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Manero A, Rivera V, Fu Q, Schwartzman JD, Prock-Gibbs H, Shah N, Gandhi D, White E, Crawford KE, Coathup MJ. Emerging Medical Technologies and Their Use in Bionic Repair and Human Augmentation. Bioengineering (Basel) 2024; 11:695. [PMID: 39061777 PMCID: PMC11274085 DOI: 10.3390/bioengineering11070695] [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: 06/13/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
As both the proportion of older people and the length of life increases globally, a rise in age-related degenerative diseases, disability, and prolonged dependency is projected. However, more sophisticated biomedical materials, as well as an improved understanding of human disease, is forecast to revolutionize the diagnosis and treatment of conditions ranging from osteoarthritis to Alzheimer's disease as well as impact disease prevention. Another, albeit quieter, revolution is also taking place within society: human augmentation. In this context, humans seek to improve themselves, metamorphosing through self-discipline or more recently, through use of emerging medical technologies, with the goal of transcending aging and mortality. In this review, and in the pursuit of improved medical care following aging, disease, disability, or injury, we first highlight cutting-edge and emerging materials-based neuroprosthetic technologies designed to restore limb or organ function. We highlight the potential for these technologies to be utilized to augment human performance beyond the range of natural performance. We discuss and explore the growing social movement of human augmentation and the idea that it is possible and desirable to use emerging technologies to push the boundaries of what it means to be a healthy human into the realm of superhuman performance and intelligence. This potential future capability is contrasted with limitations in the right-to-repair legislation, which may create challenges for patients. Now is the time for continued discussion of the ethical strategies for research, implementation, and long-term device sustainability or repair.
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Affiliation(s)
- Albert Manero
- Limbitless Solutions, University of Central Florida, 12703 Research Parkway, Suite 100, Orlando, FL 32826, USA (V.R.)
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA; (Q.F.); (K.E.C.)
| | - Viviana Rivera
- Limbitless Solutions, University of Central Florida, 12703 Research Parkway, Suite 100, Orlando, FL 32826, USA (V.R.)
| | - Qiushi Fu
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA; (Q.F.); (K.E.C.)
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Jonathan D. Schwartzman
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Hannah Prock-Gibbs
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Neel Shah
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Deep Gandhi
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Evan White
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Kaitlyn E. Crawford
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA; (Q.F.); (K.E.C.)
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Melanie J. Coathup
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA; (Q.F.); (K.E.C.)
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
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Rehani M, Stafinski T, Round J, Jones CA, Hebert JS. Bone-anchored prostheses for transfemoral amputation: a systematic review of outcomes, complications, patient experiences, and cost-effectiveness. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1336042. [PMID: 38628292 PMCID: PMC11018971 DOI: 10.3389/fresc.2024.1336042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Abstract
Introduction Bone-anchored prostheses (BAP) are an advanced reconstructive surgical approach for individuals who had transfemoral amputation and are unable to use the conventional socket-suspension systems for their prostheses. Access to this technology has been limited in part due to the lag between the start of a new procedure and the availability of evidence that is required before making decisions about widespread provision. This systematic review presents as a single resource up-to-date information on aspects most relevant to decision makers, i.e., clinical efficacy, safety parameters, patient experiences, and health economic outcomes of this technology. Methods A systematic search of the literature was conducted by an information specialist in PubMed, MEDLINE, Embase, CINAHL, Cochrane Library, the Core Collection of Web of Science, CADTH's Grey Matters, and Google Scholar up until May 31, 2023. Peer-reviewed original research articles on the outcomes of clinical effectiveness (health-related quality of life, mobility, and prosthesis usage), complications and adverse events, patient experiences, and health economic outcomes were included. The quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and ROBINS-I, as appropriate. Results Fifty studies met the inclusion criteria, of which 12 were excluded. Thirty-eight studies were finally included in this review, of which 21 reported on clinical outcomes and complications, 9 case series and 1 cohort study focused specifically on complications and adverse events, and 2 and 5 qualitative studies reported on patient experience and health economic assessments, respectively. The most common study design is a single-arm trial (pre-/post-intervention design) with varying lengths of follow-up. Discussion The clinical efficacy of this technology is evident in selected populations. Overall, patients reported increased health-related quality of life, mobility, and prosthesis usage post-intervention. The most common complication is a superficial or soft-tissue infection, and more serious complications are rare. Patient-reported experiences have generally been positive. Evidence indicates that bone-anchored implants for prosthesis fixation are cost-effective for those individuals who face significant challenges in using socket-suspension systems, although they may offer no additional advantage to those who are functioning well with their socket-suspended prostheses.
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Affiliation(s)
- Mayank Rehani
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Tania Stafinski
- Health Technology and Policy Unit, School of Public Health, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jeff Round
- Institute of Health Economics, Edmonton, AB, Canada
| | - C. Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline S. Hebert
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
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Ranaldi S, Naaim A, Marchis CD, Robert T, Dumas R, Conforto S, Frossard L. Walking ability of individuals fitted with transfemoral bone-anchored prostheses: A comparative study of gait parameters. Clin Rehabil 2023; 37:1670-1683. [PMID: 37350084 PMCID: PMC10580681 DOI: 10.1177/02692155231183779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE This study presents the walking abilities of participants fitted with transfemoral bone-anchored prostheses using a total of 14 gait parameters. DESIGN Two-centre retrospective cross-sectional comparative study. SETTING Research facilities equipped with tridimensional motion capture systems. PARTICIPANTS Two control arms included eight able-bodied participants arm (54 ± 9 years, 1.75 ± 0.07 m, 76 ± 7 kg) and nine participants fitted with transfemoral socket-suspended prostheses arm (59 ± 9 years, 1.73 ± 0.07 m, 80 ± 16 kg). The intervention arm included nine participants fitted with transfemoral bone-anchored prostheses arm (51 ± 13 years, 1.78 ± 0.09 m, 87.3 ± 16.1 kg). INTERVENTION Fitting of transfemoral bone-anchored prostheses. MAIN MEASURES Comparisons were performed for two spatio-temporal, three spatial and nine temporal gait parameters. RESULTS The cadence and speed of walking were 107 ± 6 steps/min and 1.23 ± 0.19 m/s for the able-bodied participants arm, 88 ± 7 steps/min and 0.87 ± 0.17 m/s for the socket-suspended prosthesis arm, and 96 ± 6 steps/min and 1.03 ± 0.17 m/s for bone-anchored prosthesis arm, respectively. Able-bodied participants and bone-anchored prosthesis arms were comparable in age, height, and body mass index as well as cadence and speed of walking, but the able-bodied participant arm showed a swing phase 31% shorter. Bone-anchored and socket-suspended prostheses arms were comparable for age, height, mass, and body mass index as well as cadence and speed of walking, but the bone-anchored prosthesis arm showed a step width and duration of double support in seconds 65% and 41% shorter, respectively. CONCLUSIONS Bone-anchored and socket-suspended prostheses restored equally well the gait parameters at a self-selected speed. This benchmark data provides new insights into the walking ability of individuals using transfemoral bionics bone-anchored prostheses.
