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Welke B, Hurschler C, Schwarze M, Jakubowitz E, Aschoff HH, Örgel M. Comparison of conventional socket attachment and bone-anchored prosthesis for persons living with transfemoral amputation - mobility and quality of life. Clin Biomech (Bristol, Avon) 2023; 105:105954. [PMID: 37075546 DOI: 10.1016/j.clinbiomech.2023.105954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND For patients with transfemoral amputation experiencing issues with their sockets, bone-anchored prosthesis systems are an alternative and sometimes the only way to be mobile and independent. The present cross-sectional study aimed to investigate the gait performance and quality of life of a group of patients treated with bone-anchored systems compared to those of participants treated with a conventional socket-suspended prosthesis. METHODS A total of 17 participants with a socket-suspended and 20 with a bone-anchored prosthesis were included. Gait patterns were examined for symmetry, and performance was assessed using the six-minute walk test and the timed "Up & Go" test. Magnetic resonance imaging was performed to detect signs of osteoarthritis in both hips. Mobility in everyday life and quality of life were assessed using questionnaires. FINDINGS There were no differences between the groups regarding the quality of life, daily mobility, and gait performance. The step width was significantly higher for the patients using socket-suspended prosthesis. The socket-suspended group showed a significant asymmetry regarding the step length. In the socket-suspended group, the prosthetic leg showed significantly higher cartilage abrasion than the contralateral leg did. INTERPRETATION Large differences in the measured outcomes in both groups illustrate the very different capabilities of the individual participants, which is apparently not primarily determined by the type of treatment. For patients who are satisfied with the socket treatment and perform well, bone-anchored prosthesis systems may not necessarily improve their functional capabilities and perceived quality of life.
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Affiliation(s)
- Bastian Welke
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Eike Jakubowitz
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Horst-Heinrich Aschoff
- Department of Trauma, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Marcus Örgel
- Department of Trauma, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
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Bohart Z, Cassidy C, Merrill D, Villani M, Villani R, Cappabianca L, Pitkin M. Temporary Botulinum Immobilization of Residuum Muscles for Facilitation of the Initial Ingrowth of Skin to the Porous Skin and Bone Integrated Pylon in the Technology of Direct Skeletal Attachment: Large Animal Model. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:758238. [PMID: 35891709 PMCID: PMC9312073 DOI: 10.3389/fresc.2022.758238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022]
Abstract
Enhancing the technology of bone-anchored limb prosthetics, we present a modified porcine model for developing an infection-free integration between the skin and a percutaneous bone implant. The deeply porous Skin and Bone Integrated Pylon (SBIP) presented an infection-free skin-implant interface both after implantation into the dorsum and after implantation into the residuum after below-knee amputation. However, deep ingrowth of skin into the porous cladding of the SBIP was achieved better in the dorsal procedure, while implantation to the residuum sometimes developed a stoma, probably due to the high mobility of the skin and soft tissues in the pig's thigh. Uncontrolled high skin mobility during the first week after implantation constituted a limitation for the porcine animal model, which we tried to address in the current study. As our previous studies showed that casting of the leg residuum did not sufficiently limit the skin's movement around the implant, we tested a modified protocol of the implantation, which included injection of botulinum toxin into the thigh muscles. During the course of the study, we identified proper botulinum toxin componentry, dosage, and the period after injections to achieve a maximal effect of immobilization of the muscles affecting skin movements. To verify the immobilization, we used kinetic data on the asymmetry of loading during gait with the Strideway System, Tekscan, Inc., Boston, MA, USA. We found that injections in the four muscles of the distal thigh of the left hind leg with MYOBLOC® (rimabotulinumtoxinB; 5,000 units/muscle) were sufficient to provide noticeable immobilization by the fourth week after the procedure. This conclusion was made based on the analysis of the dynamics of asymmetry in vertical ground reactions on the injected (left hind) and uninvolved (right hind) legs during gait over an instrumented walkway.
