-skeletal modelling and optimization in gait analysis. J Biomech 2017; 62:77-86. [DOI: 10.1016/j.jbiomech.2017.04.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/22/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
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Stenlund P, Trobos M, Lausmaa J, Brånemark R, Thomsen P, Palmquist A. Effect of load on the bone around bone-anchored amputation prostheses. J Orthop Res 2017; 35:1113-1122. [PMID: 27341064 DOI: 10.1002/jor.23352] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/22/2016] [Indexed: 02/04/2023]
Abstract
Osseointegrated transfemoral amputation prostheses have proven successful as an alternative method to the conventional socket-type prostheses. The method improves prosthetic use and thus increases the demands imposed on the bone-implant system. The hypothesis of the present study was that the loads applied to the bone-anchored implant system of amputees would result in locations of high stress and strain transfer to the bone tissue and thus contribute to complications such as unfavourable bone remodeling and/or elevated inflammatory response and/or compromised sealing function at the tissue-abutment interface. In the study, site-specific loading measurements were made on amputees and used as input data in finite element analyses to predict the stress and strain distribution in the bone tissue. Furthermore, a tissue sample retrieved from a patient undergoing implant revision was characterized in order to evaluate the long-term tissue response around the abutment. Within the limit of the evaluated bone properties in the present experiments, it is concluded that the loads applied to the implant system may compromise the sealing function between the bone and the abutment, contributing to resorption of the bone in direct contact with the abutment at the most distal end. This was supported by observations in the retrieved clinical sample of bone resorption and the formation of a soft tissue lining along the abutment interface. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1113-1122, 2017.
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Affiliation(s)
- Patrik Stenlund
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Chemistry, Materials and Surfaces, SP Technical Research Institute of Sweden, Borås, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jukka Lausmaa
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Chemistry, Materials and Surfaces, SP Technical Research Institute of Sweden, Borås, Sweden
| | - Rickard Brånemark
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Thomsen
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Palmquist
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Jenei P, Choi H, Tóth A, Choe H, Gubicza J. Mechanical behavior and microstructure of compressed Ti foams synthesized via freeze casting. J Mech Behav Biomed Mater 2016; 63:407-416. [DOI: 10.1016/j.jmbbm.2016.07.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/13/2016] [Accepted: 07/09/2016] [Indexed: 11/24/2022]
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Abdel-Jaber S, Belvedere C, Mattia JSD, Leardini A, Affatato S. A new protocol for wear testing of total knee prostheses from real joint kinematic data: Towards a scenario of realistic simulations of daily living activities. J Biomech 2016; 49:2925-2931. [DOI: 10.1016/j.jbiomech.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/07/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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Roohani-Esfahani SI, Newman P, Zreiqat H. Design and Fabrication of 3D printed Scaffolds with a Mechanical Strength Comparable to Cortical Bone to Repair Large Bone Defects. Sci Rep 2016; 6:19468. [PMID: 26782020 PMCID: PMC4726111 DOI: 10.1038/srep19468] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 10/19/2015] [Indexed: 11/09/2022] Open
Abstract
A challenge in regenerating large bone defects under load is to create scaffolds with large and interconnected pores while providing a compressive strength comparable to cortical bone (100-150 MPa). Here we design a novel hexagonal architecture for a glass-ceramic scaffold to fabricate an anisotropic, highly porous three dimensional scaffolds with a compressive strength of 110 MPa. Scaffolds with hexagonal design demonstrated a high fatigue resistance (1,000,000 cycles at 1-10 MPa compressive cyclic load), failure reliability and flexural strength (30 MPa) compared with those for conventional architecture. The obtained strength is 150 times greater than values reported for polymeric and composite scaffolds and 5 times greater than reported values for ceramic and glass scaffolds at similar porosity. These scaffolds open avenues for treatment of load bearing bone defects in orthopaedic, dental and maxillofacial applications.
