Magnitude and variability of loading on the osseointegrated implant of transfemoral amputees during walking

2008 ◽  
Vol 30 (7) ◽  
pp. 825-833 ◽  
Author(s):  
Winson C.C. Lee ◽  
Laurent A. Frossard ◽  
Kerstin Hagberg ◽  
Eva Haggstrom ◽  
David Lee Gow ◽  
...  
Keyword(s):  
Osseointegrated Implant ◽  
Transfemoral Amputees

scholarly journals Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: Loading compliance

2016 ◽  
Vol 41 (4) ◽  
pp. 393-401 ◽  
Author(s):  
Sofie Vertriest ◽  
Pascal Coorevits ◽  
Kerstin Hagberg ◽  
Rickard Brånemark ◽  
Eva Elisabet Häggström ◽  
...  
Keyword(s):  
Static Load ◽  
Bone Remodelling ◽  
Transfemoral Amputation ◽  
Load Bearing ◽  
Axial Forces ◽  
Osseointegrated Implant ◽  
Electronic Display ◽  
Transfemoral Amputees ◽  
The Difference ◽  
Implant Loading

Background: Load-bearing exercises are performed by transfemoral amputees fitted with an osseointegrated implant to facilitate bone remodelling. Objective: This study presents the loading compliance comparing loads prescribed and applied on the three axes of the implant during static load-bearing exercises with a specific emphasis on axial and vectorial comparisons. Study design: Cohort study. Methods: A total of 11 fully rehabilitated unilateral transfemoral amputees fitted with an osseointegrated implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included ‘axial’ and ‘vectorial’ comparisons corresponding to the difference between the force applied on the long axis of the implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively. Results: The results demonstrated that axial and vectorial differences were significant in all conditions ( p < 0.05), except for the vectorial difference for the 40 kg condition ( p = 0.182). Conclusion: The significant lack of axial compliance led to systematic underloading of the long axis of the implant. Clinical relevance This study contributes to a better understanding of the load applied on an osseointegrated implant during the static load-bearing exercises that could contribute to improve the design of apparatus to monitor loading exercises as well as clinical guidelines for the loading progression during rehabilitation.

A 15-year follow-up of transfemoral amputees with bone-anchored transcutaneous prostheses

2020 ◽  
Vol 102-B (1) ◽  
pp. 55-63 ◽  
Author(s):  
Kerstin Hagberg ◽  
Shadi-Afarin Ghassemi Jahani ◽  
Katarzyna Kulbacka-Ortiz ◽  
Peter Thomsen ◽  
Henrik Malchau ◽  
...  
Keyword(s):  
Activity Grade ◽  
Patient Reported Outcome ◽  
University Hospital ◽  
Transfemoral Amputation ◽  
Mechanical Complications ◽  
Osseointegrated Implant ◽  
Patient Reported ◽  
Transfemoral Amputees ◽  
Implant System

Aims The aim of this study was to describe implant and patient-reported outcome in patients with a unilateral transfemoral amputation (TFA) treated with a bone-anchored, transcutaneous prosthesis. Methods In this cohort study, all patients with a unilateral TFA treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) implant system in Sahlgrenska University Hospital, Gothenburg, Sweden, between January 1999 and December 2017 were included. The cohort comprised 111 patients (78 male (70%)), with a mean age 45 years (17 to 70). The main reason for amputation was trauma in 75 (68%) and tumours in 23 (21%). Patients answered the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) before treatment and at two, five, seven, ten, and 15 years’ follow-up. A prosthetic activity grade was assigned to each patient at each timepoint. All mechanical complications, defined as fracture, bending, or wear to any part of the implant system resulting in removal or change, were recorded. Results The Q-TFA scores at two, five, seven, and ten years showed significantly more prosthetic use, better mobility, fewer problems, and an improved global situation, compared with baseline. The survival rate of the osseointegrated implant part (the fixture) was 89% and 72% after seven and 15 years, respectively. A total of 61 patients (55%) had mechanical complications (mean 3.3 (SD 5.76)), resulting in exchange of the percutaneous implant parts. There was a positive relationship between a higher activity grade and the number of mechanical complications. Conclusion Compared with before treatment, the patient-reported outcome was significantly better and remained so over time. Although osseointegration and the ability to transfer loads over a 15-year period have been demonstrated, a large number of mechanical failures in the external implant parts were found. Since these were related to higher activity, restrictions in activity and improvements to the mechanical properties of the implant system are required. Cite this article: Bone Joint J 2020;102-B(1):55–63

scholarly journals Residual limb volume fluctuations in transfemoral amputees

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Linda Paternò ◽  
Michele Ibrahimi ◽  
Elisa Rosini ◽  
Giuseppe Menfi ◽  
Vito Monaco ◽  
...  
Keyword(s):  
Physical Activity ◽  
Test Session ◽  
Testing Time ◽  
Residual Limb ◽  
Limb Volume ◽  
Volume Fluctuations ◽  
Exponential Trend ◽  
Prosthesis Removal ◽  
Transfemoral Amputees ◽  
Time Required