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Affiliation(s)
- Zachary Bohart
- Department of Orthopaedics and Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA, United States
| | - Charles Cassidy
- Department of Orthopaedics and Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA, United States
| | - David Merrill
- DaVinci Biomedical Research Products, Lancaster, MA, United States
| | - Mario Villani
- DaVinci Biomedical Research Products, Lancaster, MA, United States
| | - Rosanna Villani
- DaVinci Biomedical Research Products, Lancaster, MA, United States
| | - Leo Cappabianca
- DaVinci Biomedical Research Products, Lancaster, MA, United States
| | - Mark Pitkin
- Department of Orthopaedics and Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA, United States
- Poly-Orth International, Sharon, MA, United States
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3
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Shevtsov M, Gavrilov D, Yudintceva N, Zemtsova E, Arbenin A, Smirnov V, Voronkina I, Adamova P, Blinova M, Mikhailova N, Galibin O, Akkaoui M, Pitkin M. Protecting the skin-implant interface with transcutaneous silver-coated skin-and-bone-integrated pylon in pig and rabbit dorsum models. J Biomed Mater Res B Appl Biomater 2020; 109:584-595. [PMID: 32935912 DOI: 10.1002/jbm.b.34725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/20/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
Implant-associated soft tissue infections at the skin-implant interface represent the most frequent complications in reconstructive surgery and lead to implant failures and revisions. Titanium implants with deep porosity, called skin-and-bone-integrated-pylons (SBIP), allow for skin ingrowth in the morphologically natural direction, thus restoring a reliable dermal barrier and reducing the risk of infection. Silver coating of the SBIP implant surface using physical vapor deposition technique offers the possibility of preventing biofilm formation and exerting a direct antimicrobial effect during the wound healing phase. In vivo studies employing pig and rabbit dorsum models for assessment of skin ingrowth into the pores of the pylon demonstrated the safety of transcutaneous implantation of the SBIP system. No postoperative complications were reported at the end of the follow-up period of 6 months. Histological analysis proved skin ingrowth in the minipig model without signs of silver toxicity. Analysis of silver release (using energy dispersive X-ray spectroscopy) in the model of intramedullary-inserted silver-coated SBIP in New Zealand rabbits demonstrated trace amounts of silver after 3 months of in-bone implantation. In conclusion, selected temporary silver coating of the SBIP implant surface is powerful at preventing the periprosthetic infections without imparing skin ingrowth and can be considered for clinical application.
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Affiliation(s)
- Maxim Shevtsov
- Department of Radiation Immuno-Oncology, Center for Translational Cancer Research Technische Universität München (TranslaTUM), Klinikum Rechts der Isar, Munich, Germany.,Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,Department of Biotechnology, First Pavlov State Medical University of St.Petersburg, St. Petersburg, Russia.,Department of Pediatric Neurosurgery, Almazov National Medical Research Centre, Russian Polenov Neurosurgical Institute, St. Petersburg, Russia.,Laboratory of Biomedical Cell Technologies, Far Eastern Federal University, Vladivostok, Russia
| | - Dmitriy Gavrilov
- Federal State Budgetary Institution "Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht" of the Ministry of Labour and Social Protection of the Russian Federation, St. Petersburg, Russia
| | - Natalia Yudintceva
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Elena Zemtsova
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | - Andrei Arbenin
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | - Vladimir Smirnov
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | | | - Polina Adamova
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - Miralda Blinova
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Nataliya Mikhailova
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Oleg Galibin
- Department of Biotechnology, First Pavlov State Medical University of St.Petersburg, St. Petersburg, Russia
| | | | - Mark Pitkin
- Tufts University, Boston, Massachusetts, USA.,Poly-Orth International, Sharon, Massachusetts, USA
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Gupta S, Lee HJ, Loh KJ, Todd MD, Reed J, Barnett AD. Noncontact Strain Monitoring of Osseointegrated Prostheses. SENSORS (BASEL, SWITZERLAND) 2018; 18:E3015. [PMID: 30205608 PMCID: PMC6164507 DOI: 10.3390/s18093015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/12/2018] [Accepted: 09/06/2018] [Indexed: 11/17/2022]
Abstract
The objective of this study was to develop a noncontact, noninvasive, imaging system for monitoring the strain and deformation states of osseointegrated prostheses. The proposed sensing methodology comprised of two parts. First, a passive thin film was designed such that its electrical permittivity increases in tandem with applied tensile loading and decreases while unloading. It was found that patterning the thin films could enhance their dielectric property's sensitivity to strain. The film can be deposited onto prosthesis surfaces as an external coating prior to implant. Second, an electrical capacitance tomography (ECT) measurement technique and reconstruction algorithm were implemented to capture strain-induced changes in the dielectric property of nanocomposite-coated prosthesis phantoms when subjected to different loading scenarios. The preliminary results showed that ECT, when coupled with strain-sensitive nanocomposites, could quantify the strain-induced changes in the dielectric property of thin film-coated prosthesis phantoms. The results suggested that ECT coupled with embedded thin films could serve as a new noncontact strain sensing method for scenarios when tethered strain sensors cannot be used or instrumented, especially in the case of osseointegrated prostheses.
