Background Loss of an extremity at any level has a major impact on a patient's life. Using bionic reconstruction, extremity function can be restored and the patient reintegrated into daily life. Surgical procedures including selective nerve transfer and anchoring of prostheses into bone are combined with structured rehabilitation and modern prosthetic fitting. The patient is thereby able to use the prostheses intuitively and with multiple degrees of freedom. Methods This article presents the concept and approach for modern bionic reconstruction in detail and the relevant literature. The nerve transfer matrices for targeted muscle reinnervation (TMR) and the concept of osseointegration to optimally fit a patient with a modern prosthesis are described in detail. As a clinical example, the case of a patient who suffered from traumatic amputation and subsequently received TMR in combination with an osseointegrated implant and structured rehabilitation is presented. Results Using bionic reconstruction, basic hand functions can be restored and bimanual dexterity can expand the range of daily activities. Besides this approach to bionic reconstruction, its advantages and disadvantages are compared to hand transplantation. The limitations and perspectives of modern bionic reconstruction are also discussed. Conclusions Bionic reconstruction is a sophisticated method for restoring extremity function and nowadays can be considered a standard of care for all levels of upper extremity amputations. An interdisciplinary approach and structured rehabilitation are necessary to master prosthetic function to ultimately reintegrate patients into daily life.

/pdf/bionic-reconstruction-restoration-of-extremity-function-with-54ri4g5kmi.pdf

Bionic reconstruction : Restoration of extremity function with osseointegrated and mind-controlled prostheses.

The purpose of the research was to evaluate the influence of selected parameters of the implants for bone anchored prostheses on possibility of conducting static load bearing exercises and stress-shielding intensity A press-fit implant, a threaded implant, and the proposed design were compared using the finite element method For the analyses two features were examined: diameter (190 - 210 mm) and length (750 - 1300 mm) To define the possibility of conducting rehabilitation exercises the micromotion of implants while axial loading with a force up to 1000 N was examined to evaluate the changes at implant-bone interface The stress-shielding intensity was estimated by bone mass loss over 60 months The results suggest that, in terms of micromotion generated during rehabilitation exercises, the threaded (max micromotion of 1600 μm) and the proposed (max micromotion of 4543 μm) implants ensure low and appropriate micromotion In the case of the press-fit solution the load values should be selected with care, as there is a risk of losing primary stabilisation The allowed forces (that do not stimulate the organism to generate fibrous tissue) were approx 140 N in the case of the length of 75 mm, increasing up to 560 N, while using the length of 130 mm Moreover, obtained stress-shielding intensities suggest that the proposed implant should provide appropriate secondary stability, similar to the threaded solution, due to the low bone mass loss during long-term use (improving at the same time more bone remodelling in distal Gruen zones, by providing lower bone mass loss by approx 13% to 20% in dependency of the length and diameter used) On this basis it can be concluded that the proposed design can be an appropriate alternative to commercially used implants

/pdf/the-influence-of-geometry-of-implants-for-direct-skeletal-4bjl9d9q4p.pdf

The Influence of Geometry of Implants for Direct Skeletal Attachment of Limb Prosthesis on Rehabilitation Program and Stress-Shielding Intensity.

This scoping review aims to answer two research questions: (1) What is the scope of variables used to describe loading data measured using a portable kinetic recording apparatus (Q1)? (2) What is the range of the loads applied on residuum of individuals with transfemoral amputation fitted with an osseointegrated fixation (Q2)? The objectives of this scoping review are (A) to map the scope of loading variables and (B) to report the range of loads that has been directly measured using a portable kinetic recording apparatus fitted at the distal end of the residuum during rehabilitation exercises, standardized and unscripted activities of daily living, and adverse events. This scoping review will consider studies involving individuals with transfemoral amputation fitted with a bone-anchored prosthesis using screw-type or press-fit osseointegrated fixations. The broad concept examined by this scoping review will relate to kinetics analysis or inner loading of bone-anchored prostheses. More specifically, this review will focus on the concepts associated with extraction and presentation of loading information acquired using direct measurement techniques. This scoping review will consider studies describing at least one characteristic of loading applied to screw-type or press-fit osseointegrated fixations. This scoping review will consider studies relying on measurements conducted in care facilities, experimental settings as well as open environment. This scoping review will consider a broad range of study designs in order to capture the concepts outlined above. The search strategy will aim to find unpublished and published studies.

