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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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2
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Pitkin M. Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment. EC ORTHOPAEDICS 2018; 9:285-292. [PMID: 30198026 PMCID: PMC6124505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Using the marrow canal of a tubular bone as a holding compartment for implant stems has been the paradigm in total joint arthroplasty for more than a century, and for direct skeletal attachment of limb prostheses for about forty years. Both interventions rely on the osteogenesis in the inner walls of the marrow canal in a direction radially inwards. It so remains despite the frequent aseptic loosening of the implant stems caused by the resorption of the marrow canal's inner walls which increases the canal's diameter and reduces its capacity to hold the implant. MATERIALS AND METHODS To improve the bone-device bond, we suggest an implantation methodology that activates positive osteogenic remodeling in the circular direction rather than radially inwards. The rationale is that circular osteogenesis is a component of natural healing of bone fractures and its activating may mitigate the consequences of resorption caused by stress shielding, bone developmental growth and other factors. RESULTS Circular osteogenesis occurs in response to the distraction of slots precut into the bone tube. We call this methodology distraction implantation (DI) because of its debt to Ilizarov type distraction osteogenesis (DO). The methodology is accompanied by a design of an implant stem, and has been investigated in a previous pilot animal study. CONCLUSION Distraction implantation is based on a component of natural healing of bone fractures and therefore has merit to be investigated further.
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Affiliation(s)
- Mark Pitkin
- Professor of Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, MA, USA
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Zemtsova EG, Yudintceva NM, Morozov PE, Valiev RZ, Smirnov VM, Shevtsov MA. Improved osseointegration properties of hierarchical microtopographic/nanotopographic coatings fabricated on titanium implants. Int J Nanomedicine 2018; 13:2175-2188. [PMID: 29692612 PMCID: PMC5903495 DOI: 10.2147/ijn.s161292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Titanium (Ti) implants are extensively used in reconstructive surgery and orthopedics. However, the intrinsic inertness of untreated Ti implants usually results in insufficient osseointegration. In order to improve the osteoconductivity properties of the implants, they are coated with hierarchical microtopographic/nanotopographic coatings employing the method of molecular layering of atomic layer deposition (ML-ALD). Results The analysis of the fabricated nanostructured relief employing scanning electron microscopy, atomic force microscopy, and electron spectroscopy for chemical analysis clearly demonstrated the formation of the nanotopographic (<100 nm) and microtopographic (0.1–0.5 μm) titano-organic structures on the surface of the nanograined Ti implants. Subsequent coincubation of the MC3T3-E1 mouse osteoblasts on the microtopographic/nanotopographic surface of the implants resulted in enhanced osteogenic cell differentiation (the production of alkaline phosphatase, osteopontin, and osteocalcin). In vivo assessment of the osseointegrative properties of the microtopographically/nanotopographically coated implants in a model of below-knee amputation in New Zealand rabbits demonstrated enhanced new bone formation in the zone of the bone–implant contact (as measured by X-ray study) and increased osseointegration strength (removal torque measurements). Conclusion The fabrication of the hierarchical microtopographic/nanotopographic coatings on the nanograined Ti implants significantly improves the osseointegrative properties of the intraosseous Ti implants. This effect could be employed in both translational and clinical studies in orthopedic and reconstructive surgery.