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Affiliation(s)
- Simone Ranaldi
- BioLab³ – Engineering Department, Roma TRE University, Rome, Lazio, Italy
| | - Alexandre Naaim
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, Lyon, France
| | | | - Thomas Robert
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, Lyon, France
| | - Raphael Dumas
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, Lyon, France
| | - Silvia Conforto
- BioLab³ – Engineering Department, Roma TRE University, Rome, Lazio, Italy
| | - Laurent Frossard
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Southport, QLD, Australia
- YourResearchProject, Red Hill, QLD, Australia
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Murphy EP, Sheridan GA, Page BJ, Greenstein MD, Hoellwarth JS, Fragomen AT, Rozbruch SR. Modern Internet Search Analytics and Osseointegration: What are Patients Asking and Reading Online? Strategies Trauma Limb Reconstr 2023; 18:163-168. [PMID: 38404563 PMCID: PMC10891354 DOI: 10.5005/jp-journals-10080-1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/25/2023] [Indexed: 02/27/2024] Open
Abstract
Background Osseointegration (OI) limb has been performed for over 30 years and is an example of an advance in technology and surgical technique which has led to improvements in patient mobility and quality of life. An increasing number of patients seek information about osseointegration. The aim of this study was to categorise the most frequently asked questions by patients using the Google search engine and the most frequently accessed websites with the highest return on answers. The secondary aims of this study were to assess the quality of the information provided on those websites and to stratify, by category, which websites provide the best quality information. Materials and methods Ten permutations and conjugations of the word 'osseointegration' were entered into Google. The first fifty 'People also ask' and associated websites by Google's machine learning and natural language processing engine were collected for each search term. The Rothwell classification system of questions by topic (Fact, Value, Policy) and websites by category was used (Commercial, Academic, Medical Practice, Single Surgeon Personal, Government, Social Media). Website quality was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria (Likert-style rating 0-4). Pearson's Chi-squared and Student's t-tests were performed for statistical analysis as appropriate (significance, p < 0.05). Results The 10 search terms generated 454 questions and referenced 408 websites. Of the 454 questions generated, the most common question categories were fact (70.8%), value (19.2%), and policy (10%). The most common website type was social media (37.4%). The most common question types were technical details (30.4%), specific activity (20.6%), and cost (14.1%). Only 1.6% of questions related to risks and complications. Generally, website quality was poor with 64.1% having a JAMA score of 0 or 1. Websites that were categorised as 'Government' had the highest overall JAMA scores: 71.4% had a score of 4. Conclusion Based on Google search engine's results, the most commonly asked questions about osteointegration related to technical details, specific activities and cost; only 1.6% related to risks and complications. Interestingly, social media websites represented the highest volume of search result referrals. Overall, the quality of websites was poor with the most factual information coming from governmental websites. How to cite this article Murphy EP, Sheridan GA, Page BJ, et al. Modern Internet Search Analytics and Osseointegration: What Are Patients Asking and Reading Online? Strategies Trauma Limb Reconstr 2023;18(3):163-168.
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Affiliation(s)
| | - Gerard A Sheridan
- University Hospital Galway, Galway, Ireland; Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery, New York, United States of America
| | - Brian J Page
- Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery; Maimonides Medical Center, Brooklyn, New York, United States of America Center, Hospital for Special Surgery, New York, United States of America
| | - Michael D Greenstein
- Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery, New York; University of Michigan Medical School, Ann Arbor, United States of America
| | - Jason S Hoellwarth
- Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery, New York, United States of America
| | - Austin T Fragomen
- Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery, New York, United States of America
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery, New York, United States of America
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Bandyopadhyay A, Mitra I, Goodman SB, Kumar M, Bose S. Improving Biocompatibility for Next Generation of Metallic Implants. PROGRESS IN MATERIALS SCIENCE 2023; 133:101053. [PMID: 36686623 PMCID: PMC9851385 DOI: 10.1016/j.pmatsci.2022.101053] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The increasing need for joint replacement surgeries, musculoskeletal repairs, and orthodontics worldwide prompts emerging technologies to evolve with healthcare's changing landscape. Metallic orthopaedic materials have a shared application history with the aerospace industry, making them only partly efficient in the biomedical domain. However, suitability of metallic materials in bone tissue replacements and regenerative therapies remains unchallenged due to their superior mechanical properties, eventhough they are not perfectly biocompatible. Therefore, exploring ways to improve biocompatibility is the most critical step toward designing the next generation of metallic biomaterials. This review discusses methods of improving biocompatibility of metals used in biomedical devices using surface modification, bulk modification, and incorporation of biologics. Our investigation spans multiple length scales, from bulk metals to the effect of microporosities, surface nanoarchitecture, and biomolecules such as DNA incorporation for enhanced biological response in metallic materials. We examine recent technologies such as 3D printing in alloy design and storing surface charge on nanoarchitecture surfaces, metal-on-metal, and ceramic-on-metal coatings to present a coherent and comprehensive understanding of the subject. Finally, we consider the advantages and challenges of metallic biomaterials and identify future directions.
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Affiliation(s)
- Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164-2920
| | - Indranath Mitra
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164-2920
| | - Stuart B. Goodman
- Department of Orthopedic Surgery, Stanford University Medical Center, Redwood City, CA 94063
| | | | - Susmita Bose
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164-2920
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Hoellwarth JS, Tetsworth K, Akhtar MA, Al Muderis M. Transcutaneous Osseointegration for Amputees: What Is It, How Did It Evolve, and What May Develop? CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Wade L, McGuigan MP, McKay C, Bilzon J, Seminati E. Biomechanical risk factors for knee osteoarthritis and lower back pain in lower limb amputees: protocol for a systematic review. BMJ Open 2022; 12:e066959. [PMID: 36410824 PMCID: PMC9680152 DOI: 10.1136/bmjopen-2022-066959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is a limited research exploring biomechanical risk factors for the development of knee osteoarthritis (KOA) and lower back pain (LBP) between lower limb amputee subgroups, (eg, transtibial amputees (TTA) vs transfemoral amputees (TFA), or TTA dysvascular vs TTA traumatic). Previous reviews have focused primarily on studies where symptoms of KOA or LBP are present, however, due to limited study numbers, this hinders their scope and ability to compare between amputee subgroups. Therefore, the aim of this systematic review is to descriptively compare biomechanical risk factors for developing KOA and LBP between lower limb amputee subgroups, irrespective of whether KOA or LBP was present. METHODS AND ANALYSIS This review is currently in progress and screening results are presented alongside the protocol to highlight challenges encountered during data extraction. Five electronic databases were searched (Medline-Web of Science, PubMed, CINAHL, Embase and Scopus). Eligible studies were observational or interventional, reporting biomechanical gait outcomes for individual legs in adult lower limb amputees during flat walking, incline/decline walking or stair ascent/descent. Two reviewers screened for eligibility and level of agreement was assessed using Cohen's Kappa. Data extraction is ongoing. Risk of bias will be assessed using a modified Downs and Black method, and outcome measures will be descriptively synthesised. ETHICS AND DISSEMINATION There are no ethical considerations for this systematic review. Due to its scope, results are expected to be published in three separate manuscripts: (1) biomechanical risk factors of KOA between TTA and TFA, relative to non-amputees, (2) biomechanical risk factors of LBP between TTA and TFA, relative to non-amputees and (3) biomechanical risk factors of KOA and LBP between TTA with traumatic or dysvascular causes, relative to non-amputees. PROSPERO REGISTRATION NUMBER CRD42020158247.
