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Ahmed K, Blunn GW. A scoring system to evaluate stability of percutaneous osseointegrated implants for transfemoral amputation with validation in the ITAP clinical trial. Proc Inst Mech Eng H 2024; 238:412-422. [PMID: 38415608 DOI: 10.1177/09544119241231890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Percutaneous osseointegrated implants for individuals with lower limb amputation can increase mobility, reduce socket related pain, and improve quality of life. It would be useful to have an evaluation method to assess the interface between bone and implant. We assessed outpatient radiographs from the Intraosseous Transcutaneous Amputation Prosthesis clinical trial using an interface scoring system which summed and weighted equally measures of implant collar cortical ongrowth and radiolucency along the implant stem/bone interface. Radiographs from 12 participants with unilateral transfemoral amputations (10 males, 2 females, mean age = 43.2, SD = 7.4 years) in the clinical trial from cohort I (implanted in 2008/09) or cohort II (implanted in 2013/14) were collated (mean image span = 7.2, SD = 2.4 years), scale normalised, zoned, and measured in a repeatable way. Interface scores were calculated and then compared to clinical outcomes. Explanted participants received the lowest interface scores. A higher ratio of stem to residuum and shorter residuum's produced better interface scores and there was an association (weak correlation) between participants with thin cortices and the lowest interface scores. A tapered, cemented, non curved stem may provide advantageous fixation while stem alignment did not appear critical. In summary, the interface score successfully demonstrated a non-invasive evaluation of percutaneous osseointegrated implants interfaces when applied to the Intraosseous Transcutaneous Amputation Prosthesis clinical trial. The clinical significance of this work is to identify events leading to aseptic or septic implant removal and contribute to clinical guidelines for monitoring rehabilitation, design and surgical fixation choices.
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Affiliation(s)
- Kirstin Ahmed
- Center for Bionics and Pain Research, Mölndal, Sweden
- Division of Surgery and Interventional Science, University College London, Stanmore, UK
| | - Gordon William Blunn
- Division of Surgery and Interventional Science, University College London, Stanmore, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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2
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Bayer J, Hintermüller C, Blessberger H, Steinwender C. ECG Electrode Localization: 3D DS Camera System for Use in Diverse Clinical Environments. SENSORS (BASEL, SWITZERLAND) 2023; 23:5552. [PMID: 37420719 DOI: 10.3390/s23125552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/15/2023] [Accepted: 06/08/2023] [Indexed: 07/09/2023]
Abstract
Models of the human body representing digital twins of patients have attracted increasing interest in clinical research for the delivery of personalized diagnoses and treatments to patients. For example, noninvasive cardiac imaging models are used to localize the origin of cardiac arrhythmias and myocardial infarctions. The precise knowledge of a few hundred electrocardiogram (ECG) electrode positions is essential for their diagnostic value. Smaller positional errors are obtained when extracting the sensor positions, along with the anatomical information, for example, from X-ray Computed Tomography (CT) slices. Alternatively, the amount of ionizing radiation the patient is exposed to can be reduced by manually pointing a magnetic digitizer probe one by one to each sensor. An experienced user requires at least 15 min. to perform a precise measurement. Therefore, a 3D depth-sensing camera system was developed that can be operated under adverse lighting conditions and limited space, as encountered in clinical settings. The camera was used to record the positions of 67 electrodes attached to a patient's chest. These deviate, on average, by 2.0 mm ±1.5 mm from manually placed markers on the individual 3D views. This demonstrates that the system provides reasonable positional precision even when operated within clinical environments.
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Affiliation(s)
- Jennifer Bayer
- Institute for Biomedical Mechatronics, Johannes Kepler University, 4040 Linz, Austria
| | | | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
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Shu Y, Mukherjee S, Chang T, Gilmore A, Tringe JW, Stobbe DM, Loh KJ. Multi-Defect Detection in Additively Manufactured Lattice Structures Using 3D Electrical Resistance Tomography. SENSORS (BASEL, SWITZERLAND) 2022; 22:9167. [PMID: 36501867 PMCID: PMC9736320 DOI: 10.3390/s22239167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Cellular lattice structures possess high strength-to-weight ratios suitable for advanced lightweight engineering applications. However, their quality and mechanical performance can degrade because of defects introduced during manufacturing or in-service. Their complexity and small length scale features make defects difficult to detect using conventional nondestructive evaluation methods. Here we propose a current injection-based method, electrical resistance tomography (ERT), that can be used to detect damaged struts in conductive cellular lattice structures with their intrinsic electromechanical properties. The reconstructed conductivity distributions from ERT can reveal the severity and location of damaged struts without having to probe each strut. However, the low central sensitivity of ERT may result in image artifacts and inaccurate localization of damaged struts. To address this issue, this study introduces an absolute, high throughput, conductivity reconstruction algorithm for 3D ERT. The algorithm incorporates a strut-based normalized sensitivity map to compensate for lower interior sensitivity and suppresses reconstruction artifacts. Numerical simulations and experiments on fabricated representative cellular lattice structures were performed to verify the ability of ERT to quantitatively identify single and multiple damaged struts. The improved performance of this method compared with classical ERT was observed, based on greatly decreased imaging and reconstructed value errors.