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Affiliation(s)
| | - Natalia M Yudintceva
- Institute of Cytology of the Russian Academy of Sciences (RAS), St Petersburg, Russia
| | | | | | | | - Maxim A Shevtsov
- Institute of Cytology of the Russian Academy of Sciences (RAS), St Petersburg, Russia.,Pavlov First Saint Petersburg State Medical University, St Petersburg, Russia.,Polenov Russian Scientific Research Institute of Neurosurgery, Almazov National Medical Research Centre, St Petersburg, Russia.,Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Shevtsov MA, Yudintceva NM, Blinova MI, Voronkina IV, Suslov DN, Galibin OV, Gavrilov DV, Akkaoui M, Raykhtsaum G, Albul AV, Pitkin E, Pitkin M. Evaluation of the temporary effect of physical vapor deposition silver coating on resistance to infection in transdermal skin and bone integrated pylon with deep porosity. J Biomed Mater Res B Appl Biomater 2018; 107:169-177. [PMID: 29573163 DOI: 10.1002/jbm.b.34108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/13/2018] [Accepted: 02/18/2018] [Indexed: 02/06/2023]
Abstract
Periprosthetic infection via skin-implant interface is a leading cause of failures and revisions in direct skeletal attachment of limb prostheses. Implants with deep porosity fabricated with skin and bone integrated pylons (SBIP) technology allow for skin ingrowth through the implant's structure creating natural barrier against infection. However, until the skin cells remodel in all pores of the implant, additional care is required to prevent from entering bacteria to the still nonoccupied pores. Temporary silver coating was evaluated in this work as a means to provide protection from infection immediately after implantation followed by dissolution of silver layer in few weeks. A sputtering coating with 1 µm thickness was selected to be sufficient for fighting infection until the deep ingrowth of skin in the porous structure of the pylon is completed. In vitro study showed less bacterial (Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa) growth on silver coated tablets compared to the control group. Analysis of cellular density of MG-63 cells, fibroblasts, and mesenchymal stem cells (MSCs) showed that silver coating did not inhibit the cell growth on the implants and did not affect cellular functional activity. The in vivo study did not show any postoperative complications during the 6-month observation period in the model of above-knee amputation in rabbits when SBIP implants, either silver-coated or untreated were inserted into the bone residuum. Three-phase scintigraphy demonstrated angiogenesis in the pores of the pylons. The findings suggest that a silver coating with well-chosen specifications can increase the safety of porous implants for direct skeletal attachment. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 169-177, 2019.
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Affiliation(s)
- Maxim A Shevtsov
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,Technical University of Munich, Munich, Germany.,Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia.,Polenov Russian Scientific Research Institute of Neurosurgery, St. Petersburg, Russia
| | - Natalia M Yudintceva
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Miralda I Blinova
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Irina V Voronkina
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Dmitriy N Suslov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Oleg V Galibin
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Dmitriy V Gavrilov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | | | | | - Andrey V Albul
- Veterinary Clinic "Neurology, Traumatology and Intensive Therapy of Doctor Sotnikov V.V.,", St. Petersburg, Russia
| | - Emil Pitkin
- Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark Pitkin
- Poly-Orth International, Sharon, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
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Prochor P, Sajewicz E. A comparative analysis of internal bone remodelling concepts in a novel implant for direct skeletal attachment of limb prosthesis evaluation: A finite element analysis. Proc Inst Mech Eng H 2018; 232:289-298. [DOI: 10.1177/0954411917751003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nowadays, numerous internal bone remodelling concepts are under development, in order to estimate long-term functionality of implants by evaluating the intensity of stress-shielding effect. This effect is also analysed for the implants for direct skeletal attachment, considered as a better exoprosthesis fixation method than prosthetic sockets. Most of bone remodelling approaches are based on basic concepts, differing with certain assumptions, which may affect the accuracy of the results. This article compares commonly used internal bone remodelling concepts and evaluates the functionality of the proposed Limb Prosthesis Osseointegrated Fixation System for direct skeletal attachment of limb prosthesis in comparison with two currently available implants: the Intraosseous Transcutaneous Amputation Prosthesis and the Osseointegrated Prostheses for the Rehabilitation of Amputees. Three concepts were chosen: without and with lazy zone and with the use of quadratic formula which considers bone overloading. Therefore, three finite element models were created with identical femur implanted with each of analysed implants. The implants were loaded with loads that refer to two stages of gait cycle (heel strike and toe-off). The analysed concepts have given similar results, allowing to assume that each of them can be successfully used to estimate internal bone remodelling around analysed implants for direct skeletal attachment of limb prosthesis. The results also present higher functionality of the proposed implant for direct skeletal attachment of limb prosthesis due to a significant reduction in stress-shielding in the analysed areas around implant in comparison with the Intraosseous Transcutaneous Amputation Prosthesis and the Osseointegrated Prostheses for the Rehabilitation of Amputees. It suggests that the proposed design is a better alternative to the currently used solutions.
