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Ortiz-Catalan M, Zbinden J, Millenaar J, D'Accolti D, Controzzi M, Clemente F, Cappello L, Earley EJ, Mastinu E, Kolankowska J, Munoz-Novoa M, Jönsson S, Cipriani C, Sassu P, Brånemark R. A highly integrated bionic hand with neural control and feedback for use in daily life. Sci Robot 2023; 8:eadf7360. [PMID: 37820004 DOI: 10.1126/scirobotics.adf7360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
Restoration of sensorimotor function after amputation has remained challenging because of the lack of human-machine interfaces that provide reliable control, feedback, and attachment. Here, we present the clinical implementation of a transradial neuromusculoskeletal prosthesis-a bionic hand connected directly to the user's nervous and skeletal systems. In one person with unilateral below-elbow amputation, titanium implants were placed intramedullary in the radius and ulna bones, and electromuscular constructs were created surgically by transferring the severed nerves to free muscle grafts. The native muscles, free muscle grafts, and ulnar nerve were implanted with electrodes. Percutaneous extensions from the titanium implants provided direct skeletal attachment and bidirectional communication between the implanted electrodes and a prosthetic hand. Operation of the bionic hand in daily life resulted in improved prosthetic function, reduced postamputation, and increased quality of life. Sensations elicited via direct neural stimulation were consistently perceived on the phantom hand throughout the study. To date, the patient continues using the prosthesis in daily life. The functionality of conventional artificial limbs is hindered by discomfort and limited and unreliable control. Neuromusculoskeletal interfaces can overcome these hurdles and provide the means for the everyday use of a prosthesis with reliable neural control fixated into the skeleton.
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Affiliation(s)
- Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Bionics Institute, Melbourne, Australia
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- University of Melbourne, Melbourne, Australia
| | - Jan Zbinden
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Daniele D'Accolti
- Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marco Controzzi
- Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Leonardo Cappello
- Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Eric J Earley
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Osseointegration Research Consortium, University of Colorado, Aurora, CO, USA
| | - Enzo Mastinu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Maria Munoz-Novoa
- Center for Bionics and Pain Research, Mölndal, Sweden
- Center for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Stewe Jönsson
- TeamOlmed, Department of Upper Limb Prosthetics, Kungsbacka, Sweden
| | - Christian Cipriani
- Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Paolo Sassu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rickard Brånemark
- Integrum AB, Mölndal, Sweden
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden
- K. Lisa Yang Center for Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
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2
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Zbinden J, Sassu P, Mastinu E, Earley EJ, Munoz-Novoa M, Brånemark R, Ortiz-Catalan M. Improved control of a prosthetic limb by surgically creating electro-neuromuscular constructs with implanted electrodes. Sci Transl Med 2023; 15:eabq3665. [PMID: 37437016 DOI: 10.1126/scitranslmed.abq3665] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
Remnant muscles in the residual limb after amputation are the most common source of control signals for prosthetic hands, because myoelectric signals can be generated by the user at will. However, for individuals with amputation higher up the arm, such as an above-elbow (transhumeral) amputation, insufficient muscles remain to generate myoelectric signals to enable control of the lost arm and hand joints, thus making intuitive control of wrist and finger prosthetic joints unattainable. We show that severed nerves can be divided along their fascicles and redistributed to concurrently innervate different types of muscle targets, particularly native denervated muscles and nonvascularized free muscle grafts. We engineered these neuromuscular constructs with implanted electrodes that were accessible via a permanent osseointegrated interface, allowing for bidirectional communication with the prosthesis while also providing direct skeletal attachment. We found that the transferred nerves effectively innervated their new targets as shown by a gradual increase in myoelectric signal strength. This allowed for individual flexion and extension of all five fingers of a prosthetic hand by a patient with a transhumeral amputation. Improved prosthetic function in tasks representative of daily life was also observed. This proof-of-concept study indicates that motor neural commands can be increased by creating electro-neuromuscular constructs using distributed nerve transfers to different muscle targets with implanted electrodes, enabling improved control of a limb prosthesis.
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Affiliation(s)
- Jan Zbinden
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Paolo Sassu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthoplastic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enzo Mastinu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Eric J Earley
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Osseointegration Research Consortium, University of Colorado, Aurora, CO, USA
| | - Maria Munoz-Novoa
- Center for Bionics and Pain Research, Mölndal, Sweden
- Center for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Rickard Brånemark
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden
- Integrum AB, Mölndal, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Bionics Institute, Melbourne, Australia
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3
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Farina D, Vujaklija I, Brånemark R, Bull AMJ, Dietl H, Graimann B, Hargrove LJ, Hoffmann KP, Huang HH, Ingvarsson T, Janusson HB, Kristjánsson K, Kuiken T, Micera S, Stieglitz T, Sturma A, Tyler D, Weir RFF, Aszmann OC. Toward higher-performance bionic limbs for wider clinical use. Nat Biomed Eng 2023; 7:473-485. [PMID: 34059810 DOI: 10.1038/s41551-021-00732-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/01/2021] [Indexed: 12/19/2022]
Abstract
Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs.
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Affiliation(s)
- Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Rickard Brånemark
- Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| | - Hans Dietl
- Ottobock Products SE & Co. KGaA, Vienna, Austria
| | | | - Levi J Hargrove
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Klaus-Peter Hoffmann
- Department of Medical Engineering & Neuroprosthetics, Fraunhofer-Institut für Biomedizinische Technik, Sulzbach, Germany
| | - He Helen Huang
- NCSU/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thorvaldur Ingvarsson
- Department of Research and Development, Össur Iceland, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hilmar Bragi Janusson
- School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Todd Kuiken
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Bertarelli Foundation Chair in Translational NeuroEngineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, BrainLinks-BrainTools Center and Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Agnes Sturma
- Department of Bioengineering, Imperial College London, London, UK
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Dustin Tyler
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Veterans Affairs Medical Centre, Cleveland, OH, USA
| | - Richard F Ff Weir
- Biomechatronics Development Laboratory, Bioengineering Department, University of Colorado Denver and VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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4
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Benca E, Ferrante B, Unger E, Strassl A, Hirtler L, Brånemark R, Windhager R, Hobusch GM. Patient-Specific Guides for Accurate and Precise Positioning of Osseointegrated Implants in Transfemoral Amputations: A Proof-of-Concept In Vitro Study. Medicina (B Aires) 2023; 59:medicina59030429. [PMID: 36984430 PMCID: PMC10051876 DOI: 10.3390/medicina59030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
Background and Objectives: The treatment of transfemoral amputees using osseointegrated implants for prosthetic anchorage requires accurate implant positioning when using threaded bone-anchoring implants due to the curvature of the femur and the risk of cortical penetration in misaligned implants. This study investigated the accuracy and precision in implant positioning using additively manufactured case-specific positioning guides. Materials and Methods: The geometry and density distribution of twenty anatomic specimens of human femora were assessed in quantitative computed tomography (QCT) scanning. The imaging series were used to create digital 3D specimen models, preoperatively plan the optimal implant position and manufacture specimen-specific positioning guides. Following the surgical bone preparation and insertion of the fixture (threaded bone-anchoring element) (OPRA; Integrum AB, Mölndal, Sweden), a second QCT imaging series and 3D model design were conducted to assess the operatively achieved implant position. The 3D models were registered and the deviations of the intraoperatively achieved implant position from the preoperatively planned implant position were analyzed as follows. The achieved, compared to the planned implant position, was presented as resulting mean hip abduction or adduction (A/A) and extension or flexion (E/F) and mean implant axis offset in medial or lateral (M/L) and anterior or posterior (A/P) direction measured at the most distal implant axis point. Results: The achieved implant position deviated from the preoperative plan by 0.33 ± 0.33° (A/A) and 0.68 ± 0.66° (E/F) and 0.62 ± 0.55 mm (M/L) and 0.68 ± 0.56 mm (A/P), respectively. Conclusions: Using case-specific guides, it was feasible to achieve not only accurate but also precise positioning of the implants compared to the preoperative plan. Thus, their design and application in the clinical routine should be considered, especially in absence of viable alternatives.
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Affiliation(s)
- Emir Benca
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-40980
| | - Beatrice Ferrante
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Andreas Strassl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Centre for Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | - Rickard Brånemark
- Department of Orthopaedics, Gothenburg University, 40530 Gothenburg, Sweden
- Biomechatronics Group, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Gerhard M. Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
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5
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Thesleff A, Ortiz-Catalan M, Brånemark R. The effect of cortical thickness and thread profile dimensions on stress and strain in bone-anchored implants for amputation prostheses. J Mech Behav Biomed Mater 2022; 129:105148. [DOI: 10.1016/j.jmbbm.2022.105148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/25/2021] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
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6
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Thesleff A, Ortiz-Catalan M, Brånemark R. Low plasticity burnishing improves fretting fatigue resistance in bone-anchored implants for amputation prostheses. Med Eng Phys 2022; 100:103755. [DOI: 10.1016/j.medengphy.2022.103755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/31/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
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7
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Hochgeschurz S, Bergmeister KD, Brånemark R, Aman M, Rocchi A, Restitutti F, Gumpenberger M, Sporer ME, Gstoettner C, Kramer AM, Lang S, Podesser BK, Aszmann OC. Author Correction: Avian extremity reconstruction via osseointegrated leg-prosthesis for intuitive embodiment. Sci Rep 2021; 11:19231. [PMID: 34552182 PMCID: PMC8458493 DOI: 10.1038/s41598-021-99053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sarah Hochgeschurz
- Service for Birds and Reptiles, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rickard Brånemark
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden.,Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Attillio Rocchi
- Department of Anaesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Flavia Restitutti
- Department of Anaesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Michaela Gumpenberger
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Matthias E Sporer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | | | - Susanna Lang
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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8
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Hochgeschurz S, Bergmeister KD, Brånemark R, Aman M, Rocchi A, Restitutti F, Gumpenberger M, Sporer ME, Gstoettner C, Kramer AM, Lang S, Podesser BK, Aszmann OC. Avian extremity reconstruction via osseointegrated leg-prosthesis for intuitive embodiment. Sci Rep 2021; 11:12360. [PMID: 34117270 PMCID: PMC8195993 DOI: 10.1038/s41598-021-90048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 04/13/2021] [Indexed: 11/09/2022] Open
Abstract
For large avians such as vultures, limb loss leads to loss of ambulation and eventually death from malnutrition. Prosthetic devices may replace the limb, however, conventional prosthetic sockets are not feasible in feathered limbs and the extreme stress and strain of unreflected daily use in animals. Osseointegration is a novel technique, where external prosthetic parts are connected directly to a bone anchor to provide a solid skeletal-attachment. This concept provides a high degree of embodiment since osseoperception will provide direct intuitive feedback allowing natural use of the limb in gait and feeding. Here we demonstrate for the first time an osseointegrated bionic reconstruction of a limb in a vulture after a tarsometatarsal amputation with a longterm follow-up.