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Affiliation(s)
- Logan Wade
- Department for Health, University of Bath, Bath, UK
| | | | - Carly McKay
- Department for Health, University of Bath, Bath, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
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Load applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with state-of-the-art prosthetic components. Clin Biomech (Bristol, Avon) 2021; 89:105457. [PMID: 34454327 DOI: 10.1016/j.clinbiomech.2021.105457] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study presented the load profile applied on transfemoral osseointegrated implants by bone-anchored prostheses fitted with state-of-the-art ÖSSUR microprocessor-controlled Rheo Knee XC and energy-storing-and-returning Pro-Flex XC or LP feet during five standardized daily activities. METHODS This cross-sectional cohort study included 13 participants fitted with a press-fit transfemoral osseointegrated implant. Loading data were directly measured with the tri-axial transducer of an iPecsLab (RTC Electronics, USA) fitted between the implant and knee unit. The loading profile was characterized by spatio-temporal gaits variables, magnitude of loading boundaries as well as onset and magnitude of loading extrema during walking, ascending and descending ramp and stairs. FINDINGS A total of 2127 steps was analysed. The cadence ranged between 36 ± 7 and 47 ± 6 strides/min. The absolute maximum force and moments applied across all activities was 1322 N, 388 N and 133 N as well as 22 Nm, 52 Nm and 88 Nm on and around the long, anteroposterior and mediolateral axes of the implant, respectively. INTERPRETATION This study provided new benchmark loading data applied by transfemoral bone-anchored prostheses fitted with selected ÖSSUR state-of-the-art components. Outcomes suggested that such prostheses can generate relevant loads at the interface with the osseointegrated implant to restore ambulation effectively. This study is a worthwhile contribution toward a systematic recording, analysis, and reporting of ecological prosthetic loading profiles as well as closing the evidence gaps between prescription and biomechanical benefits of state-of-the-art components. Hopefully, this will contribute to improve outcomes for growing number of individuals with limb loss opting for bionic solutions.
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Berg D, Frossard L. Health Service Delivery and Economic Evaluation of Limb Lower Bone-Anchored Prostheses: A Summary of the Queensland Artificial Limb Service's Experience. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:36210. [PMID: 37614998 PMCID: PMC10443483 DOI: 10.33137/cpoj.v4i2.36210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The emergence of skeletal prosthetic attachments leaves governmental organizations facing the challenge of implementing equitable policies that support the provision of bone-anchored prostheses (BAPs). In 2013, the Queensland Artificial Limb Service (QALS) started a five-year research project focusing on health service delivery and economic evaluation of BAPs. This paper reflects on the QALS experience, particularly the lessons learned. QALS' jurisdiction and drivers are presented first, followed by the impact of outcomes, barriers, and facilitators, as well as future developments of this work. The 21 publications produced during this project (e.g., reimbursement policy, role of prosthetists, continuous improvement procedure, quality of life, preliminary cost-utilities) were summarized. Literature on past, current, and upcoming developments of BAP was reviewed to discuss the practical implications of this work. A primary outcome of this project was a policy developed by QALS supporting up to 22 h of labor for the provision of BAP care. The indicative incremental cost-utility ratio for transfemoral and transtibial BAPs was approximately AUD$17,000 and AUD$12,000, respectively, per quality-adjusted life-year compared to socket prostheses. This project was challenged by 17 barriers (e.g., limited resources, inconsistency of care pathways, design of preliminary cost-utility analyses) but eased by 18 facilitators (e.g., action research plan, customized database, use of free repositories). In conclusion, we concluded that lower limb BAP might be an acceptable alternative to socket prostheses from an Australian government prosthetic care perspective. Hopefully, this work will inform promoters of prosthetic innovations committed to making bionic solutions widely accessible to a growing population of individuals suffering from limb loss worldwide.
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Affiliation(s)
- D Berg
- Queensland Artificial Limb Service, Brisbane, Australia
| | - L Frossard
- Your Research Project Pty Ltd, Brisbane, Australia
- Griffith University, Gold Coast, Australia
- University of the Sunshine Coast, Maroochydore, Australia
- Queensland University of Technology, Brisbane, Australia
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Guirao L, Samitier B, Frossard L. A Preliminary Cost-Utility Analysis of the Prosthetic Care Innovations: Case of the Keep Walking Implant. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:36366. [PMID: 37615003 PMCID: PMC10443520 DOI: 10.33137/cpoj.v4i2.36366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Several obstacles must be overcome before preliminary cost-utility analyses (CUA) of prosthetic care innovations can be routinely performed. The basic framework of preliminary CUAs and hands- on recommendations suggested previously might contribute to wider adoption. However, a practical application for an emerging intervention is needed to showcase the capacity of this proposed preliminary CUA framework. This study presented the outcomes of preliminary CUA of the distal weight bearing Keep Walking Implant (KWI), an emerging prosthetic care innovation that may reduce socket fittings for individuals with transfemoral amputation. The preliminary CUAs compared the provision of prosthetic care without (usual intervention) and with the KWI (new intervention) using a 15-step iterative process focused on feasibility, constructs, analysis, and interpretations of outcomes from an Australia government prosthetic care perspective over a six-year time horizon. Baseline and incremental costs were extracted from schedules of allowable expenses. Baseline utilities were extracted from a study and converted into quality-adjusted life-year (QALY). Incremental utilities were calculated based on sensible gains of QALY from baselines. The provision of the prosthetic care with the KWI could generate an indicative incremental cost-utility ratio (ICUR) of -$36,890 per QALY, which was $76,890 per QALY below willingness-to-pay threshold, provided that the KWI reduces costs by $17,910 while increasing utility by 0.485 QALY compared to usual interventions. This preliminary CUA provided administrators of healthcare organizations in Australia and elsewhere with prerequisite evidence justifying further access to market and clinical introduction of the KWI. Altogether, this work suggests that the basic framework of the preliminary CUA of a prosthetic care innovation proposed previously is feasible and informative when a series of assumptions are carefully considered. This study further confirms that preliminary CUAs prosthetic care interventions might be a relevant alternative to full CUA for other medical treatments.