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Affiliation(s)
- Yening Shu
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093, USA
- Active, Responsive, Multifunctional, and Ordered-materials Research (ARMOR) Laboratory, University of California San Diego, La Jolla, CA 92093, USA
| | | | - Tammy Chang
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - Abigail Gilmore
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - Joseph W. Tringe
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - David M. Stobbe
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - Kenneth J. Loh
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093, USA
- Active, Responsive, Multifunctional, and Ordered-materials Research (ARMOR) Laboratory, University of California San Diego, La Jolla, CA 92093, USA
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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Overmann AL, Forsberg JA. The state of the art of osseointegration for limb prosthesis. Biomed Eng Lett 2020; 10:5-16. [PMID: 32175127 PMCID: PMC7046912 DOI: 10.1007/s13534-019-00133-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/28/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022] Open
Abstract
Osseointegration (OI) is the direct attachment of bone onto a titanium implant. Recently, the term is used to describe "transdermal" implants that allow an external prosthesis to be connected directly to the skeleton. This technology eliminates the challenges of conventional socket-based prostheses, such as skin breakdown and poor fit, which are common in patients with major extremity amputations. Osseointegration patients demonstrate encouraging improvements in quality of life and function. Patients report improvement in prosthetic use, prosthetic mobility, global health, and pain reduction on a variety of clinical assessment tools. Various implants have been developed for osseointegration for amputees. These implants use a variety of fixation strategies and surface augments to allow for successful integration into the host bone. Regardless of design, all OI implants face similar challenges, particularly infections. Other challenges include the inability to determine when integration has occurred and the inability to detect loss of integration. These challenges may be met by incorporating sensing systems into the implants. The percutaneous nature of the metal devices can be leveraged so that internal sensors need not be wireless, and can be interrogated by external monitoring systems, thus providing crucial, real-time information about the state of the implant. The purpose of this review is to (1) review the basic science behind osseointegration, (2) provide an overview of current implants, practice patterns, and clinical outcomes, and (3) preview sensor technologies which may prove useful in future generations of transdermal orthopaedic implants.
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Affiliation(s)
- A. L. Overmann
- Orthopaedics, USU-Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - J. A. Forsberg
- Orthopaedics, USU-Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD USA
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Rizzo P. A review on the latest advancements in the non-invasive evaluation/monitoring of dental and trans-femoral implants. Biomed Eng Lett 2019; 10:83-102. [PMID: 32175131 DOI: 10.1007/s13534-019-00126-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/05/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
Dental implants and transcutaneous prostheses (trans-femoral implants) improve the quality of life of millions of people because they represent the optimal treatments to edentulism and amputation, respectively. The clinical procedures adopted by surgeons to insert these implants are well established. However, there is uncertainty on the outcomes of the post-operation recovery because of the uncertainty associated with the osseointegration process, which is defined as the direct, structural and functional contact between the living bone and the fixture. To guarantee the long-term survivability of dental or trans-femoral implants doctors sometimes implement non-invasive techniques to monitor and evaluate the progress of osseointegration. This may be done by measuring the stability of the fixture or by assessing the quality of the bone-fixture interface. In addition, care providers may need to quantify the structural integrity of the bone-implant system at various moments during the patients recovery. The accuracy of such non-invasive methods reduce recovery and rehabilitation time, and may increase the survival rate of the therapies with undisputable benefits for the patients. This paper provides a comprehensive review of clinically-approved and emerging non-invasive methods to evaluate/monitor the osseointegration of dental and orthopedic implants. A discussion about advantages and limitations of each method is provided based on the outcomes of the cases presented. The review on the emerging technologies covers the developments of the last decade, while the discussion about the clinically approved systems focuses mostly on the latest (2017-2018) findings. At last, the review also provides some suggestions for future researches and developments in the area of implant monitoring.
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Affiliation(s)
- Piervincenzo Rizzo
- Department of Civil and Environmental Engineering, University of Pittsburgh, 729 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA 15261 USA
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Abstract
This paper compiles and analyzes some of the most current works related to upper limb prosthesis with emphasis on man-machine interfaces. A brief introduction of the basic subjects is given to explain what a prosthesis is, what types of prostheses exist, what they serve for, how they communicate with the user (control and feedback), and what technologies are involved. The method used in this review is also discussed, as well as the cataloging process and analysis of articles for the composition of this review. Each article is analyzed individually and its results are presented in a succinct way, in order to facilitate future research and serve as a source for professionals related to the area of prosthesis, such as doctors, engineers, researchers, and anyone interested in this subject. Finally, the needs and difficulties of the current prostheses, as well as the negative and positive points in the results are analyzed, and the progress achieved so far is discussed.
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