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Affiliation(s)
- Sumit Gupta
- Department of Structural Engineering, University of California-San Diego, La Jolla, CA 92093-0085, USA.
| | - Han-Joo Lee
- Material Science and Engineering Program, University of California-San Diego, La Jolla, CA 92093-0085, USA.
| | - Kenneth J Loh
- Department of Structural Engineering, University of California-San Diego, La Jolla, CA 92093-0085, USA.
- Material Science and Engineering Program, University of California-San Diego, La Jolla, CA 92093-0085, USA.
| | - Michael D Todd
- Department of Structural Engineering, University of California-San Diego, La Jolla, CA 92093-0085, USA.
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5
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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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7
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Pitkin M, Cassidy C, Muppavarapu R, Raymond J, Shevtsov M, Galibin O, Rousselle SD. New method of fixation of in-bone implanted prosthesis. ACTA ACUST UNITED AC 2014; 50:709-22. [PMID: 24013918 DOI: 10.1682/jrrd.2012.11.0202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article presents results on the effectiveness of a new version of the titanium porous composite skin and bone integrated pylon (SBIP). The SBIP is designed for direct skeletal attachment of limb prostheses and was evaluated in a preclinical study with three rabbits. In accordance with the study protocol, a new version of the pylon (SBIP-3) was implanted into the hind leg residuum of three rabbits. The SBIP-3 has side fins that are designed to improve the bond between the bone and pylon. The fins are positioned inside two slots precut in the bone walls; their length can be adjusted to match the thickness of the bone walls. After 13 (animal 1) or 26 (animals 2 and 3) wk, the animals were sacrificed and samples collected for histopathological analysis. The space between the fins and the bone into which they were fit was filled with fibrovascular tissue and woven bone. No substantial inflammation was found. We suggest that if further studies substantiate the present results, the proposed method can become an alternative to the established technique of implanting prostheses into the medullary canal of the hosting bone.
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Affiliation(s)
- Mark Pitkin
- Physical Medicine and Rehabilitation, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111.
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8
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Welke B, Schwarze M, Hurschler C, Calliess T, Seehaus F. Multi-body simulation of various falling scenarios for determining resulting loads at the prosthesis interface of transfemoral amputees with osseointegrated fixation. J Orthop Res 2013; 31:1123-9. [PMID: 23494733 DOI: 10.1002/jor.22329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/31/2013] [Indexed: 02/04/2023]
Abstract
Conventionally, transfemoral amputees are treated with a shaft prosthesis fitted over the residual limb. To improve the quality of life of such patients, in particular those with complications relating to conventional attachment (e.g., skin irritation, stump ulcers, and poor motor-control with short stumps), osseointegrated prosthesis fixation implants have been developed and implanted in a limited population of patients. To assess possible damage to the implant/prosthesis during falling scenarios, the loads in high-risk situations were estimated using a multi-body simulation of motion. Five falling scenarios were identified and performed by healthy volunteer wearing safety equipment. Kinematic data and ground reaction forces were captured as input for the inverse-dynamics-based simulations, from which the forces and moments at a typical implant-prosthesis interface location were computed. The estimated peak loads in all five scenarios were of a magnitude that could lead to bone fracture. The largest peak force observed was 3274 ± 519 N, with an associated resultant moment of 176 ± 55 Nm on the prosthesis-implant interface. A typical femur is prone to fracture under this load, thus illustrating the need for a safety-release element in osseointegrated prosthesis fixation.