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Affiliation(s)
- L Guirao
- Servicio de Rehabilitaión - Hospital Asepeyo Sant Cugat, Barcelona, Spain
| | - B Samitier
- Servicio de Rehabilitaión - Hospital Asepeyo Sant Cugat, Barcelona, Spain
| | - L Frossard
- YourResearchProject Pty Ltd, Brisbane, Australia
- Griffith University, Gold Coast, Australia
- University of the Sunshine Coast, Maroochydore, Australia
- Queensland University of Technology, Brisbane, Australia
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Walker JD, Pirschel F, Sundiang M, Niekrasz M, MacLean JN, Hatsopoulos NG. Chronic wireless neural population recordings with common marmosets. Cell Rep 2021; 36:109379. [PMID: 34260919 PMCID: PMC8513487 DOI: 10.1016/j.celrep.2021.109379] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022] Open
Abstract
Marmosets are an increasingly important model system for neuroscience in part due to genetic tractability and enhanced cortical accessibility, due to a lissencephalic neocortex. However, many of the techniques generally employed to record neural activity in primates inhibit the expression of natural behaviors in marmosets precluding neurophysiological insights. To address this challenge, we have developed methods for recording neural population activity in unrestrained marmosets across multiple ethological behaviors, multiple brain states, and over multiple years. Notably, our flexible methodological design allows for replacing electrode arrays and removal of implants providing alternative experimental endpoints. We validate the method by recording sensorimotor cortical population activity in freely moving marmosets across their natural behavioral repertoire and during sleep.
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Affiliation(s)
- Jeffrey D Walker
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL 60615, USA; Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL 60615, USA.
| | - Friederice Pirschel
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL 60615, USA
| | - Marina Sundiang
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL 60615, USA
| | - Marek Niekrasz
- Department of Surgery, University of Chicago, Chicago, IL 60615, USA; The University of Chicago Neuroscience Institute, University of Chicago, Chicago, IL 60615, USA
| | - Jason N MacLean
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL 60615, USA; Department of Neurobiology, University of Chicago, Chicago, IL 60615, USA; The University of Chicago Neuroscience Institute, University of Chicago, Chicago, IL 60615, USA
| | - Nicholas G Hatsopoulos
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL 60615, USA; Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL 60615, USA; The University of Chicago Neuroscience Institute, University of Chicago, Chicago, IL 60615, USA
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Hoellwarth JS, Tetsworth K, Rozbruch SR, Handal MB, Coughlan A, Al Muderis M. Osseointegration for Amputees: Current Implants, Techniques, and Future Directions. JBJS Rev 2021; 8:e0043. [PMID: 32224634 PMCID: PMC7161721 DOI: 10.2106/jbjs.rvw.19.00043] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Osseointegrated prostheses provide a rehabilitation option for amputees offering greater mobility, better satisfaction, and higher use than traditional socket prostheses. There are several different osseointegrated implant designs, surgical techniques, and rehabilitation protocols with their own strengths and limitations. The 2 most prominent risks, infection and periprosthetic fracture, do not seem unacceptably frequent or insurmountable. Proximal amputations or situations leading to reduced mobility are exceptionally infrequent. Osseointegrated implants can be attached to advanced sensory and motor prostheses.
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Affiliation(s)
- Jason Shih Hoellwarth
- Department of Orthopaedic Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Kevin Tetsworth
- Department of Orthopaedics, The Royal Brisbane Hospital, Brisbane, Victoria, Australia
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY
| | - M Brianne Handal
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Adam Coughlan
- Department of Orthopaedics, The Royal Brisbane Hospital, Brisbane, Victoria, Australia
| | - Munjed Al Muderis
- Department of Orthopaedic Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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13
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Safari R. Lower limb prosthetic interfaces: Clinical and technological advancement and potential future direction. Prosthet Orthot Int 2020; 44:384-401. [PMID: 33164655 DOI: 10.1177/0309364620969226] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, UK
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14
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Loading applied on osseointegrated implant by transtibial bone-anchored prostheses during daily activities: Preliminary characterization of prosthetic feet. ACTA ACUST UNITED AC 2020; 32:258-271. [PMID: 33013144 DOI: 10.1097/jpo.0000000000000280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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McMenemy L, Ramasamy A, Sherman K, Mistlin A, Phillip R, Evriviades D, Kendrew J. Direct Skeletal Fixation in bilateral above knee amputees following blast: 2 year follow up results from the initial cohort of UK service personnel. Injury 2020; 51:735-743. [PMID: 31932040 DOI: 10.1016/j.injury.2020.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/31/2019] [Accepted: 01/04/2020] [Indexed: 02/02/2023]
Abstract
AIMS The aim of the study is to evaluate the clinical outcome and complications from the initial cohort of blast injured bilateral lower limb, above knee amputees who underwent Direct Skeletal Fixation (DSF). PATIENTS AND METHODS We undertook a retrospective analysis of a prospective data base identifying patients who had undergone implantation with the Australian Osseointegration Group of Australia-Osseointegration Prosthetic Limb (OGAP-OPL) prosthesis, with minimum 24 months follow up. Patient demographics, injury profile, and polymicrobial colonisation status were recorded. Physical functional performance measures recorded were the 6 minute Walk Test (6-MWT) and patient reported outcome measures were the Short Form Health Survey-36 (SF-36). Post operatively, complications including infection, re-operation, and fracture were recorded. RESULTS 7 patients (14 femora) were identified (mean age 29.8yrs), all injured by dismounted blast. Mean follow up was 46 months. All were polytrauma patients and all had previous polymicrobial colonisation. Following surgery, all patients mobilised with significant improvement in 6-minute walk time, with a mean improvement of 154 m (248 m vs 402 m, p = 0.018). The physical component score for the SF-36 demonstrated a statistically significant improvement from 34.65 to 54.5 (p = 0.018) and the mental component score demonstrated a similar improvement (41.55-58.19 p = 0.018). At follow up, no patient required explantation of the implant. Each had been prescribed a minimum of 1 course of antibiotics with no evidence of deep infection. CONCLUSION DSF is an option for amputees who, due to the nature of their injuries, may not be able to tolerate traditional suspension socket prostheses and have exhausted all other treatment options. At a minimum of 2 year follow up, the absence of significant infective complications suggests DSF may be utilised in the blast injured despite chronic polymicrobial colonisation. Longer term surveillance of these patients is required to assess the long-term suitability of this technique in this cohort of patients.