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Affiliation(s)
- Sarah Hochgeschurz
- Service for Birds and Reptiles, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rickard Brånemark
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden.,Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Attillio Rocchi
- Department of Anaesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Flavia Restitutti
- Department of Anaesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Michaela Gumpenberger
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Matthias E Sporer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | | | - Susanna Lang
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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9
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Gstoettner C, Salminger S, Sturma A, Moser V, Hausner T, Brånemark R, Aszmann OC. Successful salvage via re-osseointegration of a loosened implant in a patient with transtibial amputation. Prosthet Orthot Int 2021; 45:76-80. [PMID: 33834747 DOI: 10.1177/0309364620953985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CASE DESCRIPTION Osseointegration is a relatively new technique for prosthetic limb attachment that offers various improvements for patients with amputation and facilitates joint preservation. We present a case of implant loosening during rehabilitation in a patient with transtibial amputation that was successfully managed through a combination of measures, aiming to promote re-osseointegration of the implant. OBJECTIVES Not much is known about structured management of adverse events after osseointegration. Septic or aseptic loosening is currently regarded as implant failure, prompting removal and possible re-implantation at a later stage. The objective of this case report was to evaluate the feasibility of salvaging a loosened implant. STUDY DESIGN Case report. TREATMENT A novel treatment approach was employed to enable renewed osseointegration of the implant. First, the bone-implant interface was disrupted and renewed through axial rotation and distal repositioning of the implant. Afterwards, extracorporal shockwave therapy and antibiotic treatment were administered. Prosthetic rehabilitation was then started anew. Regular follow-up x-rays and clinical evaluations were conducted, including standardized outcome tests. OUTCOMES These combined measures led to a successful re-osseointegration of the implant. In a 21-month follow-up, the patient regained a stable and secure gait pattern, using his prosthesis every day for 15 hours and scoring above average on standardized outcome measures. CONCLUSION This represents the first report of implant salvage after failed primary osseointegration. As the associated risks of this novel treatment are very low, investigations are warranted to evaluate this approach on a larger scale.
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Affiliation(s)
- Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Department of Bioengineering, Imperial College London, London, UK
| | - Veith Moser
- AUVA Trauma Hospital Lorenz Böhler-European Hand Trauma Center, Vienna, Austria
| | - Thomas Hausner
- AUVA Trauma Hospital Lorenz Böhler-European Hand Trauma Center, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria
| | - Rickard Brånemark
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Biomechatronics Group, Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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10
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Abstract
Bone-anchored implants give patients with unmanageable stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates.Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons.Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines.Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist-antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints.As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price.Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter-individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ankles (A-MPK/As) might succeed in uneven ground-walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way.Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor-controlled prosthetic components. Cite this article: EFORT Open Rev 2020;5:724-741. DOI: 10.1302/2058-5241.5.190070.
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Affiliation(s)
- Gerhard M Hobusch
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Kevin Döring
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Rickard Brånemark
- Gothenburg University, Gothenburg, Sweden.,Biomechatronics Group, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Reinhard Windhager
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
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11
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Vincitorio F, Staffa G, Aszmann OC, Fontana M, Brånemark R, Randi P, Macchiavelli T, Cutti AG. Targeted Muscle Reinnervation and Osseointegration for Pain Relief and Prosthetic Arm Control in a Woman with Bilateral Proximal Upper Limb Amputation. World Neurosurg 2020; 143:365-373. [PMID: 32791219 DOI: 10.1016/j.wneu.2020.08.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bilateral proximal upper limb loss is a dramatic life-changing event. Replacement of the lost function with prosthetic arms, including multiple mechatronic joints, has remained a challenge from the control, comfort, and pain management perspectives. Targeted muscle reinnervation (TMR) is a peripheral nerve surgical procedure proposed to improve the intuitive control of the prosthetic arm and for neuroma and phantom pain management. Moreover, osseointegrated percutaneous implants (OPIs) allow for direct skeletal attachment of the prosthetic arm, ensuring freedom of movement to the patient's residual articulations. CASE DESCRIPTION We have reported the first combined application of TMR and an OPI to treat a 24-year-old woman with a bilateral amputation at the shoulder level on the right side and at the very proximal transhumeral level on the left side. TMR was performed bilaterally in a single day, accounting for the peculiar patient's anatomy, as preparatory stage to placement of the OPI, and considering the future availability of implantable electromyographic sensors. The 2 OPI surgeries on the left side were completed after 8.5 months, and prosthetic treatment was completed 17 months after TMR. CONCLUSIONS The use of TMR resolved the phantom pain bilaterally and the right-side neuroma pain. It had also substantially reduced the left side neuroma pain. The actual prosthetic control result was intuitive, although partially different from expectations. At 2 years after TMR, the patient reported improvement in essential activities of daily living, with a remarkable preference for the OPI prosthesis. Only 1 suspected case of superficial infection was noted, which had resolved. Overall, this combined treatment required a highly competent multidisciplinary team and exceptional commitment by the patient and her family.
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Affiliation(s)
- Francesca Vincitorio
- Complex Operative Unit of the Peripheral Nervous System, Ospedale degli Infermi, Faenza, Italy
| | - Guido Staffa
- Complex Operative Unit of the Peripheral Nervous System, Ospedale degli Infermi, Faenza, Italy
| | - Oskar C Aszmann
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria; Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Maurizio Fontana
- Complex Operative Unit of the Peripheral Nervous System, Ospedale degli Infermi, Faenza, Italy
| | - Rickard Brånemark
- Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Pericle Randi
- INAIL Prosthetic Center, Italian Workers' Compensation Authority, Vigorso di Budrio, Italy
| | - Thomas Macchiavelli
- INAIL Prosthetic Center, Italian Workers' Compensation Authority, Vigorso di Budrio, Italy
| | - Andrea G Cutti
- INAIL Prosthetic Center, Italian Workers' Compensation Authority, Vigorso di Budrio, Italy.
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12
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Mastinu E, Engels LF, Clemente F, Dione M, Sassu P, Aszmann O, Brånemark R, Håkansson B, Controzzi M, Wessberg J, Cipriani C, Ortiz-Catalan M. Neural feedback strategies to improve grasping coordination in neuromusculoskeletal prostheses. Sci Rep 2020; 10:11793. [PMID: 32678121 PMCID: PMC7367346 DOI: 10.1038/s41598-020-67985-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/11/2020] [Indexed: 11/09/2022] Open
Abstract
Conventional prosthetic arms suffer from poor controllability and lack of sensory feedback. Owing to the absence of tactile sensory information, prosthetic users must rely on incidental visual and auditory cues. In this study, we investigated the effect of providing tactile perception on motor coordination during routine grasping and grasping under uncertainty. Three transhumeral amputees were implanted with an osseointegrated percutaneous implant system for direct skeletal attachment and bidirectional communication with implanted neuromuscular electrodes. This neuromusculoskeletal prosthesis is a novel concept of artificial limb replacement that allows to extract control signals from electrodes implanted on viable muscle tissue, and to stimulate severed afferent nerve fibers to provide somatosensory feedback. Subjects received tactile feedback using three biologically inspired stimulation paradigms while performing a pick and lift test. The grasped object was instrumented to record grasping and lifting forces and its weight was either constant or unexpectedly changed in between trials. The results were also compared to the no-feedback control condition. Our findings confirm, in line with the neuroscientific literature, that somatosensory feedback is necessary for motor coordination during grasping. Our results also indicate that feedback is more relevant under uncertainty, and its effectiveness can be influenced by the selected neuromodulation paradigm and arguably also the prior experience of the prosthesis user.
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Affiliation(s)
- Enzo Mastinu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Leonard F Engels
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesco Clemente
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Prensilia SRL, Pontedera, Italy
| | - Mariama Dione
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paolo Sassu
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Rickard Brånemark
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Bo Håkansson
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Marco Controzzi
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Johan Wessberg
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Cipriani
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.
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13
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Abstract
We report the use of a bone-anchored, self-contained robotic arm with both sensory and motor components over 3 to 7 years in four patients after transhumeral amputation. The implant allowed for bidirectional communication between a prosthetic hand and electrodes implanted in the nerves and muscles of the upper arm and was anchored to the humerus through osseointegration, the process in which bone cells attach to an artificial surface without formation of fibrous tissue. Use of the device did not require formal training and depended on the intuitive intent of the user to activate movement and sensory feedback from the prosthesis. Daily use resulted in increasing sensory acuity and effectiveness in work and other activities of daily life. (Funded by the Promobilia Foundation and others.).