/pdf/load-characteristics-following-transfemoral-amputation-in-257lslxie0.pdf

Load characteristics following transfemoral amputation in individuals fitted with bone-anchored prostheses: a scoping review protocol.

This study directly measured the load acting on the abutment of the osseointegrated implant system of transfemoral amputees during level walking, and studied the variability of the load within and among amputees. Twelve active transfemoral amputees (age: 54±12 years, mass:84.3±16.3 kg, height: 17.8±0.10 m) fitted with an osseointegrated implant for over 1 year participated in the study. The load applied on the abutment was measured during unimpeded, level walking in a straight line using a commercial six-channel transducer mounted between the abutment and the prosthetic knee. The pattern and the magnitude of the three-dimensional forces and moments were revealed. Results showed a low step-to-step variability of each subject, but a high subject-to-subject variability in local extrema of body-weight normalized forces and moments and impulse data. The high subject-to-subject variability suggests that the mechanical design of the implant system should be customized for each individual, or that a fit-all design should take into consideration the highest values of load within a broad range of amputees. It also suggests specific loading regime in rehabilitation training are necessary for a given subject. Thus the loading magnitude and variability demonstrated should be useful in designing an osseointegrated implant system better able to resist mechanical failure and in refining the rehabilitation protocol.

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

The success of our index case employing the use of the Osseointegration Implant (OI) is largely due to the coordinated efforts of the assembled team of medical professionals including nursing, surgeon and anesthesiologist. The anesthesetic methods and techniques were a central component of each of this patient’s surgeries. This is a report of the anesthetic methods employed in managing this patient’s pain before, during and after the implantation with the novel Longitude™ OI device. The index patient was well know to the team having undergone multiple prior surgical procedures at our institution. This report will detail the anesthesia provided at the time of the transfemoral amputation, followed by the Stage I implantation of the Longitude™ OI device and finally concluded at the time of the stage II docking through the skin procedure. In each case the patient was offered neuraxial subarachnoid block [1] and declined.

/pdf/anesthesia-and-pain-control-for-osteointegration-4sgqt2uccp.pdf

Anesthesia and Pain Control for Osteointegration Implantation Into the Femur - Stage II Osteointegration Implant (OI) Skin Coupling Procedure

This scoping review aims to answer two research questions (1) What is the clinical indicators’ intra-variability for both screw-type (Q1) and press-fit fixations (Q2)? (2) What is the clinical indicators’ inter-variability between screw-type and press-fit fixations (Q3)? The objectives of this scoping review are therefore, to characterize the rehabilitation programs performed by individuals with transfemoral amputation following the implantation of an osseointegrated fixation for bone-anchored prostheses; to describe partial weight bearing exercises in each rehabilitation program for screw-type and press-fit fixations; and to compare key rehabilitation parameters for each of these exercises within each program for screw-type and press-fit fixations (intra-variability) as between programs for screw-type and press-fit fixations (inter-variability). This scoping review will consider studies involving individuals with transfemoral amputation fitted with a bone-anchored prosthesis using either screw-type or press-fit osseointegrated fixation. This scoping review will examine the concepts of intra-variability and inter-variability in clinical indicators of the rehabilitation programs for screw-type and press-fit fixations fitted to bone-anchored prosthesis of individuals with transfemoral amputation. This scoping review will consider studies providing broad and specific clinical elements underlying the rehabilitation program aiming at promoting bone remodeling around osseointegrated fixation. Also, this scoping review will consider studies relying on measurements conducted in different settings. This scoping review will consider a broad range of study designs in order to capture the concepts outlined above. The search strategy will aim to find both unpublished and published studies

/pdf/rehabilitation-programs-after-the-implantation-of-54lipcfnbz.pdf

Rehabilitation programs after the implantation of transfemoral osseointegrated fixations for bone-anchored prostheses: a systematic review protocol.

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Rehabilitation programs after the implantation of transfemoral osseointegrated fixations for bone-anchored prostheses: a systematic review protocol.