AbstractThis study constitutes the first attempt to systematically quantify residual limb volume fluctuations in transfemoral amputees. The study was carried out on 24 amputees to investigate variations due to prosthesis doffing, physical activity, and testing time. A proper experimental set-up was designed, including a 3D optical scanner to improve precision and acceptability by amputees. The first test session aimed at measuring residual limb volume at 7 time-points, with 10 min intervals, after prosthesis doffing. This allowed for evaluating the time required for volume stabilization after prosthesis removal, for each amputee. In subsequent sessions, 16 residual limb scans in a day for each amputee were captured to evaluate volume fluctuations due to prosthesis removal and physical activity, in two times per day (morning and afternoon). These measurements were repeated in three different days, a week apart from each other, for a total of 48 scans for each amputee. Volume fluctuations over time after prosthesis doffing showed a two-term decay exponential trend (R2 = 0.97), with the highest variation in the initial 10 min and an average stabilization time of 30 min. A statistically significant increase in residual limb volume following both prosthesis removal and physical activity was verified. No differences were observed between measures collected in the morning and in the afternoon.Clinical Trials.gov ID: NCT04709367.

scholarly journals Loading Effect of Prosthetic Feet’s Anthropomorphicity on Transtibial Osseointegrated Implant

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 681-687
Author(s):  
Mark Pitkin ◽  
Laurent Frossard
Keyword(s):  
Free Flow ◽  
Convex Shape ◽  
Bone Implant ◽  
Concave Shape ◽  
Early Loosening ◽  
Osseointegrated Implants ◽  
Osseointegrated Implant ◽  
Quantitative Characteristics ◽  
The Difference ◽  
The Moment

ABSTRACT Introduction Osseointegrated implants for direct skeletal attachment of transtibial prosthesis carry risks that are yet to be fully resolved, such as early loosening, mechanical failure of percutaneous and medullar parts of implant, periprosthetic issues, and infections. Underloading could lead to early loosening and infection. Overloading might compromise the bone–implant interface. Therefore, Goldilocks loading regimen applied by transtibial bone-anchored prostheses is critical for safe and efficient development of osseointegration around the implant during rehabilitation and beyond. We hypothesized that Goldilocks loading could be achieved when ambulating with a so-called anthropomorphic prosthetic ankle showing moment–angle relationship similar to a sound ankle. Materials and Methods Quantitative characteristics of the moment–angle curve of the sound ankle during dorsiflexion phase of a free-pace walking were extracted for 4 able-bodied participants (experiment 1). A slope of the moment–angle curve (stiffness) was calculated twice: for the first half and for the second half of the moment–angle curve. The difference of stiffnesses (those at the second half minus at the first half) was called the index of anthropomorphicity (IA). By definition, positive IA is associated with concave shape of the moment–angle curve, and the negative IA is associated with convex shape. In experiment 2, the same recordings and calculations were performed for 3 participants fitted with transtibial osseointegrated fixation during walking with their usual feet and the Free-Flow Foot (Ohio Willow Wood). The Free-Flow Foot was selected for its anthropomorphicity demonstrated in the previous studies with amputees using traditional socket attachment. Results The IA was 5.88 ± 0.93 for the able-bodied participants, indicating that the stiffness during the first part of the dorsiflexion phase was substantially fewer than during the second parts, as the calf muscles resisted to angulation in ankle substantially less than during the second part of dorsiflexion phase. For amputees fitted with Free-Flow Foot, IA was 2.68 ± 1.09 and −2.97 ± 2.37 for the same amputees fitted with their usual feet. Conclusions Indexes of anthropomorphicity, while of different magnitude, were positive in control able-bodied group and in the amputee group wearing Free-Flow Foot, which was qualitatively associated with concave shape of their moment–angle curves. The 3 usual feet worn by the participants were classified as nonanthropomorphic as their individual moment–angle curves were convex and the corresponding IAs were negative. Furthermore, this study showed that a foot with anthropomorphic characteristics tends to decrease maximal loads at the bone–implant interface as compared to the nonanthropomorphic feet and possibly may minimize the risks to compromise the integrity of this interface.