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Affiliation(s)
- Max Ortiz-Catalan
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
| | - Enzo Mastinu
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
| | - Paolo Sassu
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
| | - Oskar Aszmann
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
| | - Rickard Brånemark
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
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Mastinu E, Clemente F, Sassu P, Aszmann O, Brånemark R, Håkansson B, Controzzi M, Cipriani C, Ortiz-Catalan M. Grip control and motor coordination with implanted and surface electrodes while grasping with an osseointegrated prosthetic hand. J Neuroeng Rehabil 2019; 16:49. [PMID: 30975158 PMCID: PMC6460734 DOI: 10.1186/s12984-019-0511-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background Replacement of a lost limb by an artificial substitute is not yet ideal. Resolution and coordination of motor control approximating that of a biological limb could dramatically improve the functionality of prosthetic devices, and thus reduce the gap towards a suitable limb replacement. Methods In this study, we investigated the control resolution and coordination exhibited by subjects with transhumeral amputation who were implanted with epimysial electrodes and an osseointegrated interface that provides bidirectional communication in addition to skeletal attachment (e-OPRA Implant System). We assessed control resolution and coordination in the context of routine and delicate grasping using the Pick and Lift and the Virtual Eggs Tests. Performance when utilizing implanted electrodes was compared with the standard-of-care technology for myoelectric prostheses, namely surface electrodes. Results Results showed that implanted electrodes provide superior controllability over the prosthetic terminal device compared to conventional surface electrodes. Significant improvements were found in the control of the grip force and its reliability during object transfer. However, these improvements failed to increase motor coordination, and surprisingly decreased the temporal correlation between grip and load forces observed with surface electrodes. We found that despite being more functional and reliable, prosthetic control via implanted electrodes still depended highly on visual feedback. Conclusions Our findings indicate that incidental sensory feedback (visual, auditory, and osseoperceptive in this case) is insufficient for restoring natural grasp behavior in amputees, and support the idea that supplemental tactile sensory feedback is needed to learn and maintain the motor tasks internal model, which could ultimately restore natural grasp behavior in subjects using prosthetic hands.
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Affiliation(s)
- Enzo Mastinu
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
| | - Francesco Clemente
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Prensilia SRL, Pisa, Italy
| | - Paolo Sassu
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Aszmann
- Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Rickard Brånemark
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden
| | - Bo Håkansson
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Marco Controzzi
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Max Ortiz-Catalan
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
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15
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Stenlund P, Kulbacka-Ortiz K, Jönsson S, Brånemark R. Loads on Transhumeral Amputees Using Osseointegrated Prostheses. Ann Biomed Eng 2019; 47:1369-1377. [DOI: 10.1007/s10439-019-02244-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
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16
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Ackerley R, Backlund Wasling H, Ortiz-Catalan M, Brånemark R, Wessberg J. Case Studies in Neuroscience: Sensations elicited and discrimination ability from nerve cuff stimulation in an amputee over time. J Neurophysiol 2018; 120:291-295. [PMID: 29742031 DOI: 10.1152/jn.00909.2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The present case study details sensations elicited by electrical stimulation of peripheral nerve axons using an implanted nerve cuff electrode, in a participant with a transhumeral amputation. The participant uses an osseointegrated electromechanical interface, which enables skeletal attachment of the prosthesis and long-term, stable, bidirectional communication between the implanted electrodes and prosthetic arm. We focused on evoking somatosensory percepts, where we tracked and quantified the evolution of perceived sensations in the missing hand, which were evoked from electrical stimulation of the nerve, for over 2 yr. These sensations included small, pointlike areas of either vibration or pushing, to larger sensations over wider areas, indicating the recruitment of a few and many afferents, respectively. Furthermore, we used a two-alternative forced choice paradigm to measure the level of discrimination between trains of brief electrical stimuli, to gauge what the participant could reliably distinguish between. At best, the participant was able to distinguish a 0.5-Hz difference and on average acquired a 3.8-Hz just-noticeable difference at a more stringent psychophysical level. The current work shows the feasibility for long-term sensory feedback in prostheses, via electrical axonal stimulation, where small and relatively stable percepts were felt that may be used to deliver graded sensory feedback. This opens up opportunities for signaling feedback during movements (e.g., for precision grip), but also for conveying more complex cutaneous sensations, such as texture. NEW & NOTEWORTHY We demonstrate the long-term stability and generation of sensations from electrical peripheral nerve stimulation in an amputee, through an osseointegrated implant. We find that perceived tactilelike sensations could be generated for over 2 yr, in the missing hand. This is useful for prosthetic development and the implementation of feedback in artificial body parts.
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Affiliation(s)
- Rochelle Ackerley
- Department of Physiology, University of Gothenburg , Gothenburg , Sweden.,Aix Marseille University, CNRS, LNSC (Laboratoire de Neurosciences Sensorielles et Cognitives-UMR 7260), Marseille , France
| | | | - Max Ortiz-Catalan
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology , Gothenburg , Sweden.,Integrum AB, Mölndal , Sweden
| | - Rickard Brånemark
- International Centre for Osseointegration Research, Education and Surgery (iCORES), Department of Orthopaedics, University of California , San Francisco, California
| | - Johan Wessberg
- Department of Physiology, University of Gothenburg , Gothenburg , Sweden
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17
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Thesleff A, Brånemark R, Håkansson B, Ortiz-Catalan M. Biomechanical Characterisation of Bone-anchored Implant Systems for Amputation Limb Prostheses: A Systematic Review. Ann Biomed Eng 2018; 46:377-391. [PMID: 29327257 PMCID: PMC5809556 DOI: 10.1007/s10439-017-1976-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/28/2017] [Indexed: 01/06/2023]
Abstract
Bone-anchored limb prostheses allow for the direct transfer of external loads from the prosthesis to the skeleton, eliminating the need for a socket and the associated problems of poor fit, discomfort, and limited range of movement. A percutaneous implant system for direct skeletal attachment of an external limb must provide a long-term, mechanically stable interface to the bone, along with an infection barrier to the external environment. In addition, the mechanical integrity of the implant system and bone must be preserved despite constant stresses induced by the limb prosthesis. Three different percutaneous implant systems for direct skeletal attachment of external limb prostheses are currently clinically available and a few others are under investigation in human subjects. These systems employ different strategies and have undergone design changes with a view to fulfilling the aforementioned requirements. This review summarises such strategies and design changes, providing an overview of the biomechanical characteristics of current percutaneous implant systems for direct skeletal attachment of amputation limb prostheses.
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Affiliation(s)
- Alexander Thesleff
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Integrum AB, Mölndal, Sweden
| | - Rickard Brånemark
- International Centre for Osseointegration Research, Education and Surgery (iCORES), Department of Orthopaedics, University of California, San Francisco, CA, USA
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden
| | - Bo Håkansson
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Max Ortiz-Catalan
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
- Integrum AB, Mölndal, Sweden.
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18
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Vertriest S, Coorevits P, Hagberg K, Brånemark R, Häggström EE, Vanderstraeten G, Frossard LA. Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: Loading compliance. Prosthet Orthot Int 2017; 41:393-401. [PMID: 27117014 DOI: 10.1177/0309364616640949] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Sofie Vertriest
- 1 Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium
| | - Pascal Coorevits
- 2 Department of Public Health, Unit of Medical Informatics and Statistics, Ghent University, Ghent, Belgium
| | - Kerstin Hagberg
- 3 Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.,4 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Brånemark
- 4 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,5 Centre of Orthopaedic Osseointegration, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Elisabet Häggström
- 3 Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.,4 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Guy Vanderstraeten
- 1 Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium.,6 Department of Physical Medicine and Orthopaedic Surgery, University, Ghent, Belgium
| | - Laurent Alain Frossard
- 7 Queensland University of Technology, Brisbane, QLD, Australia.,8 University of the Sunshine Coast, Maroochydore, QLD, Australia
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Stenlund P, Trobos M, Lausmaa J, Brånemark R, Thomsen P, Palmquist A. Effect of load on the bone around bone-anchored amputation prostheses. J Orthop Res 2017; 35:1113-1122. [PMID: 27341064 DOI: 10.1002/jor.23352] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/22/2016] [Indexed: 02/04/2023]
Abstract
Osseointegrated transfemoral amputation prostheses have proven successful as an alternative method to the conventional socket-type prostheses. The method improves prosthetic use and thus increases the demands imposed on the bone-implant system. The hypothesis of the present study was that the loads applied to the bone-anchored implant system of amputees would result in locations of high stress and strain transfer to the bone tissue and thus contribute to complications such as unfavourable bone remodeling and/or elevated inflammatory response and/or compromised sealing function at the tissue-abutment interface. In the study, site-specific loading measurements were made on amputees and used as input data in finite element analyses to predict the stress and strain distribution in the bone tissue. Furthermore, a tissue sample retrieved from a patient undergoing implant revision was characterized in order to evaluate the long-term tissue response around the abutment. Within the limit of the evaluated bone properties in the present experiments, it is concluded that the loads applied to the implant system may compromise the sealing function between the bone and the abutment, contributing to resorption of the bone in direct contact with the abutment at the most distal end. This was supported by observations in the retrieved clinical sample of bone resorption and the formation of a soft tissue lining along the abutment interface. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1113-1122, 2017.