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Affiliation(s)
- Bastian Welke
- Laboratory for Biomechanics and Biomaterials, Department of Orthopedics, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
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9
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Fox JD, Capadona JR, Marasco PD, Rowan SJ. Bioinspired Water-Enhanced Mechanical Gradient Nanocomposite Films That Mimic the Architecture and Properties of the Squid Beak. J Am Chem Soc 2013; 135:5167-74. [DOI: 10.1021/ja4002713] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Justin D. Fox
- Department of Macromolecular
Science and Engineering, Case Western Reserve University, 2100 Adelbert Road, Kent Hale Smith Building, Cleveland, Ohio 44106-7202,
United States
| | - Jeffrey R. Capadona
- Department
of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther
King Jr. Drive, Wickenden Building, Cleveland, Ohio 44106, United
States
- Advanced Platform
Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard
151 W/APT, Cleveland, Ohio 44106-1702, United
States
| | - Paul D. Marasco
- Advanced Platform
Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard
151 W/APT, Cleveland, Ohio 44106-1702, United
States
| | - Stuart J. Rowan
- Department of Macromolecular
Science and Engineering, Case Western Reserve University, 2100 Adelbert Road, Kent Hale Smith Building, Cleveland, Ohio 44106-7202,
United States
- Department
of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther
King Jr. Drive, Wickenden Building, Cleveland, Ohio 44106, United
States
- Department of Chemistry, Case Western Reserve University, Cleveland, Ohio 44106,
United States
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10
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Frossard L. Biomechanical analyses of the performance of Paralympians: from foundation to elite level. Interview by Sarah A. Curran. Prosthet Orthot Int 2012; 36:380-95. [PMID: 22918919 DOI: 10.1177/0309364612453257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A biomechanical analysis of sports performance provides an objective method of determining performance of a particular sporting technique. In particular, it aims to add to the understanding of the mechanisms influencing performance, characterization of athletes and provide insights into injury predisposition. While the performance in sport of able-bodied athletes is well recognized in the literature, less information and understanding are known on the complexity, constraints and demands placed on the body of an individual with a disability. This article provides a dialogue that outlines scientific issues of the performance analysis of multi-level athletes with a disability, including Paralympians. Four integrated themes are explored, the first of which focuses on how biomechanics can contribute to the understanding of sports performance in athletes with a disability and how it may be used as an evidence-based tool. This latter point questions the potential for a possible cultural shift led by the emergence of user-friendly instruments. The second theme briefly discusses the role of reliability of sports performance and addresses the debate of two-dimensional and three-dimensional analyses. The third theme addresses key biomechanical parameters and provides guidance to clinicians and coaches on the approaches adopted using the biomechanical/sports performance analysis for an athlete with a disability starting out, to the emerging and elite Paralympian. For completeness of this discourse, the final theme is based on the controversial issues on the role of assisted devices, and the inclusion of Paralympians into able-bodied sport. All combined, this dialogue highlights the intricate relationship between biomechanics and training of individuals with a disability. Furthermore, it illustrates the complexity of modern training of athletes, which can only lead to a better appreciation of the performances to be delivered in the London 2012 Paralympic Games.
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Affiliation(s)
- Laurent Frossard
- Wales Centre for Podiatric Studies, Cardiff Metropolitan University, Cardiff, UK
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Pitkin M, Cassidy C, Muppavarapu R, Edell D. Recording of electric signal passing through a pylon in direct skeletal attachment of leg prostheses with neuromuscular control. IEEE Trans Biomed Eng 2012; 59:1349-53. [PMID: 22345523 DOI: 10.1109/tbme.2012.2187784] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Direct recordings were made of electrical signals emanating from the muscles in a rabbit's residuum. The signals were transmitted via wires attached on one end to the muscles, and on the other to an external recording system. The cable was held in a titanium tube inside a pylon that had been transcutaneously implanted into the residuum's bone. The tube was surrounded by porous titanium cladding to enhance its bond with the bone and with the skin of the residuum. This study was the first known attempt to merge the technology of direct skeletal attachment of limb prostheses with the technology of neuromuscular control of prostheses, providing a safe and reliable passage of the electrical signal from the muscles inside the residuum to the outside recording system.
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Affiliation(s)
- M Pitkin
- Department of Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA 02111, USA.