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Affiliation(s)
- Louise McMenemy
- Centre for Blast Injury Studies, Bessemer Building, Imperial College London, South Kensington Campus, Exhibition Road, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
| | - Arul Ramasamy
- Centre for Blast Injury Studies, Bessemer Building, Imperial College London, South Kensington Campus, Exhibition Road, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
| | - Kate Sherman
- Defence Medical Rehabilitation Centre, Stanford Hall, Stanford on Soar, Loughborough LE12 5QW, UK.
| | - Alan Mistlin
- Defence Medical Rehabilitation Centre, Stanford Hall, Stanford on Soar, Loughborough LE12 5QW, UK.
| | - Rhodri Phillip
- Defence Medical Rehabilitation Centre, Stanford Hall, Stanford on Soar, Loughborough LE12 5QW, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
| | | | - Jon Kendrew
- Centre for Blast Injury Studies, Bessemer Building, Imperial College London, South Kensington Campus, Exhibition Road, London, UK; Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
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Load response of an osseointegrated implant used in the treatment of unilateral transfemoral amputation: An early implant loosening case study. Clin Biomech (Bristol, Avon) 2020; 73:201-212. [PMID: 32036173 DOI: 10.1016/j.clinbiomech.2020.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osseointegrated implants for transfemoral amputees facilitate direct load transfer between the prosthetic limb and femur; however, implant loosening is a common complication, and the associated implant-bone loads remain poorly understood. This case study aimed to use patient-specific computational modeling to evaluate bone-implant interface loading during standing and walking in a transfemoral amputee with an osseointegrated implant prior to prosthesis loosening and revision surgery. METHODS One male transfemoral amputee with an osseointegrated implant was recruited (age: 59-yrs, weight: 83 kg) and computed tomography (CT) performed on the residual limb approximately 3 months prior to implant failure. Gait analyses were performed, and the CT images used to develop a finite element model of the patient's implant and surrounding bone. Simulations of static weight bearing, and over-ground walking were then performed. FINDINGS During standing, maximum and minimum principal strains in trabecular bone adjacent to the implant were 0.26% and -0.30%, respectively. Strains generated at the instant of contralateral toe-off and contralateral heel strike during walking were substantially higher and resulted in local trabecular bone yielding. Specifically, the maximum and minimum principal strains in the thin layer of trabecular bone surrounding the distal end of the implant were 1.15% and -0.98%, respectively. INTERPRETATION Localised yielding of trabecular bone at the interface between the femur and implant in transfemoral amputee osseointegrated prosthesis recipients may present a risk of implant loosening due to periprosthetic bone fracture during walking. Rehabilitation exercises should aim to produce implant-bone loading that stimulates bone remodelling to provide effective bone conditioning prior to ambulation.
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17
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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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Affiliation(s)
- Laurent Frossard
- Griffith University, Gold Coast, QLD, Australia.,University of the Sunshine Coast, Maroochydore, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia.,YourResearchProject Pty Ltd, Brisbane, QLD, Australia
| | - Luciann Ferrada
- Queensland Artificial Limb Service, Brisbane, QLD, Australia
| | - Debra Berg
- Queensland Artificial Limb Service, Brisbane, QLD, Australia
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18
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Barnes SC, Clasper JC, Bull AMJ, Jeffers JRT. Micromotion and Push-Out Evaluation of an Additive Manufactured Implant for Above-the-Knee Amputees. J Orthop Res 2019; 37:2104-2111. [PMID: 31166039 DOI: 10.1002/jor.24389] [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: 01/25/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
In comparison to through-knee amputees the outcomes for above-the-knee amputees are relatively poor; based on this novel techniques have been developed. Most current percutaneous implant-based solutions for transfemoral amputees make use of high stiffness intramedullary rods for skeletal fixation, which can have risks including infection, femoral fractures, and bone resorption due to stress shielding. This work details the cadaveric testing of a short, cortical bone stiffness-matched subcutaneous implant, produced using additive manufacture, to determine bone implant micromotion and push-out load. The results for the micromotions were all <20 μm and the mean push-out load was 2,099 Newtons. In comparison to a solid control, the stiffness-matched implant exhibited significantly higher micromotion distributions and no significant difference in terms of push-out load. These results suggest that, for the stiffness-matched implant at time zero, osseointegration would be facilitated and that the implant would be securely anchored. For these metrics, this provides justification for the use of a short-stem implant for transfemoral amputees in this subcutaneous application. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2104-2111, 2019.
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Affiliation(s)
- Spencer C Barnes
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Jon C Clasper
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Defence Medical Group South East, Frimley Park Hospital, Camberley, United Kingdom
| | - Anthony M J Bull
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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19
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Radiographic Evaluation of Bone Remodeling Around Osseointegration Implants Among Transfemoral Amputees. J Orthop Trauma 2019; 33:e303-e308. [PMID: 30973503 DOI: 10.1097/bot.0000000000001488] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine periprosthetic bone remodeling among the recipients of 2 types of lower-limb osseointegrated systems, the Integral Leg Prosthesis (ILP) and the Osseointegration Prosthetic Limb (OPL) type A, over a >24-month period. DESIGN Retrospective cohort study. SETTING Private hospital, with a specialized osseointegration unit. PATIENTS Twenty-eight patients with transfemoral lower-limb amputations were fitted with osseointegrated systems. Of these patients, 15 received the ILP and 13 the OPL osseointegrated implant. INTERVENTION Radiographic measurements were taken at baseline (0.4 ± 0.5 years) and at follow-up (3.0 ± 0.8 years) after the osseointegration procedure. MAIN OUTCOME MEASUREMENTS Radiographic bone density, longitudinal bone coverage, and bone width outcomes were measured in inverse "Gruen zones." Bone remodeling was evaluated by comparing changes between baseline and follow-up measurements. RESULTS Radiographic bone density decreased in all zones among both ILP and OPL groups. Cortical bone thickness increased among the OPL group in zones 3 (P < 0.05) and 5 (P < 0.05). Distal bone coverage of the ILP implant decreased by 2.3% (P < 0.01) and 4.1% (P < 0.05) of the total implant length on the medial and lateral sides, respectively. CONCLUSIONS Decreased bone density with increased periprosthetic cortical thickness suggests a change in the bone architecture for the OPL group. The findings of this study raise concerns for the long-term success of the ILP implant. Radiographic analysis of x-rays seems to be a useful tool for clinicians to evaluate bone remodeling around osseointegrated prosthesis. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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20
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Matthews DJ, Arastu M, Uden M, Sullivan JP, Bolsakova K, Robinson K, Sooriakumaran S, Ward D. UK trial of the Osseointegrated Prosthesis for the Rehabilitation for Amputees: 1995-2018. Prosthet Orthot Int 2019; 43:112-122. [PMID: 30112981 DOI: 10.1177/0309364618791616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Amputation of a limb impacts on patients' self-perception and quality of life. Prostheses directly anchored to the skeleton are being investigated, aiming to avoid soft tissue complications. OBJECTIVES: We report outcome data for the UK trial of the Osseointegrated Prosthesis for the Rehabilitation of Amputees Implant System with a minimum of 9-year follow-up. METHODS: Eighteen transfemoral amputees received unilateral implants between 1997 and 2008. Five were implanted before a formalised protocol, called Osseointegrated Prosthesis for the Rehabilitation of Amputees, was developed. Mean follow-up of the Pre-Osseointegrated Prosthesis for the Rehabilitation of Amputees group is 11.4 years (1.8-18.6 years), while for the Post-Osseointegrated Prosthesis for the Rehabilitation of Amputees group it is 12.3 years (2.9-15.9). RESULTS: The Kaplan-Meier cumulative survivorship is 40% for the Pre-Osseointegrated Prosthesis for the Rehabilitation of Amputees group and 80.21% for the Post-Osseointegrated Prosthesis for the Rehabilitation of Amputees group. Five implants (28%) have been removed, three (17%) for deep infection, one (5.6%) for chronic pain, later proven to be infected and one (5.6%) due to implant fracture secondary to loosening due to infection. Two patients (11%) have peri-implant infections suppressed with oral antibiotics. Eleven cases (61%) of superficial infection were successfully treated with antibiotics. 36-Item short-form health survey and Questionnaire for persons with a Transfemoral Amputation showed significant improvements in quality of life up to 5 years after implantation. CONCLUSION: This small cohort of patients demonstrates osseointegrated prosthesis allows prolonged usage and improves patients' quality of life compared to conventional prostheses. CLINICAL RELEVANCE These prostheses may provide a future gold standard for amputees and this study provides the first outcome data over such a time period to be reported from outside of the developers group.