Anterior-posterior ground reaction forces across a range of running speeds in unilateral transfemoral amputees

2020 ◽  
pp. 1-12
Author(s):  
Hiroyuki Sakata ◽  
Satoru Hashizume ◽  
Ryo Amma ◽  
Genki Hisano ◽  
Hiroto Murata ◽  
...  
Keyword(s):  
Ground Reaction Forces ◽  
Reaction Forces ◽  
Transfemoral Amputees ◽  
Anterior Posterior

scholarly journals Mechanical Gait Analysis of Transfemoral Amputees: SACH Foot Versus the Flex-Foot

1997 ◽  
Vol 9 (4) ◽  
pp. 144-151 ◽  
Author(s):  
Pamela A. Macfarlane ◽  
David H. Nielsen ◽  
Donald G. Shurr
Keyword(s):  
Gait Analysis ◽  
Transfemoral Amputees

scholarly journals Design of Mechanism and Preliminary Field Validation of Low-Cost Transfemoral Rotator for Use in the Developing World

2016 ◽  
Author(s):  
Matthew L. Cavuto ◽  
Matthew Chun ◽  
Nora Kelsall ◽  
Karl Baranov ◽  
Keriann Durgin ◽  
...  
Keyword(s):  
Developing World ◽  
Low Cost ◽  
Field Studies ◽  
Field Validation ◽  
User Testing ◽  
Common Solution ◽  
Locking Mechanism ◽  
Medial Rotation ◽  
Transfemoral Amputees ◽  
And Function

Transfemoral (above-knee) amputees face a unique and challenging set of restrictions to movement and function. Most notably, they are unable to medially rotate their lower-leg and subsequently cross their legs. The best and most common solution to this issue today is a transfemoral rotator, which allows medial rotation of the leg distal to the knee through a lockable turntable mechanism. However, currently available transfemoral rotators can cost thousands of dollars, and few equivalent technologies exist in the developing world. This paper, supported by the results of field studies and user testing, establishes a framework for the design of a low-cost and easily manufacturable transfemoral rotator for use in the developing world. Two prototypes are presented, each with a unique internal locking mechanism and form. A preliminary field study was conducted on six transfemoral amputees in India and qualitative user and prosthetist feedback was collected. Both prototypes successfully allowed all subjects to complete tasks such as crossing legs, putting on pants, and tying shoes while maintaining functionality of walking and standing. Future iterations of the mechanism will be guided by a combination of the most positively received features of the prototypes and general feedback suggestions from the users.

Successful Placement of a BAHA Implant in a Patient With Epidermolysis Bullosa: A Case Report and Review of the Literature

2017 ◽  
Vol 126 (11) ◽  
pp. 778-780 ◽  
Author(s):  
Jason R. Brown ◽  
D. Micah Milgraum ◽  
Farhaad R. Riyaz ◽  
Marla N. Jahnke ◽  
Prasad John Thottam
Keyword(s):  
Hearing Loss ◽  
Epidermolysis Bullosa ◽  
Hearing Aids ◽  
External Auditory Canal ◽  
Skin Irritation ◽  
Minor Trauma ◽  
Mixed Hearing Loss ◽  
Osseointegrated Implant ◽  
Bone Anchored Hearing Aid ◽  
Conductive Hearing

Introduction: Epidermolysis bullosa (EB) is a spectrum of mechanobullous disorders characterized by blistering following minor trauma or traction to the skin. Hearing loss in this population is poorly described in the otolaryngology literature, and its treatment oftentimes results in external auditory canal skin irritation. Case Presentation: We present the case of a 26-year-old female with EB and mixed hearing loss unable to wear conventional hearing aids due to sequelae of the external auditory canals. An osseointegrated implant was used as other hearing aids were deemed to be too destructive of the external auditory canal skin. Management and Outcome: Our patient underwent placement of a right bone-anchored hearing aid with minimal disruption of the surrounding skin using a minimally invasive punch technique. Over 1 year of follow-up, her course was complicated by 1 simple cellulitic infection at the surgical site treated successfully with oral antibiotics. Discussion: The literature regarding the otolaryngologic manifestations of EB is sparse. The otologic sequelae are particularly overlooked in the workup and management. Based on the results of this case study, it appears that an osseointegrated implant can be safely utilized to treat significant mixed or conductive hearing loss in patients with EB.

scholarly journals Standing on slopes – how current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task

2017 ◽  
Vol 14 (1) ◽  
Author(s):  
Michael Ernst ◽  
Björn Altenburg ◽  
Malte Bellmann ◽  
Thomas Schmalz
Keyword(s):  
Transfemoral Amputees ◽  
Prosthetic Feet ◽  
Everyday Task

A surgical template for aligned placement of the osseointegrated implant

1988 ◽  
Vol 59 (6) ◽  
pp. 684-688 ◽  
Author(s):  
C.M. Johnson ◽  
J.A. Lewandowski ◽  
J.F. McKinney
Keyword(s):  
Surgical Template ◽  
Osseointegrated Implant
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