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Affiliation(s)
- Patrik Stenlund
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Chemistry, Materials and Surfaces, SP Technical Research Institute of Sweden, Borås, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jukka Lausmaa
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Chemistry, Materials and Surfaces, SP Technical Research Institute of Sweden, Borås, Sweden
| | - Rickard Brånemark
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Thomsen
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Palmquist
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Clemente F, Håkansson B, Cipriani C, Wessberg J, Kulbacka-Ortiz K, Brånemark R, Fredén Jansson KJ, Ortiz-Catalan M. Touch and Hearing Mediate Osseoperception. Sci Rep 2017; 7:45363. [PMID: 28349945 PMCID: PMC5368565 DOI: 10.1038/srep45363] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/27/2017] [Indexed: 12/24/2022] Open
Abstract
Osseoperception is the sensation arising from the mechanical stimulation of a bone-anchored prosthesis. Here we show that not only touch, but also hearing is involved in this phenomenon. Using mechanical vibrations ranging from 0.1 to 6 kHz, we performed four psychophysical measures (perception threshold, sensation discrimination, frequency discrimination and reaction time) on 12 upper and lower limb amputees and found that subjects: consistently reported perceiving a sound when the stimulus was delivered at frequencies equal to or above 400 Hz; were able to discriminate frequency differences between stimuli delivered at high stimulation frequencies (~1500 Hz); improved their reaction time for bimodal stimuli (i.e. when both vibration and sound were perceived). Our results demonstrate that osseoperception is a multisensory perception, which can explain the improved environment perception of bone-anchored prosthesis users. This phenomenon might be exploited in novel prosthetic devices to enhance their control, thus ultimately improving the amputees' quality of life.
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Affiliation(s)
| | - Bo Håkansson
- Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Johan Wessberg
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katarzyna Kulbacka-Ortiz
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rickard Brånemark
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden.,International Center for Osseointegration Research, Education and Surgery (iCORES), Department of Orthopaedics, University of California, San Francisco, USA
| | | | - Max Ortiz-Catalan
- Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden.,Integrum AB, Gothenburg, Sweden
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21
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Lennerås M, Tsikandylakis G, Trobos M, Omar O, Vazirisani F, Palmquist A, Berlin Ö, Brånemark R, Thomsen P. The clinical, radiological, microbiological, and molecular profile of the skin-penetration site of transfemoral amputees treated with bone-anchored prostheses. J Biomed Mater Res A 2016; 105:578-589. [PMID: 27750392 PMCID: PMC5216444 DOI: 10.1002/jbm.a.35935] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/06/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
The breach of the skin barrier is a critical issue associated with the treatment of individuals with transfemoral amputation (TFA) using osseointegrated, percutaneous titanium implants. Thirty TFA patients scheduled for abutment exchange or removal were consecutively enrolled. The aims were to determine the macroscopic skin signs, the presence of bacteria and the gene expression in abutment‐adherent cells and to conduct correlative and comparative analyses between the different parameters. Redness and a granulation ring were present in 47% of the patients. Bacteria were detected in 27/30 patients, commonly in the bone canal. Staphylococcus aureus, coagulase‐negative staphylococci, streptococci, and Enterococcus faecalis were the most common. A positive correlation was found between TNF‐α expression and the detection of S. aureus. Staphylococcus aureus together with other bacterial species revealed a positive relationship with MMP‐8 expression. A negative correlation was demonstrated between the length of the residual femur bone and the detection of a granulation ring and E. faecalis. A positive correlation was revealed between fixture loosening and pain and the radiological detection of endosteal bone resorption. Fixture loosening was also correlated with the reduced expression of interleukin‐10 and osteocalcin. It is concluded that several relationships exist between clinical, radiological, microbiological, and molecular assessments of the percutaneous area of TFAs. Further long term studies on larger patient cohorts are required to determine the precise cause‐effect relationships and unravel the role of host‐bacteria interactions in the skin, bone canal and on the abutment for the longevity of percutaneous implants as treatment of TFA. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 578–589, 2017.
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Affiliation(s)
- Maria Lennerås
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Georgios Tsikandylakis
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.,Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Forugh Vazirisani
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Örjan Berlin
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.,Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.,Centre for Advanced Reconstruction of Extremities (CARE) Sahlgrenska University Hospital, Mölndal, SE-431 30, Sweden
| | - Rickard Brånemark
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.,Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.,Centre for Advanced Reconstruction of Extremities (CARE) Sahlgrenska University Hospital, Mölndal, SE-431 30, Sweden.,Department of Orthopaedics, International Center for Osseointegration Research, Education and Surgery (iCORES), University of California, San Francisco
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
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22
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Zaborowska M, Tillander J, Brånemark R, Hagberg L, Thomsen P, Trobos M. Biofilm formation and antimicrobial susceptibility of staphylococci and enterococci from osteomyelitis associated with percutaneous orthopaedic implants. J Biomed Mater Res B Appl Biomater 2016; 105:2630-2640. [PMID: 27779811 DOI: 10.1002/jbm.b.33803] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/24/2016] [Accepted: 10/02/2016] [Indexed: 11/06/2022]
Abstract
Staphylococci and enterococci account for most deep infections associated with bone-anchored percutaneous implants for amputation treatment. Implant-associated infections are difficult to treat; therefore, it is important to investigate if these infections have a biofilm origin and to determine the biofilm antimicrobial susceptibility to improve treatment strategies. The aims were: (i) to test a novel combination of the Calgary biofilm device and a custom-made susceptibility MIC plate (Sensititre® ), (ii) to determine the biofilm formation and antimicrobial resistance in clinical isolates causing implant-associated osteomyelitis, and (iii) to describe the associated clinical outcome. Enterococci and staphylococci were characterized by microtitre plate assay, Congo Red Agar plate test, and PCR. Biofilm susceptibility to 10 antimicrobials and its relationship to treatment outcomes were determined. The majority of the strains produced biofilm in vitro showing inter- and intraspecies differences. Biofilms showed a significantly increased antimicrobial resistance compared with their planktonic counterparts. Slime-producing strains tolerated significantly higher antimicrobial concentrations compared with non-producers. All seven staphylococcal strains carried ica genes, but two did not produce slime. The degree of biofilm formation and up-regulated antibiotic resistance may translate into a variable risk of treatment failure. This new method set-up allows for the reproducible determination of minimum biofilm eradication concentration of antimicrobial agents, which may guide future antimicrobial treatment decisions in orthopaedic implant-associated infection. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2630-2640, 2017.
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Affiliation(s)
- Magdalena Zaborowska
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Tillander
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Brånemark
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, International Center for Osseointegration Research Education and Surgery (iCORES), University of California, San Francisco
| | - Lars Hagberg
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Häggström E, Hagberg K, Rydevik B, Brånemark R. Vibrotactile evaluation: osseointegrated versus socket-suspended transfemoral prostheses. ACTA ACUST UNITED AC 2015; 50:1423-34. [PMID: 24699977 DOI: 10.1682/jrrd.2012.08.0135] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 06/18/2013] [Indexed: 11/05/2022]
Abstract
This study investigated detection thresholds of vibrometric stimuli in patients with transfemoral amputation supplied with osseointegrated (OI) and socket-suspended prostheses. It included 17 patients tested preoperatively with socket-suspended prostheses and after 2 yr with OI prostheses and a control group (n = 17) using socket-suspended prostheses, evaluated once. Assessments on the prosthetic and intact feet were conducted at six frequencies (8, 16, 32, 64, 125, and 250 Hz). Furthermore, measurements were conducted to investigate how vibrometric signals are transmitted through a test prosthesis. The results showed that the OI group had improved ability to detect vibrations through the prosthesis at 125 Hz (p = 0.01) at follow-up compared with the preoperative measurement. Compared with the control group, the OI group at follow-up had better ability to detect high frequency vibrations through the prosthesis (125 Hz, p = 0.02; 250 Hz, p = 0.03). The vibrometric signal transmitted through the test prosthesis was reduced at 8, 125, and 250 Hz but was amplified at 16, 32, and 64 Hz. Differences between the OI and the control groups were found in the highest frequencies in which the test prosthesis showed reduction of the vibrometric signal. The study provides insight into the mechanisms of vibration transmission between the exterior and bone-anchored as well as socket-suspended amputation prostheses.
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Affiliation(s)
- Eva Häggström
- Department of Prosthetics and Orthotics, University of Gothenburg, Sahlgrenska University Hospital, Falkenbergsgatan 3, SE 412 85 Gothenburg, Sweden.