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Affiliation(s)
| | - Mateen Arastu
- 1 Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
| | - Maggie Uden
- 2 St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - David Ward
- 1 Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
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21
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Complications of bone-anchored prostheses for individuals with an extremity amputation: A systematic review. PLoS One 2018; 13:e0201821. [PMID: 30092081 PMCID: PMC6084937 DOI: 10.1371/journal.pone.0201821] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to provide an overview of device-related complications occurring in individuals with an upper or lower extremity amputation treated with a screw, press-fit or other type of bone-anchored implant as well as interventions related to these complications. METHOD A systematic literature search was conducted in the MEDLINE, Cochrane, EMBASE, CINAHL and Web of Science databases. The included studies reported on device-related complications and interventions occurring in individuals with bone-anchored prostheses. The outcomes evaluated were death, infection, bone/device breakage, implant loosening, soft tissue complications, systemic events, antibiotic and surgical treatment. Subgroup analyses were performed for the following groups: a) implant type (screw, press-fit and other types of implants) and b) level of amputation (transfemoral, transtibial and upper extremity amputation). RESULTS Of 309 studies, 12 cohort studies were eligible for inclusion, all of which had methodological shortcomings and 12 studies were excluded due to complete overlap of patient data. Implant infection were rare in certain transfemoral implants (screw: 2-11%, press-fit: 0-3%, Compress: 0%) but common in transtibial implants (29%). The same was observed for implant loosening, in transfemoral (screw: 6%, press-fit: 0-3%, Compress: 0%), transtibial implants (29%) as well as for upper extremity implants (13-23%). Intramedullary device breakage were rare in transfemoral implants (screw: 0%, press-fit: 1%, Compress: unknown) but frequent in individuals with transradial implants (27%) and absent in transtibial implants. Soft tissue infections and complications were common and underreported in most articles. CONCLUSIONS Major complications (e.g. implant infection, implant loosening and intramedullary device breakage) are rare in transfemoral bone-anchored prosthesis and seem to occur less frequently in individuals with press-fit implants. Minor complications, such as soft tissue infections and complications, are common but are substantially influenced by the learning curve, implant design and surgical technique. Data for patients treated with a transtibial, upper extremity or Compress implant are underreported, precluding definitive conclusions. There is a need for either an international database to report on or a standard core set of complications as well as the need to follow classification systems that result in unequivocal data.
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Pather S, Vertriest S, Sondergeld P, Ramis MA, Frossard L. Load characteristics following transfemoral amputation in individuals fitted with bone-anchored prostheses: a scoping review protocol. ACTA ACUST UNITED AC 2018; 16:1286-1310. [PMID: 29894396 DOI: 10.11124/jbisrir-2017-003398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
REVIEW QUESTION The main purpose of this scoping review is to characterize loading information applied on the residuum of individuals with transfemoral amputation fitted with an osseointegrated fixation for bone-anchored prostheses.The objectives of this scoping review are: i) to map the scope of loading variables, and ii) to report the range of magnitude of loads that has been directly measured using a portable kinetic recording apparatus fitted at the distal end of the residuum during rehabilitation exercises, standardized and unscripted activities of daily living, and adverse events.The specific review questions are.
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Affiliation(s)
- Shanthan Pather
- School of Chemistry, Physics and Mechanical Engineering, Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia
| | - Sofie Vertriest
- Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium
| | - Peter Sondergeld
- Library, Queensland University of Technology, Brisbane, Australia
| | - Mary-Anne Ramis
- CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence
| | - Laurent Frossard
- School of Exercise and Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,School of Health and Sport Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Australia
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23
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Frossard LA, Merlo G, Burkett B, Quincey T, Berg D. Cost-effectiveness of bone-anchored prostheses using osseointegrated fixation: Myth or reality? Prosthet Orthot Int 2018; 42:318-327. [PMID: 29119860 DOI: 10.1177/0309364617740239] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In principle, lower limb bone-anchored prostheses could alleviate expenditure associated with typical socket manufacturing and residuum treatments due to socket-suspended prostheses. OBJECTIVE This study reports (a) the incremental costs and (b) heath gain as well as (c) cost-effectiveness of bone-anchored prostheses compared to socket-suspended prostheses. STUDY DESIGN Retrospective individual case-controlled observations and systematic review. METHODS Actual costs were extracted from financial records and completed by typical costs when needed over 6-year time horizon for a cohort of 16 individuals. Health gains corresponding to quality-adjusted life-year were calculated using health-related quality-of-life data presented in the literature. RESULTS The provision of bone-anchored prostheses costed 21% ± 41% more but increased quality-adjusted life-years by 17% ± 5% compared to socket-suspended prostheses. The incremental cost-effectiveness ratio ranged between -$25,700 per quality-adjusted life-year and $53,500 per quality-adjusted life-year with indicative incremental cost-effectiveness ratio of approximately $17,000 per quality-adjusted life-year. Bone-anchored prosthesis was cost-saving and cost-effective for 19% and 88% of the participants, respectively. CONCLUSION This study indicated that bone-anchored prostheses might be an acceptable alternative to socket-suspended prostheses at least from a prosthetic care perspective in Australian context. Altogether, this initial evidence-based economic evaluation provided a working approach for decision makers responsible for policies around care of individuals with lower limb amputation worldwide. Clinical relevance For the first time, this study provided evidence-based health economic benefits of lower limb bone-anchored prostheses compared to typical socket-suspended prostheses from a prosthetic care perspective that is essential to clinicians and decision makers responsible for policies.