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Affiliation(s)
- Piotr Prochor
- Department of Biocybernetics and Biomedical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Bialystok, Poland
| | - Eugeniusz Sajewicz
- Department of Biocybernetics and Biomedical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Bialystok, Poland
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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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8
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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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Shevtsov MA, Yudintceva NM, Blinova MI, Pinaev GP, Galibin OV, Potokin IL, Popat KC, Pitkin MR. Application of the skin and bone integrated pylon with titanium oxide nanotubes and seeded with dermal fibroblasts. Prosthet Orthot Int 2015; 39:477-86. [PMID: 25249382 PMCID: PMC4370813 DOI: 10.1177/0309364614550261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 08/06/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Direct skeletal attachment of limb prostheses is associated with high rate of transcutaneous infection and loosening of the fixture in the medullary canal prompting for careful assessment of various means for enhancing the skin-device and bone-device interface. The skin and bone integrated pylon system constitutes a technological platform for different modifications being evaluated previously. OBJECTIVES The current study assessed the combination of nano-treatment skin and bone integrated pylon with its pre-seeding with dermal fibroblasts. We hypothesized that this combination will enhance cell interaction with skin and bone integrated pylon compared to nano-treatment and the fibroblast seeding when done separately. STUDY DESIGN The feasibility and safety of in-bone implantation of the skin and bone integrated pylon with nanotubes was investigated in vitro and in vivo in the animal model. METHODS TiO2 nanotubes were fabricated on the skin and bone integrated pylon, and the fibroblasts taken from rabbit's skin were cultured on the pylons before implantation. RESULTS The in vitro experiments demonstrated higher cellular density in the samples with a nanotubular surface than in the non-modified pylons used as control. There were no postoperative complications in any of the animals during the 6-month observation period. Subsequent scanning electron microscopy of the pylon extracted from the rabbit's femur showed the stable contact between the pylon and soft tissues in comparison to control samples where the patchy fibrovascular ingrowth was detected. CONCLUSION The promising results prompt further investigation of the integrative properties of the nanotextured skin and bone integrated pylon system seeded with dermal fibroblasts and its optimization for clinical application. CLINICAL RELEVANCE The study is devoted to the development of more safe and efficient technology of direct skeletal attachment of limb prostheses aimed in improving quality of life of people with amputations.
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Affiliation(s)
- Maxim A. Shevtsov
- Institute of cytology of the Russian Academy of Sciences (RAS), St. Petersburg, 194064, Russian Federation,I.P. Pavlov State Medical University, St. Petersburg, 197022, Russian Federation
| | - Natalia M. Yudintceva
- Institute of cytology of the Russian Academy of Sciences (RAS), St. Petersburg, 194064, Russian Federation
| | - Miralda I. Blinova
- Institute of cytology of the Russian Academy of Sciences (RAS), St. Petersburg, 194064, Russian Federation
| | - Grigoriy P. Pinaev
- Institute of cytology of the Russian Academy of Sciences (RAS), St. Petersburg, 194064, Russian Federation
| | - Oleg V. Galibin
- I.P. Pavlov State Medical University, St. Petersburg, 197022, Russian Federation
| | - Igor L. Potokin
- Research institute of highly pure biopreparations, 197110, St. Petersburg, Russian Federation
| | | | - Mark R. Pitkin
- Tufts University School of Medicine, Boston, MA 02111, USA,Poly-Orth International, Sharon, MA 02067, USA,Corresponding author: Mark Pitkin, PhD. Tufts University School of Medicine, Physical Medicine and Rehabilitation, 136 Harrison Ave, Boston, MA 02111; 787-297-1204.
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Pitkin M. Design features of implants for direct skeletal attachment of limb prostheses. J Biomed Mater Res A 2013; 101:3339-48. [PMID: 23554122 DOI: 10.1002/jbm.a.34606] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/11/2022]
Abstract
In direct skeletal attachment (DSA) of limb prostheses, a construct is implanted into an amputee's residuum bone and protrudes out of the residuum's skin. This technology represents an alternative to traditional suspension of prostheses via various socket systems, with clear indications when the sockets cannot be properly fitted. Contemporary DSA was invented in the 1990s, and several implant systems have been introduced since then. The current review is intended to compare the design features of implants for DSA whose use in humans or in animal studies has been reported in the literature.
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Affiliation(s)
- M Pitkin
- Tufts University School of Medicine, Boston, Massachusetts, 02111; Poly-Orth International, Sharon, Massachusetts, 02067
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