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Shah FA, Nilson B, Brånemark R, Thomsen P, Palmquist A. The bone-implant interface – nanoscale analysis of clinically retrieved dental implants. Nanomedicine: Nanotechnology, Biology and Medicine 2014; 10:1729-37. [DOI: 10.1016/j.nano.2014.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/25/2014] [Accepted: 05/30/2014] [Indexed: 11/16/2022]
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Ortiz-Catalan M, Håkansson B, Brånemark R. An osseointegrated human-machine gateway for long-term sensory feedback and motor control of artificial limbs. Sci Transl Med 2014; 6:257re6. [PMID: 25298322 DOI: 10.1126/scitranslmed.3008933] [Citation(s) in RCA: 257] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Max Ortiz-Catalan
- Division of Signal Processing and Biomedical Engineering, Department of Signals and Systems, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden. Center of Orthopaedic Osseointegration and Center of Advanced Reconstruction of Extremities, Department of Orthopaedics, Sahlgrenska University Hospital, University of Gothenburg, SE-431 80 Mölndal, Sweden.
| | - Bo Håkansson
- Division of Signal Processing and Biomedical Engineering, Department of Signals and Systems, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Rickard Brånemark
- Center of Orthopaedic Osseointegration and Center of Advanced Reconstruction of Extremities, Department of Orthopaedics, Sahlgrenska University Hospital, University of Gothenburg, SE-431 80 Mölndal, Sweden
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26
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Palmquist A, Windahl SH, Norlindh B, Brånemark R, Thomsen P. Retrieved bone-anchored percutaneous amputation prosthesis showing maintained osseointegration after 11 years-a case report. Acta Orthop 2014; 85:442-5. [PMID: 24798110 PMCID: PMC4105779 DOI: 10.3109/17453674.2014.919559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg,BIOMATCELL VINN Excellence Center for Biomaterials and Cell Therapy
| | - Sara H Windahl
- Center for Bone and Arthritis Research, Department of Internal Medicine, Sahlgrenska Academy at University of Gothenburg
| | - Birgitta Norlindh
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg,BIOMATCELL VINN Excellence Center for Biomaterials and Cell Therapy
| | - Rickard Brånemark
- BIOMATCELL VINN Excellence Center for Biomaterials and Cell Therapy,Department of Orthopaedics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg,BIOMATCELL VINN Excellence Center for Biomaterials and Cell Therapy
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27
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Hagberg K, Hansson E, Brånemark R. Outcome of percutaneous osseointegrated prostheses for patients with unilateral transfemoral amputation at two-year follow-up. Arch Phys Med Rehabil 2014; 95:2120-7. [PMID: 25064778 DOI: 10.1016/j.apmr.2014.07.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/30/2014] [Accepted: 07/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To report outcomes regarding general and specific physical health-related quality of life of treatment with percutaneous osseointegrated prostheses. DESIGN Prospective 2-year case-control study. SETTING University hospital. PARTICIPANTS Individuals (N=39; mean age, 44 ± 12.4 y) with unilateral transfemoral amputation as a result of trauma (n=23), tumor (n=11), or other cause (n=5). At baseline, 33 of the 39 participants used socket-suspended prostheses. INTERVENTION Osseointegrated prosthesis. MAIN OUTCOME MEASURES Questionnaire for Persons with Transfemoral Amputation (Q-TFA), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical functioning (PF) and physical component summary (PCS), SF-6D, and Physiological Cost Index (PCI). RESULTS At 2 years postimplantation, 6 of 7 Q-TFA scores improved (P<.0001) compared with baseline (prosthetic use, mobility, problem, global, capability, walking habits). The walking aid subscore did not improve (P=.327). Of the 39 participants, increased prosthesis use was reported by 26, same amount of use by 11, and less use by 2. Improvement was reported in 16 of the 30 separate problem items (P<.05). Unchanged items included problems regarding phantom limb pain and pain from the back, shoulders, and contralateral limb. The PF, PCS, and SF-6D improved a mean of 24.1 ± 21.4 (P<.0001), 8.5 ± 9.7 (P<.0001), and .039 ± .11 (P=.007) points, respectively. Walking energy cost decreased (mean PCI at baseline, .749; mean PCI at follow-up, .61; P<.0001). CONCLUSIONS Two years after intervention, patients with a unilateral TFA treated with an OPRA implant showed important improvements in prosthetic function and physical quality of life. However, walking aids used and the presence of phantom limb pain and pain in other extremities were unchanged. This information is valuable when considering whether percutaneous osseointegrated prostheses are a relevant treatment option.
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Affiliation(s)
- Kerstin Hagberg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Elisabeth Hansson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Brånemark
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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28
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Vertriest S, Coorevits P, Hagberg K, Brånemark R, Häggström E, Vanderstraeten G, Frossard L. Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: reliability of kinetic data. IEEE Trans Neural Syst Rehabil Eng 2014; 23:423-30. [PMID: 25051557 DOI: 10.1109/tnsre.2014.2337956] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an osseointegrated implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA implant performed five trials in four loading conditions. The forces and moments on the three axes of the implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( %SEMs ). The ICCs of all variables were above 0.9 and the %SEM values ranged between 0 and 87%. This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.
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29
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Zaborowska M, Welch K, Brånemark R, Khalilpour P, Engqvist H, Thomsen P, Trobos M. Bacteria-material surface interactions: methodological development for the assessment of implant surface induced antibacterial effects. J Biomed Mater Res B Appl Biomater 2014; 103:179-87. [PMID: 24816674 DOI: 10.1002/jbm.b.33179] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/19/2014] [Accepted: 04/12/2014] [Indexed: 01/09/2023]
Abstract
The choice of material for implanted prostheses is of great importance concerning bacterial colonization and biofilm formation. Consequently, methods to investigate bacterial behavior are needed in order to develop new infection resistant surfaces. In this study, different methodological setups were used to evaluate the antimicrobial effect of photocatalytic titanium oxide and silver surfaces. Biofilm formation and eradication under static and dynamic culture conditions were studied with the use of the following analytical techniques: viable colony-forming unit (CFU) counting, imprinting, fluorescence, and bioluminescence. The present study demonstrates that different methods are needed in order to evaluate the prophylactic and treatment effects on planktonic and biofilm bacteria and to assess the antimicrobial effect of different surface treatments/coatings. Choosing the right antibacterial testing model for the specific application is also of great importance. Both in situ approaches and indirect methods provide valuable complementary information.
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Affiliation(s)
- Magdalena Zaborowska
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
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30
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Ortiz-Catalan M, Sander N, Kristoffersen MB, Håkansson B, Brånemark R. Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient. Front Neurosci 2014; 8:24. [PMID: 24616655 PMCID: PMC3935120 DOI: 10.3389/fnins.2014.00024] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/27/2014] [Indexed: 11/17/2022] Open
Abstract
A variety of treatments have been historically used to alleviate phantom limb pain (PLP) with varying efficacy. Recently, virtual reality (VR) has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investigate a treatment in which the virtual limb responds directly to myoelectric activity at the stump, while the illusion of a restored limb is enhanced through augmented reality (AR). Further, phantom motions are facilitated and encouraged through gaming. The proposed set of technologies was administered to a chronic PLP patient who has shown resistance to a variety of treatments (including mirror therapy) for 48 years. Individual and simultaneous phantom movements were predicted using myoelectric pattern recognition and were then used as input for VR and AR environments, as well as for a racing game. The sustained level of pain reported by the patient was gradually reduced to complete pain-free periods. The phantom posture initially reported as a strongly closed fist was gradually relaxed, interestingly resembling the neutral posture displayed by the virtual limb. The patient acquired the ability to freely move his phantom limb, and a telescopic effect was observed where the position of the phantom hand was restored to the anatomically correct distance. More importantly, the effect of the interventions was positively and noticeably perceived by the patient and his relatives. Despite the limitation of a single case study, the successful results of the proposed system in a patient for whom other medical and non-medical treatments have been ineffective justifies and motivates further investigation in a wider study.
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Affiliation(s)
- Max Ortiz-Catalan
- Biomedical Engineering Division, Department of Signals and Systems, Chalmers University of Technology Gothenburg, Sweden ; Department of Orthopaedics, Centre of Orthopaedic Osseointegration, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Nichlas Sander
- Biomedical Engineering Division, Department of Signals and Systems, Chalmers University of Technology Gothenburg, Sweden
| | - Morten B Kristoffersen
- Biomedical Engineering Division, Department of Signals and Systems, Chalmers University of Technology Gothenburg, Sweden ; Department of Orthopaedics, Centre of Orthopaedic Osseointegration, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Bo Håkansson
- Biomedical Engineering Division, Department of Signals and Systems, Chalmers University of Technology Gothenburg, Sweden
| | - Rickard Brånemark
- Department of Orthopaedics, Centre of Orthopaedic Osseointegration, Sahlgrenska University Hospital Gothenburg, Sweden
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Brånemark R, Berlin Ö, Hagberg K, Bergh P, Gunterberg B, Rydevik B. A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation. Bone Joint J 2014; 96-B:106-13. [DOI: 10.1302/0301-620x.96b1.31905] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with transfemoral amputation (TFA) often experience problems related to the use of socket-suspended prostheses. The clinical development of osseointegrated percutaneous prostheses for patients with a TFA started in 1990, based on the long-term successful results of osseointegrated dental implants. Between1999 and 2007, 51 patients with 55 TFAs were consecutively enrolled in a prospective, single-centre non-randomised study and followed for two years. The indication for amputation was trauma in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical procedure was used to introduce a percutaneous implant to which an external amputation prosthesis was attached. The assessment of outcome included the use of two self-report questionnaires, the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Short-Form (SF)-36. The cumulative survival at two years’ follow-up was 92%. The Q-TFA showed improved prosthetic use, mobility, global situation and fewer problems (all p < 0.001). The physical function SF-36 scores were also improved (p < 0.001). Superficial infection was the most frequent complication, occurring 41 times in 28 patients (rate of infection 54.9%). Most were treated effectively with oral antibiotics. The implant was removed in four patients because of loosening (three aseptic, one infection). Osseointegrated percutaneous implants constitute a novel form of treatment for patients with TFA. The high cumulative survival rate at two years (92%) combined with enhanced prosthetic use and mobility, fewer problems and improved quality of life, supports the ‘revolutionary change’ that patients with TFA have reported following treatment with osseointegrated percutaneous prostheses. Cite this article: Bone Joint J 2014;96-B:106–13.