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Affiliation(s)
- Laurent Alain Frossard
- 1 Queensland University of Technology, Brisbane, QLD, Australia.,2 University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Gregory Merlo
- 1 Queensland University of Technology, Brisbane, QLD, Australia.,3 Australian Centre for Health Services Innovation, Brisbane, QLD, Australia
| | - Brendan Burkett
- 2 University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Tanya Quincey
- 4 Queensland Artificial Limb Service, Brisbane, QLD, Australia
| | - Debra Berg
- 4 Queensland Artificial Limb Service, Brisbane, QLD, Australia
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Hansson E, Hagberg K, Cawson M, Brodtkorb TH. Patients with unilateral transfemoral amputation treated with a percutaneous osseointegrated prosthesis: a cost-effectiveness analysis. Bone Joint J 2018; 100-B:527-534. [PMID: 29629586 DOI: 10.1302/0301-620x.100b4.bjj-2017-0968.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aims The aim of this study was to compare the cost-effectiveness of treatment with an osseointegrated percutaneous (OI-) prosthesis and a socket-suspended (S-) prosthesis for patients with a transfemoral amputation. Patients and Methods A Markov model was developed to estimate the medical costs and changes in quality-adjusted life-years (QALYs) attributable to treatment of unilateral transfemoral amputation over a projected period of 20 years from a healthcare perspective. Data were collected alongside a prospective clinical study of 51 patients followed for two years. Results OI-prostheses had an incremental cost per QALY gained of €83 374 compared with S-prostheses. The clinical improvement seen with OI-prostheses was reflected in QALYs gained. Results were most sensitive to the utility value for both treatment arms. The impact of an annual decline in utility values of 1%, 2%, and 3%, for patients with S-prostheses resulted in a cost per QALY gained of €37 020, €24 662, and €18 952, respectively, over 20 years. Conclusion From a healthcare perspective, treatment with an OI-prosthesis results in improved quality of life at a relatively high cost compared with that for S-prosthesis. When patients treated with S-prostheses had a decline in quality of life over time, the cost per QALY gained by OI-prosthesis treatment was considerably reduced. Cite this article: Bone Joint J 2018;100-B:527-34.
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Affiliation(s)
- E Hansson
- Institute of Health and Care Sciences, Sahlgrenska Academy University of Gothenburg, Medicinaregatan 3, Gothenburg 413 90, Sweden and Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - K Hagberg
- University of Gothenburg, Medicinaregatan 3, Gothenburg 413 90, Sweden and Advanced Reconstruction of Extremities and Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - M Cawson
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester M20 2LS, UK
| | - T H Brodtkorb
- RTI Health Solutions, Vällebergsv 9B, Ljungskile 459 30, Sweden
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Thesleff A, Brånemark R, Håkansson B, Ortiz-Catalan M. Biomechanical Characterisation of Bone-anchored Implant Systems for Amputation Limb Prostheses: A Systematic Review. Ann Biomed Eng 2018; 46:377-391. [PMID: 29327257 PMCID: PMC5809556 DOI: 10.1007/s10439-017-1976-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/28/2017] [Indexed: 01/06/2023]
Abstract
Bone-anchored limb prostheses allow for the direct transfer of external loads from the prosthesis to the skeleton, eliminating the need for a socket and the associated problems of poor fit, discomfort, and limited range of movement. A percutaneous implant system for direct skeletal attachment of an external limb must provide a long-term, mechanically stable interface to the bone, along with an infection barrier to the external environment. In addition, the mechanical integrity of the implant system and bone must be preserved despite constant stresses induced by the limb prosthesis. Three different percutaneous implant systems for direct skeletal attachment of external limb prostheses are currently clinically available and a few others are under investigation in human subjects. These systems employ different strategies and have undergone design changes with a view to fulfilling the aforementioned requirements. This review summarises such strategies and design changes, providing an overview of the biomechanical characteristics of current percutaneous implant systems for direct skeletal attachment of amputation limb prostheses.
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Affiliation(s)
- Alexander Thesleff
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Integrum AB, Mölndal, Sweden
| | - Rickard Brånemark
- International Centre for Osseointegration Research, Education and Surgery (iCORES), Department of Orthopaedics, University of California, San Francisco, CA, USA
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden
| | - Bo Håkansson
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Max Ortiz-Catalan
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
- Integrum AB, Mölndal, Sweden.
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Frossard L, Merlo G, Quincey T, Burkett B, Berg D. Development of a Procedure for the Government Provision of Bone-Anchored Prosthesis Using Osseointegration in Australia. PHARMACOECONOMICS - OPEN 2017; 1:301-314. [PMID: 29441506 PMCID: PMC5711750 DOI: 10.1007/s41669-017-0032-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Governmental organizations are facing challenges in adjusting procedures providing equitable assistance to consumers with amputation choosing newly available osseointegrated fixations for bone-anchored prostheses (BAPs) over socket-suspended prostheses. OBJECTIVES The aims of this study were to (1) present a procedure focusing on tasks, documents and costs of prosthetic care, and (2) share observed obstacles and facilitators to implementation. METHODS This research aimed at developing a governmental procedure for the provision of BAPs was designed as an action research study. A total of 18 individuals with transfemoral amputation solely funded by a Queensland State organization were considered. RESULTS The procedure, developed between January 2011 and June 2015, included seven processes involving fixed expenses during treatment and five processes regulating ongoing prosthetic care expenses. Prosthetic care required 22 h of labor, corresponding to AUD$3300 per patient, during rehabilitation. Prosthetists spend 64 and 36% of their time focusing on prosthetic care and other activities, respectively. The procedure required adjustments related to the scope of practice of prosthetists, funding of prosthetic limbs during rehabilitation, and allocation of microprocessor-controlled prosthetic knees. Approximately 41% (7) and 59% (10) of obstacles were within (e.g. streamlining systematic processes, sustaining evaluation of this complex procedure) or outside (e.g. early and consistent consultations of stakeholders, lack of a definitive rehabilitation program) governmental control, respectively, and approximately 89% (17) of the facilitators were within governmental control (e.g. adapting existing processes). CONCLUSION This study provides a working plan to stakeholders developing and implementing policies around the care of individuals choosing osseointegration for BAPs.