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Affiliation(s)
- Seyed-Iman Roohani-Esfahani
- Biomaterials and Tissue Engineering Research Unit, School of Aeronautical Mechanical and Mechatronics Engineering, University of Sydney, 2006, NSW, Australia
| | - Peter Newman
- Biomaterials and Tissue Engineering Research Unit, School of Aeronautical Mechanical and Mechatronics Engineering, University of Sydney, 2006, NSW, Australia
| | - Hala Zreiqat
- Biomaterials and Tissue Engineering Research Unit, School of Aeronautical Mechanical and Mechatronics Engineering, University of Sydney, 2006, NSW, Australia
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Abdel-Jaber S, Belvedere C, Leardini A, Affatato S. Wear simulation of total knee prostheses using load and kinematics waveforms from stair climbing. J Biomech 2015; 48:3830-6. [DOI: 10.1016/j.jbiomech.2015.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/20/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
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Lovecchio N, Zago M, Sciumè L, Lopresti M, Sforza C. Squat exercise to estimate knee megaprosthesis rehabilitation: a pilot study. J Phys Ther Sci 2015; 27:2409-12. [PMID: 26311992 PMCID: PMC4540892 DOI: 10.1589/jpts.27.2409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study evaluated a specific rehabilitation protocol using a half squat
after total knee reconstruction with distal femur megaprosthesis and tibial
allograft-prosthesis composite. [Subject and Methods] Squat execution was recorded by a
three-dimensional system before and after a specific rehabilitation program on a
28-year-old patient. Squat duration, body center of mass trajectory, and vertical range of
motion were determined. Step width and joint angles and symmetry (hip flexion, extension,
and rotation, knee flexion, and ankle dorsal and plantar flexion) were estimated. Knee and
hip joint symmetry was computed using a bilateral cyclogram technique. [Results] After
rehabilitation, the squat duration was longer (75%), step width was similar, and vertical
displacement was higher. Hip flexion increased by over 20%, and ankle dorsiflexion
diminished by 14%. The knee had the highest symmetry gain (4.1–3.4%). Angle-angle plot
subtended areas decreased from 108° to 40°2 (hip) and from 204° to
85°2 (knee), showing improvement in movement symmetry. [Conclusion] We
concluded that the squat is an effective multifactorial exercise to estimate
rehabilitation outcomes after megaprosthesis, also considering that compressive and shear
forces are minimal up to 60–70° of knee flexion.
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Affiliation(s)
- Nicola Lovecchio
- Laboratorio di Anatomia Funzionale dell'Apparato Locomotore, Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Matteo Zago
- Laboratorio di Anatomia Funzionale dell'Apparato Locomotore, Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Luciana Sciumè
- Scuola di Specializzazione in Medicina Fisica e Riabilitazione, Università degli Studi di Milano, Italy
| | - Maurizio Lopresti
- S.C. Medicina Fisica e Riabilitazione, Istituto Ortopedico G. Pini, Italy
| | - Chiarella Sforza
- Laboratorio di Anatomia Funzionale dell'Apparato Locomotore, Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
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In vitro effects on mobile polyethylene insert under highly demanding daily activities: stair climbing. INTERNATIONAL ORTHOPAEDICS 2014; 39:1433-40. [DOI: 10.1007/s00264-014-2622-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/26/2014] [Indexed: 12/12/2022]
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Farrell BJ, Prilutsky BI, Kistenberg RS, Dalton JF, Pitkin M. An animal model to evaluate skin-implant-bone integration and gait with a prosthesis directly attached to the residual limb. Clin Biomech (Bristol, Avon) 2014; 29:336-49. [PMID: 24405567 PMCID: PMC3959271 DOI: 10.1016/j.clinbiomech.2013.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the number of advantages of bone-anchored prostheses, their use in patients is limited due to the lack of complete skin-implant integration. The objective of the present study was to develop an animal model that would permit both detailed investigations of gait with a bone-anchored limb prosthesis and histological analysis of the skin-implant-bone interface after physiological loading of the implant during standing and walking. METHODS Full-body mechanics of walking in two cats were recorded and analyzed before and after implantation of a percutaneous porous titanium pylon into the right tibia and attachment of a prosthesis. The rehabilitation procedures included initial limb casting, progressively increasing loading on the implant, and standing and locomotor training. Detailed histological analysis of bone and skin ingrowth into implant was performed at the end of the study. FINDINGS The two animals adopted the bone-anchored prosthesis for standing and locomotion, although loads on the prosthetic limb during walking decreased by 22% and 62%, respectively, 4months after implantation. The animals shifted body weight to the contralateral side and increased propulsion forces by the contralateral hindlimb. Histological analysis of the limb implants demonstrated bone and skin ingrowth. INTERPRETATION The developed animal model to study prosthetic gait and tissue integration with the implant demonstrated that porous titanium implants may permit bone and skin integration and prosthetic gait with a bone-anchored prosthesis. Future studies with this model will help optimize the implant and prosthesis properties.
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Affiliation(s)
- Brad J Farrell
- School of Applied Physiology, Center for Human Movement Science, Georgia Institute of Technology, Atlanta, GA, USA
| | - Boris I Prilutsky
- School of Applied Physiology, Center for Human Movement Science, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Robert S Kistenberg
- School of Applied Physiology, Center for Human Movement Science, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Mark Pitkin
- Tufts University School of Medicine, Boston, MA, USA; Poly-Orth International, Sharon, MA, USA
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D’Angeli V, Belvedere C, Ortolani M, Giannini S, Leardini A. Load along the tibial shaft during activities of daily living. J Biomech 2014; 47:1198-205. [DOI: 10.1016/j.jbiomech.2014.01.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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