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12
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Pitkin M, Pilling J, Raykhtsaum G. Mechanical properties of totally permeable titanium composite pylon for direct skeletal attachment. J Biomed Mater Res B Appl Biomater 2012; 100:993-9. [PMID: 22287509 DOI: 10.1002/jbm.b.32663] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 09/16/2011] [Accepted: 11/27/2011] [Indexed: 11/11/2022]
Abstract
Composite pylons containing a solid titanium core with drilled holes surrounded by a porous sintered titanium shell have been fabricated and tested in bending along with the raw cores and pylons composed of the porous titanium alone. The new pylons were designed with the concept of enhanced in-growth of bone and skin cells and are intended for direct skeletal attachment of limb prostheses considering requirements for long-lasting anchorage to the residuum bone and a need for a safe skin-implant seal. Load-displacement thresholds were determined after which the integrity of the porous component may be compromised. The composite pylons have a flexural strength and stiffness substantially greater than that of pylons composed of the porous titanium alone. The drilled holes in the solid insert have been shown to have virtually no effect on the flexural strength of the pylon, while meeting a requirement for total permeability of the device for unrestricted cell ingrowth. The predicted strength of the pylons and associated failure modes are in close agreement with those measured.
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Affiliation(s)
- M Pitkin
- Tufts University, Boston, Massachusetts 02111, USA.
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13
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Collinger JL, Dicianno BE, Weber DJ, Cui XT, Wang W, Brienza DM, Boninger ML. Integrating rehabilitation engineering technology with biologics. PM R 2011; 3:S148-57. [PMID: 21703573 DOI: 10.1016/j.pmrj.2011.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 03/08/2011] [Indexed: 12/23/2022]
Abstract
Rehabilitation engineers apply engineering principles to improve function or to solve challenges faced by persons with disabilities. It is critical to integrate the knowledge of biologics into the process of rehabilitation engineering to advance the field and maximize potential benefits to patients. Some applications in particular demonstrate the value of a symbiotic relationship between biologics and rehabilitation engineering. In this review we illustrate how researchers working with neural interfaces and integrated prosthetics, assistive technology, and biologics data collection are currently integrating these 2 fields. We also discuss the potential for further integration of biologics and rehabilitation engineering to deliver the best technologies and treatments to patients. Engineers and clinicians must work together to develop technologies that meet clinical needs and are accessible to the intended patient population.
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Affiliation(s)
- Jennifer L Collinger
- Department of Veterans Affairs, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, 6425 Penn Avenue, 4th floor, Pittsburgh, PA 15206, USA
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14
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Pantall A, Durham S, Ewins D. Surface electromyographic activity of five residual limb muscles recorded during isometric contraction in transfemoral amputees with osseointegrated prostheses. Clin Biomech (Bristol, Avon) 2011; 26:760-5. [PMID: 21474221 DOI: 10.1016/j.clinbiomech.2011.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 01/09/2011] [Accepted: 03/14/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoral osseointegrated implants represent a new development in amputee rehabilitation, eliminating socket pressure discomfort, improving hip range of movement and facilitating prosthetic limb attachment. A clinical aspect that has not previously been reported on is the function of muscles in the residuum with implications concerning energy expenditure, hip-hiking and viability of the electrogram as a myoprocessor. Typically, amputees fitted with osseointegrated fixation have shorter residuums and weaker attachment of cleaved muscles. Function of muscle can be assessed by surface electromyography through changes in amplitude and median frequency of the signal. METHODS Five male transfemoral amputees with osseointegrated fixations participated together with a control group comprised of ten adult males. Electrodes recorded surface electromyographic activity of five residual limb muscles or left lower limb muscles of control subjects. Isometric contractions were performed against resistance. The increase in mean rectified amplitude from resting to maximally contracting was calculated and median frequencies estimated. FINDINGS The amputees were unable to maintain a maximum voluntary contraction of constant amplitude. Amplitude increase was lowest for rectus femoris and adductor magnus. The median frequency of adductor magnus was significantly greater (P=0.02) for the amputees than intact subjects and there was a significant difference (P<0.01) between gluteus maximus and adductor magnus for amputee subjects. INTERPRETATION High electromyographic amplitude variability suggests that using residuum muscles singly as a myoprocessor might be challenging. Adductor magnus displayed a different sEMG profile compared to intact subjects indicating decreased function and neuromuscular changes. Further work into optimal muscle anchorage is required to ensure maximal mechanical performance.