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Affiliation(s)
- R. Brånemark
- Sahlgrenska University Hospital, Department
of Orthopaedics, Institute of Clinical Sciences, University
of Gothenburg, Gothenburg, Sweden
| | - Ö. Berlin
- Sahlgrenska University Hospital, Department
of Orthopaedics, Institute of Clinical Sciences, University
of Gothenburg, Gothenburg, Sweden
| | - K. Hagberg
- Sahlgrenska University Hospital, Department
of Orthopaedics, Institute of Clinical Sciences, University
of Gothenburg, Gothenburg, Sweden
| | - P. Bergh
- Sahlgrenska University Hospital, Department
of Orthopaedics, Institute of Clinical Sciences, University
of Gothenburg, Gothenburg, Sweden
| | - B. Gunterberg
- Sahlgrenska University Hospital, Department
of Orthopaedics, Institute of Clinical Sciences, University
of Gothenburg, Gothenburg, Sweden
| | - B. Rydevik
- Sahlgrenska University Hospital, Department
of Orthopaedics, Institute of Clinical Sciences, University
of Gothenburg, Gothenburg, Sweden
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32
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Frossard L, Häggström E, Hagberg K, Brånemark R. Load applied on bone-anchored transfemoral prosthesis: characterization of a prosthesis-a pilot study. ACTA ACUST UNITED AC 2013; 50:619-34. [PMID: 24013910 DOI: 10.1682/jrrd.2012.04.0062] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objectives of this study were to (1) record the inner-prosthesis loading during activities of daily living (ADLs), (2) present a set of variables comparing loading data, and (3) provide an example of characterization of two prostheses. The load was measured at 200 Hz using a multi-axial transducer mounted between the residuum and the knee of an individual with unilateral transfemoral amputation fitted with a bone-anchored prosthesis. The load was measured while using two different prosthetic knees, mechanical (PRO1) and micro processor-controlled (PRO2), during six ADLs. The characterization of the prostheses was achieved using a set of variables split into four categories, including temporal characteristics, maximum loading, loading slopes, and impulse. Approximately 360 gait cycles were analyzed for each prosthesis. PRO1 showed a cadence improved by 19% and 7%, a maximum force on the long axis reduced by 11% and 19%, and an impulse reduced by 32% and 15% during descent of incline and stairs compared with PRO2, respectively. This work confirmed that the proposed apparatus and characterization can reveal how changes of prosthetic components are translated into inner-prosthetic loading.
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Affiliation(s)
- Laurent Frossard
- Department of Kinesiology, Université du Québec à Montréal, C.P. 2222, Succursale, Centre-Ville, Montréal, Québec, H3C 3P8 Canada.
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33
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Ortiz-Catalan M, Brånemark R, Håkansson B. BioPatRec: A modular research platform for the control of artificial limbs based on pattern recognition algorithms. Source Code Biol Med 2013; 8:11. [PMID: 23597283 PMCID: PMC3669028 DOI: 10.1186/1751-0473-8-11] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 04/10/2013] [Indexed: 11/10/2022]
Abstract
Background Processing and pattern recognition of myoelectric signals have been at the core of prosthetic control research in the last decade. Although most studies agree on reporting the accuracy of predicting predefined movements, there is a significant amount of study-dependent variables that make high-resolution inter-study comparison practically impossible. As an effort to provide a common research platform for the development and evaluation of algorithms in prosthetic control, we introduce BioPatRec as open source software. BioPatRec allows a seamless implementation of a variety of algorithms in the fields of (1) Signal processing; (2) Feature selection and extraction; (3) Pattern recognition; and, (4) Real-time control. Furthermore, since the platform is highly modular and customizable, researchers from different fields can seamlessly benchmark their algorithms by applying them in prosthetic control, without necessarily knowing how to obtain and process bioelectric signals, or how to produce and evaluate physically meaningful outputs. Results BioPatRec is demonstrated in this study by the implementation of a relatively new pattern recognition algorithm, namely Regulatory Feedback Networks (RFN). RFN produced comparable results to those of more sophisticated classifiers such as Linear Discriminant Analysis and Multi-Layer Perceptron. BioPatRec is released with these 3 fundamentally different classifiers, as well as all the necessary routines for the myoelectric control of a virtual hand; from data acquisition to real-time evaluations. All the required instructions for use and development are provided in the online project hosting platform, which includes issue tracking and an extensive “wiki”. This transparent implementation aims to facilitate collaboration and speed up utilization. Moreover, BioPatRec provides a publicly available repository of myoelectric signals that allow algorithms benchmarking on common data sets. This is particularly useful for researchers lacking of data acquisition hardware, or with limited access to patients. Conclusions BioPatRec has been made openly and freely available with the hope to accelerate, through the community contributions, the development of better algorithms that can potentially improve the patient’s quality of life. It is currently used in 3 different continents and by researchers of different disciplines, thus proving to be a useful tool for development and collaboration.
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Affiliation(s)
- Max Ortiz-Catalan
- Department of Signals and Systems, Biomedical Engineering Division, Chalmers University of Technology, Gothenburg, Sweden.
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Ortiz-Catalan M, Brånemark R, Håkansson B, Delbeke J. On the viability of implantable electrodes for the natural control of artificial limbs: review and discussion. Biomed Eng Online 2012; 11:33. [PMID: 22715940 PMCID: PMC3438028 DOI: 10.1186/1475-925x-11-33] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 05/14/2012] [Indexed: 01/06/2023] Open
Abstract
The control of robotic prostheses based on pattern recognition algorithms is a widely studied subject that has shown promising results in acute experiments. The long-term implementation of this technology, however, has not yet been achieved due to practical issues that can be mainly attributed to the use of surface electrodes and their highly environmental dependency. This paper describes several implantable electrodes and discusses them as a solution for the natural control of artificial limbs. In this context "natural" is defined as producing control over limb movement analogous to that of an intact physiological system. This includes coordinated and simultaneous movements of different degrees of freedom. It also implies that the input signals must come from nerves or muscles that were originally meant to produce the intended movement and that feedback is perceived as originating in the missing limb without requiring burdensome levels of concentration. After scrutinizing different electrode designs and their clinical implementation, we concluded that the epimysial and cuff electrodes are currently promising candidates to achieving a long-term stable and natural control of robotic prosthetics, provided that communication from the electrodes to the outside of the body is guaranteed.
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Affiliation(s)
- Max Ortiz-Catalan
- Department of Signals and Systems, Biomedical Engineering Division, Chalmers University of Technology, Göteborg, Sweden
- Centre of Orthopaedic Osseointegration, Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Rickard Brånemark
- Centre of Orthopaedic Osseointegration, Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Bo Håkansson
- Department of Signals and Systems, Biomedical Engineering Division, Chalmers University of Technology, Göteborg, Sweden
| | - Jean Delbeke
- School of Medicine (MD), Institute of Neuroscience (SSS/IoNS/COSY), Université catholique de Louvain, Brussels, Belgium
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Nebergall A, Bragdon C, Antonellis A, Kärrholm J, Brånemark R, Malchau H. Stable fixation of an osseointegated implant system for above-the-knee amputees: titel RSA and radiographic evaluation of migration and bone remodeling in 55 cases. Acta Orthop 2012; 83:121-8. [PMID: 22489885 PMCID: PMC3339524 DOI: 10.3109/17453674.2012.678799] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Rehabilitation of patients with transfemoral amputations is particularly difficult due to problems in using standard socket prostheses. We wanted to assess long-term fixation of the osseointegrated implant system (OPRA) using radiostereometric analysis (RSA) and periprosthetic bone remodeling. METHODS 51 patients with transfemoral amputations (55 implants) were enrolled in an RSA study. RSA and plain radiographs were scheduled at 6 months and at 1, 2, 5, 7, and 10 years after surgery. RSA films were analyzed using UmRSA software. Plain radiographs were graded for bone resorption, cancellization, cortical thinning, and trabecular streaming or buttressing in specifically defined zones around the implant. RESULTS At 5 years, the median (SE) migration of the implant was -0.02 (0.06) mm distally. The rotational movement was 0.42 (0.32) degrees around the longitudinal axis. There was no statistically significant difference in median rotation or migration at any follow-up time. Cancellization of the cortex (plain radiographic grading) appeared in at least 1 zone in over half of the patients at 2 years. However, the prevalence of cancellization had decreased by the 5-year follow-up. INTERPRETATION The RSA analysis for the OPRA system indicated stable fixation of the implant. The periprosthetic bone remodeling showed similarities with changes seen around uncemented hip stems. The OPRA system is a new and promising approach for addressing the challenges faced by patients with transfemoral amputations.
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Affiliation(s)
- Audrey Nebergall
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Anne Antonellis
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
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Palmquist A, Grandfield K, Norlindh B, Mattsson T, Brånemark R, Thomsen P. Bone-titanium oxide interface in humans revealed by transmission electron microscopy and electron tomography. J R Soc Interface 2011; 9:396-400. [PMID: 21849383 DOI: 10.1098/rsif.2011.0420] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Osseointegration, the direct contact between an implant surface and bone tissue, plays a critical role in interfacial stability and implant success. Analysis of interfacial zones at the micro- and nano-levels is essential to determine the extent of osseointegration. In this paper, a series of state-of-the-art microscopy techniques are used on laser-modified implants retrieved from humans. Partially laser-modified implants were retrieved after two and a half months' healing and processed for light and electron microscopy. Light microscopy showed osseointegration, with bone tissue growing both towards and away from the implant surface. Transmission electron microscopy revealed an intimate contact between mineralized bone and the laser-modified surface, including bone growth into the nano-structured oxide. This novel observation was verified by three-dimensional Z-contrast electron tomography, enabling visualization of an apatite layer, with different crystal direction compared with the apatite in the bone tissue, encompassing the nano-structured oxide. In conclusion, the present study demonstrates the nano-scale osseointegration and bonding between apatite and surface-textured titanium oxide. These observations provide novel data in human specimens on the ultrastructure of the titanium-bone interface.