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Affiliation(s)
- Laurent Frossard
- Queensland University of Technology, Brisbane, QLD Australia
- University of the Sunshine Coast, Maroochydore, QLD Australia
| | - Gregory Merlo
- Queensland University of Technology, Brisbane, QLD Australia
- Australian Centre for Health Services and Innovation, Brisbane, QLD Australia
| | - Tanya Quincey
- Queensland Artificial Limb Service, Brisbane, QLD Australia
| | - Brendan Burkett
- University of the Sunshine Coast, Maroochydore, QLD Australia
| | - Debra Berg
- Queensland Artificial Limb Service, Brisbane, QLD Australia
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Hansen CH, Hansen RL, Jørgensen PH, Petersen KK, Norlyk A. The process of becoming a user of an osseointegrated prosthesis following transfemoral amputation: a qualitative study. Disabil Rehabil 2017; 41:276-283. [PMID: 28960110 DOI: 10.1080/09638288.2017.1385651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate what characterizes the process of becoming a user of an osseointegrated prosthesis following transfemoral amputation. METHOD The study is based on the descriptive phenomenological framework Reflective Lifeworld Research. Data were collected through in-depth interviews with seven participants who had undergone transfemoral implant surgery and currently used their osseointegrated prosthesis. Data were analyzed according to the guidelines given in Reflective Lifeworld Research. RESULTS The essential meaning of becoming a user of an osseointegrated prosthesis is characterized by determination to achieve rehabilitation results as well as a struggle to get familiar with the new prosthesis. When familiar with the prosthesis, participants begin to experience radical improvements in their everyday life, compared to their life with the socket suspended prosthesis. The essential meaning is elaborated on in four constituents: Determination to achieve rehabilitation results with the short training prosthesis, struggling to get familiar with the osseointegrated prosthesis, experiencing improvements in everyday life and reconnecting with one's prior self-perception. CONCLUSION All the participants experienced increased action space and a more positive outlook on life. However, it took determination and stamina to become a user of an osseointegrated prosthesis, and participants faced several challenges throughout this process. Consequently, it remains important to raise awareness of the difficulties faced during this process. Implications for Rehabilitation The findings from this study suggest an increased healthcare support to users of an transfemoral osseointegrated prosthesis in the period of rehabilitation and adjustment, as the results of being able to use the osseointegrated prosthesis may outweigh the obstacles of getting there. Implementation of long-term follow-up and psychosocial support initiatives may improve the adjustment process following osseointegration. Support of patients with an osseointegrated prosthesis may be facilitated through formation of specific rehabilitation groups together with increased use of information technology such as social media and relevant online communities which provide forums for interaction and dialog with people in similar situations.
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Affiliation(s)
- Cathrine Hjorth Hansen
- a Section for Nursing, Department of Public Health , Aarhus University , Aarhus , Denmark
| | - Rehne Lessman Hansen
- b Department of Orthopaedic Surgery , University Hospital of Aarhus , Aarhus , Denmark
| | | | - Klaus Kjaer Petersen
- b Department of Orthopaedic Surgery , University Hospital of Aarhus , Aarhus , Denmark
| | - Annelise Norlyk
- c Section for Nursing, Department of Public Health , Aarhus University/VIA University College , Aarhus , Denmark
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McGough RL, Goodman MA, Randall RL, Forsberg JA, Potter BK, Lindsey B. The Compress® transcutaneous implant for rehabilitation following limb amputation. Unfallchirurg 2017; 120:300-305. [DOI: 10.1007/s00113-017-0339-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vertriest S, Pather S, Sondergeld P, Ramis MA, Frossard L. Rehabilitation programs after the implantation of transfemoral osseointegrated fixations for bone-anchored prostheses: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:607-619. [PMID: 28267022 DOI: 10.11124/jbisrir-2016-003023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The primary objective of this scoping review is to characterize rehabilitation programs for individuals with transfemoral amputation following the implantation of screw-type or press-fit osseointegrated fixations for bone-anchored prostheses.The secondary objective of this review is to describe partial weight bearing exercises including static and dynamic exercises as well as use of walking aids in each rehabilitation program for screw-type and press-fit fixations.The third objective of this review is to compare key rehabilitation parameters for various partial weight bearing exercises (e.g. type of training prosthesis, loading time and progression, monitoring of loading, loading direction, instructions given to patients and the use of loading regulators) within each program for screw-type and press-fit fixations (intra-variability) and between programs for screw-type and press-fit fixations (inter-variability).The specific review questions are.
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Affiliation(s)
- Sofie Vertriest
- 1Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium 2Faculty of Science and Engineering, School of Mechanical, Manufacturing and Medical Engineering, Queensland University of Technology, Brisbane, Australia 3Library, Queensland University of Technology, Brisbane, Australia 4CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence, Queensland University of Technology, Brisbane, Australia 5Faculty of Health, School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia 6Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
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Leijendekkers RA, van Hinte G, Frölke JP, van de Meent H, Nijhuis-van der Sanden MWG, Staal JB. Comparison of bone-anchored prostheses and socket prostheses for patients with a lower extremity amputation: a systematic review. Disabil Rehabil 2016; 39:1045-1058. [PMID: 27494092 DOI: 10.1080/09638288.2016.1186752] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to provide an overview of a) the used measurement instruments in studies evaluating effects on quality of life (QoL), function, activity and participation level in patients with a lower extremity amputation using bone-anchored prostheses compared to socket prostheses and b) the effects themselves. METHOD A systematic literature search was conducted in MEDLINE, Cochrane, EMBASE, CINAHL and Web of Science. Included studies compared QoL, function, activity and/or participation level in patients with bone-anchored or socket prostheses. A best-evidence synthesis was performed. RESULTS Out of 226 studies, five cohort and two cross-sectional studies were eligible for inclusion, all had methodological shortcomings. These studies used 10 different measurement instruments and two separate questions to assess outcome. Bone-anchored prostheses were associated with better condition-specific QoL and better outcomes on several of the physical QoL subscales, outcomes on the physical bodily pain subscale were inconclusive. Outcomes on function and activity level increased, no change was found at participation level. The level of evidence was limited. CONCLUSIONS There is a need for a standard set of instruments. There was limited evidence that bone-anchored prostheses resulted in higher QoL, function and activity levels than socket prostheses, in patients with socket-related problems. Implications for Rehabilitation Use of bone-anchored prostheses in combination with intensive outpatient rehabilitation may improve QoL, function and activity level compared with socket prosthesis use in patients with a transfemoral amputation and socket-related problems. All clinicians and researchers involved with bone-anchored prostheses should use and publish data on QoL, function, activity and participation level. There needs to be an agreement on a standard set of instruments so that interventions for patients with a lower extremity amputation are assessed consistently.
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Affiliation(s)
- Ruud A Leijendekkers
- a Department of Orthopaedics , Physical Therapy, Radboud University Medical Centre , Nijmegen , The Netherlands.,b Master Clinical Health Sciences, Program in Physical Therapy Science , University Utrecht and University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Gerben van Hinte
- a Department of Orthopaedics , Physical Therapy, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Jan Paul Frölke
- c Department of Surgery , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Hendrik van de Meent
- d Department of Rehabilitation , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- a Department of Orthopaedics , Physical Therapy, Radboud University Medical Centre , Nijmegen , The Netherlands.,e Scientific Centre for Quality of Care, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - J Bart Staal
- e Scientific Centre for Quality of Care, Radboud University Medical Centre , Nijmegen , The Netherlands.,f Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences , Nijmegen , The Netherlands
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