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Affiliation(s)
- Annette Pantall
- Georgia Institute of Technology, Atlanta , GA 30332–0356, USA.
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15
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Lundberg M, Hagberg K, Bullington J. My prosthesis as a part of me: a qualitative analysis of living with an osseointegrated prosthetic limb. Prosthet Orthot Int 2011; 35:207-14. [PMID: 21697203 DOI: 10.1177/0309364611409795] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bone-anchored prosthesis is still a rather unusual treatment for patients with limb loss. OBJECTIVES The aim of this study was to improve our understanding about the experience of living with an osseointegrated prosthesis (OI-prosthesis) compared to one suspended with a socket, through the use of qualitative research methodology. STUDY DESIGN A qualitative phenomenological research method. METHODS Thirteen Swedish patients (37-67 years) with unilateral upper or lower limb amputation (10 transfemoral, 2 transhumeral, 1 transradial), who had been using OI-prostheses for 3 to 15 years, were recruited by means of purposive sampling. An audio-taped in-depth interview was performed. The guiding question was 'How do you experience living with your osseointegrated prosthesis compared to your earlier prostheses suspended with sockets?'. The empirical phenomenological psychological method was used for data analysis. RESULTS The results showed that all participants described living with an OI-prosthesis as a revolutionary change. These experiences were described in terms of three typologies, called 'Practical prosthesis', 'Pretend limb' and 'A part of me'. CONCLUSIONS The most important finding was that the change went beyond the functional improvements, integrating the existential implications in the concept of quality of life. CLINICAL RELEVANCE This qualitative in-depth interview study on patients using bone-anchored prosthetic limbs showed that all described a revolutionary change in their lives as amputees and the meaning of that change went beyond the functional improvements, integrating existential implications in the concept of quality of life.
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Affiliation(s)
- Mari Lundberg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Frossard L, Stevenson N, Sullivan J, Uden M, Pearcy M. Categorization of Activities of Daily Living of Lower Limb Amputees During Short-Term Use of a Portable Kinetic Recording System: A Preliminary Study. ACTA ACUST UNITED AC 2011. [DOI: 10.1097/jpo.0b013e318207914c] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frossard LA. Load on osseointegrated fixation of a transfemoral amputee during a fall: Determination of the time and duration of descent. Prosthet Orthot Int 2010; 34:472-87. [PMID: 20961183 DOI: 10.3109/03093646.2010.520057] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mitigation of fall-related injuries for populations of transfemoral amputees fitted with a socket or an osseointegrated fixation is challenging. Wearing a protective device fitted within the prosthesis might be a possible solution, provided that issues with automated fall detection and time of deployment of the protective mechanism are solved. The first objective of this study was to give some examples of the times and durations of descent during a real forward fall of a transfemoral amputee that occurred inadvertently while attending a gait measurement session to assess the load applied on the residuum. The second objective was to present five semi-automated methods of detection of the time of descent using the load data. The load was measured directly at 200 Hz using a six-channel transducer. The average time and duration of descent were 242 ± 42 ms (145-310 ms) and 619 ± 42 ms (550-715 ms), respectively. This study demonstrated that the transition between walking and falling was characterized by times of descent that occurred sequentially. The sensitivity and specificity of an automated algorithm might be improved by combining several methods of detection based on the deviation of the loads measured from their own trends and from a template previously established.
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Affiliation(s)
- Laurent Alain Frossard
- Département de Kinanthropologie, Université du Québec à Montréal, Montréal, Quebec, Canada.