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Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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Palmquist A, Johansson A, Suska F, Brånemark R, Thomsen P. Acute Inflammatory Response to Laser‐Induced Micro‐ and Nano‐Sized Titanium Surface Features. Clin Implant Dent Relat Res 2011; 15:96-104. [DOI: 10.1111/j.1708-8208.2011.00361.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anders Palmquist
- Researcher, Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Anna Johansson
- biomedical scientist, Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Felicia Suska
- research, Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Rickard Brånemark
- orthopaedic surgeon, Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Peter Thomsen
- professor, Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden, and Institute of Biomaterials and Cell Therapy, Göteborg, Sweden
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Abstract
BACKGROUND The osseointegration programme for upper extremity amputation started in Sweden in 1990, when a titanium fixture was first implanted into a thumb. This method has since been used for transhumeral and below-elbow amputation. The treatment involves two surgical procedures. During the first a titanium fixture is surgically attached to the skeleton, and a second procedure six months later involves a skin penetrating abutment to which the prosthesis is attached. OBJECTIVES To describe the osseointegration procedure for surgery, prosthetics and rehabilitation. METHODS Patients with short stumps and previous problems with prosthetic fitting were selected. From 1990 to April 2010, 37 upper limb cases were treated and fitted with prosthesis: 10 thumbs, 1 partial hand, 10 transradial and 16 transhumeral amputations. Of these, 7 patients are currently not prosthetic users. RESULTS Patients indicated that function and quality of life had improved since osseointegration. CONCLUSION Osseointegration is an important platform for present and future prosthetic technology. The prosthetic situation is improved due to the stable fixation, freedom of motion and functionality. CLINICAL RELEVANCE The two-stage osseointegration procedure has the potential to change the rehabilitation strategy for selected upper limb amputees. The method eliminates the need for a socket and the prosthesis will always fit. The stable prosthetic fixation and increased freedom of motion generates improved function. Specially designed components and rehabilitation procedures have been developed.
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Affiliation(s)
- Stewe Jönsson
- Department of Prosthetics & Orthotics, Centre of Orthopaedic Osseointegration, Sahlgrenska University Hospital Gothenburg, Sweden
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Palmquist A, Emanuelsson L, Brånemark R, Thomsen P. Biomechanical, histological and ultrastructural analyses of laser micro- and nano-structured titanium implant after 6 months in rabbit. J Biomed Mater Res B Appl Biomater 2011; 97:289-98. [PMID: 21394900 DOI: 10.1002/jbm.b.31814] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 11/25/2010] [Accepted: 12/19/2010] [Indexed: 11/08/2022]
Abstract
Short-term, experimental studies of partly laser-modified implants with nano-scale surface topographical features have recently shown a considerable increase in the biomechanical anchorage to bone. The aim of this study is to evaluate the biomechanical and bone-bonding ability of partly laser-modified implants compared with machined implants after a healing period of 6 months in a rabbit model. The results showed a 170% increase in removal torque. Histology and scanning electron microscopy demonstrated osseointegration for both implant types, but also revealed a different fracture pattern at the interface and in the bone. Transmission electron microscopy and chemical analysis showed coalescence between mineralized tissue and the nano-structured surface of the laser modified implant. Taken together, the results indicate that nano-structured surfaces promote in vivo long-term bone bonding and interface strength.
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Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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Tillander J, Hagberg K, Hagberg L, Brånemark R. Osseointegrated titanium implants for limb prostheses attachments: infectious complications. Clin Orthop Relat Res 2010; 468:2781-8. [PMID: 20473597 PMCID: PMC2939339 DOI: 10.1007/s11999-010-1370-0] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 04/19/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND The concept of osseointegration involves direct contact between titanium implant and bone. This transcutaneous prosthetic system for amputees is intended to assure stable long-term fixation. Most metal transcutaneous implants have failed, primarily owing to infection. QUESTIONS/PURPOSES We determined the frequency and describe the presentation of infectious complications with this novel method. We also evaluated the bacterial flora at the skin-penetration area and its relation to the development of local and implant-related infection. PATIENTS AND METHODS We prospectively followed 39 patients with arm and leg amputations fitted with transcutaneous osseointegrated titanium implants a mean of 56 months earlier (range, 132-133 months). There were 33 femoral, one tibial, four ulnar, four radial, and three humeral implants. Patients were selected during a 6-month period in 2005 and identically reevaluated after 3 years. Implant infection was defined as definite, probable, or possible based on clinical, radiologic, and microbiologic evidence. RESULTS The frequency of implant infection was 5% at inclusion and 18% at followup. One patient with infection recovered owing to antibiotic treatment and another patient had the implant removed. Most implant infections had low infectious activity, and in five of the seven patients with infections, prosthetic use was not affected. The most common bacteria in superficial and deep cultures were Staphylococcus aureus and coagulase-negative staphylococci. CONCLUSIONS Despite frequent colonization around the skin-implant interface by potentially virulent bacteria such as Staphylococcus aureus and bacteria associated with biomedical device infections such as coagulase-negative staphylococci, this titanium implant system for bone-anchored prostheses caused few infections leading to disability or implant removal. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jonatan Tillander
- Department of Infectious Diseases, University of Gothenburg, SE-416 85 Göteborg, Sweden
| | - Kerstin Hagberg
- Department of Orthopedics, University of Gothenburg, Göteborg, Sweden
| | - Lars Hagberg
- Department of Infectious Diseases, University of Gothenburg, SE-416 85 Göteborg, Sweden
| | - Rickard Brånemark
- Department of Orthopedics, University of Gothenburg, Göteborg, Sweden
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Palmquist A, Lindberg F, Emanuelsson L, Brånemark R, Engqvist H, Thomsen P. Biomechanical, histological, and ultrastructural analyses of laser micro- and nano-structured titanium alloy implants: a study in rabbit. J Biomed Mater Res A 2010; 92:1476-86. [PMID: 19425049 DOI: 10.1002/jbm.a.32439] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to evaluate the biomechanical properties and ultrastructure of the bone response of partly laser-modified Ti6Al4V implants compared with turned, machined implants after 8 weeks in rabbit. The surface analyses performed with interference microscopy and electron microscopy showed increased surface topography with micro- and nano-sized surface features as well as increased oxide thickness of the modified surface. The biomechanical testing demonstrated a 270% increase in torque value for the surface modified implants compared with the control implants. Histological evaluation of ground sections of specimens subjected to biomechanical testing revealed ongoing bone formation and remodeling. A histological feature exclusively observed at the laser-modified surface was the presence of fracture in the mineralized bone rather than at the interface between the bone and implant. Transmission electron microscopy (TEM) was performed on Focused Ion Beam (FIB) prepared samples of the intact bone-implant interface, demonstrating a direct contact between nanocrystalline hydroxyapatite and the oxide of the laser-modified implant surface. In conclusion, laser-modified titanium alloy implants have significantly stronger bone anchorage compared with machined implants and show no adverse tissue reactions.
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Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Palmquist A, Lindberg F, Emanuelsson L, Brånemark R, Engqvist H, Thomsen P. Morphological studies on machined implants of commercially pure titanium and titanium alloy (Ti6Al4V) in the rabbit. J Biomed Mater Res B Appl Biomater 2009; 91:309-19. [PMID: 19507145 DOI: 10.1002/jbm.b.31404] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to evaluate the bone response to commercially pure titanium grade I and titanium alloy grade V (90% Ti, 6% Al, and 4% V, depicted Ti6Al4V) after 8 weeks in rabbit tibia. Interference microscopy and scanning electron microscopy were used for surface analyses. Transmission electron microscopy (TEM) was used for evaluation of surface crystallinity and chemistry after preparation of ultrathin sections using focused ion beam (FIB) microscopy. Three different embedding resins commonly used for histological preparation were evaluated with respect to adaptation to a turned implant surface. Epoxy Agar 100 resin and acrylic Technovit 7200 resin showed low separation while acrylic LR White resin showed large separation at the interface. The retrieved specimens were embedded in acrylic Technovit 7200 resin after fixation and dehydration. The histological evaluation revealed osseointegration for both c.p. titanium grade I and Ti6Al4V alloy, but no quantitative differences in bone contact and bone area were detected. Because a separation of implant and tissue occurred in the interface between implant and bone embedded in acrylic Technovit 7200 resin, additional factors related to implant surface properties and technical procedures are likely to influence the possibilities to prepare ultrathin sections by FIB.
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Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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Ferencz S, Mangold V, Dérczy K, Takács I, Balatonyi B, Horváth S, Jávor S, Brånemark R, Horváth OP, Roth E, Wéber G. [A new method for prosthetisation of vascular patients with lower limb amputation: initial experiences with osseointegration technique]. Magy Seb 2009; 62:293-297. [PMID: 19828418 DOI: 10.1556/maseb.62.2009.5.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION/AIMS Prostheses use for lower limb amputees is difficult, while the socket is hard, the prosthesis is heavy. Drawbacks of conventional prosthesis are mainly associated with the socket, therefore osseointegration technique is a promising solution, since it doesn't require a socket. Our aim was to introduce this technique in Hungary and extend indication for vascular patients. METHODS The method includes two operative and one rehabilitation phases: during first operation a titanium screw is fixed into the femoral bone marrow cavity, this connects to an abutment, which also penetrates the skin, making a direct connection between the femur and the prosthesis during the second intervention. During rehabilitation the patient makes loading exercises and learns to walk with new prosthesis. RESULTS This method was launched in Hungary in 2005. Two female amputees were operated on initially, their second surgery was performed in 2006 (when titanium screw was applied in the male patients, as well). Incorporation of titanium screw was exquisite, and rehabilitation was successful. One of our male patients died eight months after his first operation due to myocardial infarction. CONCLUSION Based on our experiences, the osseointegration technique facilitates rehabilitation of vascular patients for prostheses use. Adequate follow-up and stable vascular diseases are not contraindications, although further clinical trials are needed to determine its indication.
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Affiliation(s)
- Sándor Ferencz
- Pécsi Tudományegyetem Altalános Orvostudományi Kar, Sebészeti Oktató és Kutató Intézet, 7624 Pécs, Alkotmány u. 20.
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Hagberg K, Häggström E, Brånemark R. Physiological cost index (PCI) and walking performance in individuals with transfemoral prostheses compared to healthy controls. Disabil Rehabil 2009; 29:643-9. [PMID: 17453985 DOI: 10.1080/09638280600902869] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Uncomplicated methods for evaluation of prosthetic walking performance for individuals with lower limb amputations are valuable. The Physiological Cost Index (PCI), the comfortable walking speed (CWS) and self-reported walking distances are three examples of such measures. The aim was to obtain values for these measures for individuals walking with transfemoral prostheses and to compare the results with healthy controls. METHOD Individuals with an established transfemoral amputation for reasons other than vascular disease (TFA-group, n = 41, 30 male/11 female, mean age 49, SD 11.5) were compared to age-and gender matched healthy controls (Healthy group, n = 22). PCI was assessed walking in CWS for 5 min and self-reported distances accomplished outdoors was assessed with the Walking Habit Score (0 - 100). RESULTS Mean PCI was 0.55 (SD 0.19) in the TFA-group and 0.31 (SD 0.09) in the Healthy group (p < 0.001). The CWS was 62 (SD 12.6) and 90 (SD 12.8) m/min and the Walking Habit Score 48 (SD 19) and 74 (SD 16) score-points respectively (p < 0.001). CONCLUSIONS By using uncomplicated and inexpensive methods, this study shows that walking with transfemoral prostheses is done with considerably increased energy cost, slower CWS and that limited walking distances outdoors are performed compared to healthy controls.
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Affiliation(s)
- K Hagberg
- Department of Orthopaedics, Göteborg University and Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Göteborg, Sweden.
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Hagberg K, Brånemark R. One hundred patients treated with osseointegrated transfemoral amputation prostheses--rehabilitation perspective. J Rehabil Res Dev 2009; 46:331-344. [PMID: 19675986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Treatment with osseointegrated transfemoral prostheses has been shown to improve quality of life. The treatment has been performed in Sweden since 1990 and consists of two surgical procedures followed by rehabilitation. During the first years, the rehabilitation process was not standardized. In 1999, a treatment protocol called OPRA (Osseointegrated Prostheses for the Rehabilitation of Amputees) was established. This article describes the current rehabilitation protocol and illustrates the overall results. The OPRA rehabilitation protocol is graded to stimulate the process of osseointegration and prepare the patient for unrestricted prosthetic use. It includes initial training with a short training prosthesis followed by gradually increased prosthetic activity. Between May 1990 and June 2008, we treated 100 patients with 106 implants (6 bilaterally; 61% males, 39% females; mean age 43 years; mean time since amputation 11.5 years.) The majority had amputations due to trauma (67%) or tumor (21%) (other = 12%). Currently, 68 patients are using their prostheses (follow-up: 3 months- 17.5 years) and 32 are not (4 are deceased, 7 are before second surgery, 6 are in initial training, 4 are not using prosthesis, and 11 had the implant removed). The majority of treatment failures occurred in patients before we established the OPRA protocol. The implementation of graded rehabilitation is considered to be of utmost importance for improved results.
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Affiliation(s)
- Kerstin Hagberg
- Centre of Orthopaedic Osseointegration, Department of Orthopaedics, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
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Jarmar T, Palmquist A, Brånemark R, Hermansson L, Engqvist H, Thomsen P. Technique for preparation and characterization in cross-section of oral titanium implant surfaces using focused ion beam and transmission electron microscopy. J Biomed Mater Res A 2008; 87:1003-9. [DOI: 10.1002/jbm.a.31856] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lee WCC, Doocey JM, Brånemark R, Adam CJ, Evans JH, Pearcy MJ, Frossard LA. FE stress analysis of the interface between the bone and an osseointegrated implant for amputees--implications to refine the rehabilitation program. Clin Biomech (Bristol, Avon) 2008; 23:1243-50. [PMID: 18809231 DOI: 10.1016/j.clinbiomech.2008.06.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 06/24/2008] [Accepted: 06/24/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND The direct anchorage of lower-limb prosthesis to the bone has been shown to be an excellent alternative for amputees experiencing complications in using a conventional prosthetic socket. During rehabilitation phase, amputees are asked to apply static loading on the abutment perpendicular to a weigh scale to prepare the bone to tolerate the forces likely to be developed during walking. The weigh scale measures only the vertical force. A different loading protocol can affect the bone-implant interface stresses and the outcome of the rehabilitation. METHODS This study developed a Finite Element model to study the stresses in the bone adjacent to the implant. Three loading conditions were applied based on the experimentally measured load: (1) vertical force applied along the long axis of the limb, corresponding to the load clinically prescribed in the weight bearing exercise; (2) loads applied on the three axes, corresponding to the "true" load measured simultaneously by a tri-axial load transducer during the same exercise; and (3) loads experienced during independent walking. FINDINGS The model revealed that the weigh scale might in fact be applying much higher and less uniform stresses on the bone than expected. During walking, high stress occurred at various locations of the implanted region, which was different from the patterns of stress distribution during weight bearing exercises. INTERPRETATIONS The difference in stress among three loading conditions implies that tri-axial load should be monitored during the weight bearing exercises and carefully prescribed.
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Affiliation(s)
- Winson C C Lee
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia.
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Jarmar T, Palmquist A, Brånemark R, Hermansson L, Engqvist H, Thomsen P. Characterization of the surface properties of commercially available dental implants using scanning electron microscopy, focused ion beam, and high-resolution transmission electron microscopy. Clin Implant Dent Relat Res 2008; 10:11-22. [PMID: 18254738 DOI: 10.1111/j.1708-8208.2007.00056.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Since osseointegration of the respective implant is claimed by all manufacturing companies, it is obvious that not just one specific surface profile including the chemistry controls bone apposition. PURPOSE The purpose was to identify and separate out a particular set of surface features of the implant surfaces that can contribute as factors in the osseointegration process. MATERIAL AND METHODS The surface properties of several commercially available dental implants were extensively studied using profilometry, scanning electron microscopy, and transmission electron microscopy. Ultrathin sections prepared with focused ion beam microscopy (FIB) provided microstructural and chemical data which have not previously been communicated. The implants were the Nobel Biocare TiUnite (Nobel Biocare AB, Göteborg, Sweden), Nobel Biocare Steri-Oss HA-coated (Nobel Biocare AB, Yorba Linda, CA, USA), Astra-Tech OsseoSpeed (Astra Tech AB, Mölndal, Sweden), Straumann SLA (Straumann AG, Waldenburg, Switzerland), and the Brånemark Integration Original Fixture implant (Brånemark Integration, Göteborg, Sweden). RESULTS It was found that their surface properties had differences. The surfaces were covered with crystalline TiO(2) (both anatase and rutile), amorphous titanium oxide, phosphorus doped amorphous titanium oxide, fluorine, titanium hydride, and hydroxyapatite, respectively. CONCLUSION This indicates that the provision of osseointegration is not exclusively linked to a particular set of surface features if the implant surface character is a major factor in that process. The studied methodology provides an effective tool to also analyze the interface between implant and surrounding bone. This would be a natural next step in understanding the ultrastructure of the interface between bone and implants.
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Affiliation(s)
- Tobias Jarmar
- Department of Engineering Sciences, Uppsala University, Box 534, SE-751 21 Uppsala, Sweden.
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Frossard L, Stevenson N, Smeathers J, Häggström E, Hagberg K, Sullivan J, Ewins D, Gow DL, Gray S, Brånemark R. Monitoring of the load regime applied on the osseointegrated fixation of a trans-femoral amputee: a tool for evidence-based practice. Prosthet Orthot Int 2008; 32:68-78. [PMID: 18330805 DOI: 10.1080/03093640701676319] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to provide a description of the continuous recording of the true load regime experienced during daily living by the abutment of a trans-femoral amputee fitted with an osseointegrated fixation. The specific objectives: (i) To present an apparatus and a procedure allowing recording of the load regime, and (ii) an example of the raw data and six performance indicators of the usage of the prosthesis obtained with this method. A subject was monitored for a period of 5 hours as he went about his daily activities. The load regime was directly measured and recorded using a commercial transducer and data logger. The overall load profile presented alternative periods of variable length of inactivity (64%) and activity (36%), respectively. The maximum load applied on the mediolateral, anteroposterior and the long axes represented 21%, 21% and 120% of the body weight, respectively. The anteroposterior, mediolateral and long components of the impulse were 395 kN.s, 359 kN.s and 2,323 kN.s, respectively. The amputee generated a total of 2312 gait cycles of the prosthetic leg, giving an approximate overall cadence of 8 stride/min. Preliminary outcomes indicated that the proposed method was an improvement on the current techniques as it provided the true loading and actual usage of the prosthesis during daily living. This study is a stepping stone in the development of future affordable, on-board and user-friendly load recording systems that can be used in evidence-based practice.
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Affiliation(s)
- Laurent Frossard
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia.
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