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18
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Frossard LA, Tranberg R, Haggstrom E, Pearcy M, Brånemark R. Load on osseointegrated fixation of a transfemoral amputee during a fall: loading, descent, impact and recovery analysis. Prosthet Orthot Int 2010; 34:85-97. [PMID: 20196690 DOI: 10.3109/03093640903585024] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Falling represents a health risk for lower limb amputees fitted with an osseointegrated fixation mainly because of the potential damage to the fixation. The purpose of this study was to characterize a real forward fall that occurred inadvertently to a transfemoral amputee fitted with an osseointegrated fixation while attending a gait measurement session to assess the load applied on the residuum. The objective was to analyze the load applied on the fixation with an emphasis on the sequence of events, the pattern and the magnitude of the forces and moments. The load was measured directly at 200 Hz using a six-channel transducer. Complementary video footage was also studied. The fall was divided into four phases: Loading (240 ms), descent (620 ms), impact (365 ms) and recovery (2495 ms). The main impact forces and moments occurred 870 ms and 915 ms after the heel contact, and corresponded to 133% BW and 17 % BWm, or 1.2 and 11.2 times the maximum forces and moments applied during the previous steps of the participant, respectively. This study provided key information to engineers and clinicians facing the challenge to design equipment, and rehabilitation and exercise programs to restore safely the locomotion of lower limb amputees.
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Affiliation(s)
- Laurent Alain Frossard
- Centre for Health Innovation and Solutions, The University of Queensland, Herston, Australia.
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19
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Frossard L, Gow DL, Hagberg K, Cairns N, Contoyannis B, Gray S, Brånemark R, Pearcy M. Apparatus for monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation: a proof-of-concept study. Gait Posture 2010; 31:223-8. [PMID: 19926285 DOI: 10.1016/j.gaitpost.2009.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 10/06/2009] [Accepted: 10/20/2009] [Indexed: 02/02/2023]
Abstract
The purpose of this proof-of-concept study was to determine the relevance of direct measurements to monitor the load applied on the osseointegrated fixation of transfemoral amputees during static load bearing exercises. The objectives were (A) to introduce an apparatus using a three-dimensional load transducer, (B) to present a range of derived information relevant to clinicians, (C) to report on the outcomes of a pilot study and (D) to compare the measurements from the transducer with those from the current method using a weighing scale. One transfemoral amputee fitted with an osseointegrated implant was asked to apply 10 kg, 20 kg, 40 kg and 80 kg on the fixation, using self-monitoring with the weighing scale. The loading was directly measured with a portable kinetic system including a six-channel transducer, external interface circuitry and a laptop. As the load prescribed increased from 10 kg to 80 kg, the forces and moments applied on and around the antero-posterior axis increased by four-fold anteriorly and 14-fold medially, respectively. The forces and moments applied on and around the medio-lateral axis increased by nine-fold laterally and 16-fold from anterior to posterior, respectively. The long axis of the fixation was overloaded and underloaded in 17% and 83% of the trials, respectively, by up to + or - 10%. This proof-of-concept study presents an apparatus that can be used by clinicians facing the challenge of improving basic knowledge on osseointegration, for the design of equipment for load bearing exercises and for rehabilitation programs.
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Affiliation(s)
- Laurent Frossard
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia.
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Pitkin M, Raykhtsaum G, Pilling J, Shukeylo Y, Moxson V, Duz V, Lewandowski J, Connolly R, Kistenberg RS, Dalton JF, Prilutsky B, Jacobson S. Mathematical modeling and mechanical and histopathological testing of porous prosthetic pylon for direct skeletal attachment. ACTA ACUST UNITED AC 2009; 46:315-30. [PMID: 19675985 DOI: 10.1682/jrrd.2008.09.0123] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article presents recent results in the development of the skin and bone integrated pylon (SBIP) intended for direct skeletal attachment of limb prostheses. In our previous studies of the porous SBIP-1 and SBIP-2 prototypes, the bond site between the porous pylons and residuum bone and skin did not show the inflammation characteristically observed when solid pylons are used. At the same time, porosity diminished the strength of the pylon. To find a reasonable balance between the biological conductivity and the strength of the porous pylon, we developed a mathematical model of the composite permeable structure. A novel manufacturing process was implemented, and the new SBIP-3 prototype was tested mechanically. The minimal strength requirements established earlier for the SBIP were exceeded threefold. The first histopathological analysis of skin, bone, and the implanted SBIP-2 pylons was conducted on two rats and one cat. The histopathological analysis provided new evidence of inflammation-free, deep ingrowth of skin and bone cells throughout the SBIP structure.
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Affiliation(s)
- Mark Pitkin
- Tufts University School of Medicine, Physical Medicine and Rehabilitation, Boston, MA 02111, USA.
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