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Purpose: Outcome measurement provides clinicians, services and funders with useful information. However, little is known about the experience of participating in outcome measurement during lower limb prosthetic rehabilitation from the patient's perspective. Materials and methods: Thirty-two participants who underwent lower limb amputation within 5 years, and had experience of taking part in outcome measurement during prosthetic rehabilitation, were recruited from UK limb fitting centers and social media. Data were collected using focus groups and interviews and analysed using reflexive thematic analysis. Results: Four themes were identified. (1) How does participating in outcome measurement make me feel? (2) Do the outcome measures used in routine clinical care capture an accurate picture of my recovery? (3) Who is outcome measurement for? and (4) are prosthetic services measuring what is meaningful? These themes suggest outcome measurement is not a neutral activity for patients following lower limb amputation. Conclusions: Harnessing the positive impacts of measuring outcomes could be used for motivation, to support adjustment and recovery, to improve communication and to support shared decision-making. This could make outcome measurement more meaningful and patient-centered. However, there may be potential for patients to respond negatively to outcome measures and clinicians should consider their impact on psychosocial factors. IMPLICATIONS FOR REHABILITATION: Outcome measurement in prosthetic rehabilitation can provide clinicians, service providers and funders with important information. Adopting a patient-centred approach could make the process more meaningful and therefore beneficial for patients themselves. Measuring what is important to patients by considering a holistic approach beyond physical domains may make outcome measurement more meaningful. Patient centred approaches may include talking to patients about outcome measurement, using it to support motivation, goal setting and decision-making, as well as exploring outcome ranges to account for, or even capture variability. However, the potential for negative responses should not be overlooked, and clinicians should consider the psychosocial impact of outcome measurement on this patient group, especially when using performance-based measures. [ABSTRACT FROM AUTHOR]

Background/Objectives: Total hip arthroplasty (THA) planning is crucial for restoring hip function and minimizing complications. The present systematic review and meta-analysis aimed to assess and compare the accuracy of 2D versus 3D preoperative planning in THA. Methods: The inclusion criteria were randomized controlled trials (RCTs) and observational studies (ROSs) published in English comparing the accuracy of 2D and 3D preoperative planning for total hip arthroplasty. We excluded review articles, registers, studies not written in English, studies that did not report the cup sizing accuracy or stem sizing accuracy or give a description of the preoperative planning method used, and non-comparative studies. In June 2024, following the PRISMA 2020 statement, a systematic review and a meta-analysis of the literature were conducted in PubMed, Scopus, and the Cochrane Library. The statistical analysis software Review Manager (RevMan) version 5.4 was used to perform the meta-analysis to compare the accuracy of 2D and 3D planning, and to assess the risk of bias, the ROBINS-I tool was used. Results: The analysis included 777 patients from six studies. The analysis showed that 3D planning offers superior precision compared to 2D planning, both for the cup (96.92% vs. 87.14%) and the stem (94.72% vs. 86.28%). The forest plots assessed a better trend for 3D planning in terms of exact size prediction and accuracy within ±1 size. Conclusions: The three-dimensional method was more precise and accurate than two-dimensional planning, both for the stem and the cup. It offered a detailed three-dimensional view of the patient's anatomy. The main limitation was the challenge in finding homogeneous data regarding biomechanical parameters, surgical approaches, and different planning systems for both three-dimensional and two-dimensional methods. [ABSTRACT FROM AUTHOR]

In designing femoral components, which restore native (i.e., healthy) knee kinematics, the flexion–extension (F-E) axis of the tibiofemoral joint should match that of the native knee. Because the F–E axis is governed by the curvature of the femoral condyles in the sagittal plane, the primary objective was to determine the variation in radii of curvature. Eleven high accuracy three-dimensional (3D) femur models were generated from ultrahigh resolution CT scans. The sagittal profile of each condyle was created. The radii of curvature at 15 deg increments of arc length were determined based on segment circles best-fit to ±15 deg of arc at each increment. Results were standardized to the radius of the best-fit overall circle to 15 deg–105 deg for the femoral condyle having a radius closest to the mean radius. Medial and lateral femoral condyles exhibited multiradius of curvature sagittal profiles where the radius decreased at 30 deg flexion by 10 mm and at 15 deg flexion by 8 mm, respectively. On either side of the decrease, radii of segment circles were relatively constant. Beyond the transition angles where the radii decreased, the anterior-posterior (A-P) positions of the centers of curvature varied 4.8 mm and 2.3 mm for the medial and lateral condyles, respectively. A two-radius of curvature profile approximates the radii of curvature of both native femoral condyles, but the transition angles differ with the transition angle of the medial femoral condyle occurring about 15 deg later in flexion. Owing to variation in A-P positions of centers of curvature, the F-E axis is not strictly fixed in the femur. [ABSTRACT FROM AUTHOR]

Aimss: The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy. Methods: We included patients who underwent THA using Wagner Cone due to proximal femur anatomical abnormalities between August 2014 and January 2019 at a single institution. We investigated implant survival time using the endpoint of dislocation and revision, and compared the prevalence of prosthetic impingements between the Wagner Cone, a tapered cone stem, and the Taperloc, a tapered wedge stem, through simulation. We also collected Oxford Hip Score (OHS), visual analogue scale (VAS) satisfaction, and VAS pain by postal survey in August 2023 and explored variables associated with those scores. Results: Of the 58 patients (62 hips), two (two hips) presented with dislocation or reoperation, and Kaplan-Meier analysis indicated a five-year survival rate of 96.7% (95% CI 92.4 to 100). Mean stem anteversion was 35.2° (SD 18.2°) for the Taperloc stem and 29.8° (SD 7.9°) for the Wagner Cone stem; mean reduction from Taperloc to Wagner Cone was 5.4° (SD 18.8°). Overall, 55 hips (52 patients) were simulated, and the prevalence of prosthetic impingement was lower for the Wagner Cone (5.5%, 3/55) compared with the Taperloc (20.0%, 11/55) stem, with an odds ratio of 0.20 (p = 0.038). Among the 33 respondents to the postal survey (36 hips), the mean scores were VAS pain 10.9, VAS satisfaction 86.9, and OHS 44.7. A multivariable analysis revealed that reduction of stem anteversion from Taperloc to Wagner Cone was more favourable for VAS pain (p = 0.029) and VAS satisfaction (p = 0.002). Conclusion: The mid-term survival rate for THA using the Wagner Cone stem was high, which may be supported by a reduction in prosthetic impingement. The reduction in excessive stem anteversion by using a tapered cone stem was associated with reduced pain and increased patient satisfaction. Cite this article: Bone Jt Open 2024;5(10):858–867.

Purpose: This study aimed to evaluate the pressure distribution and comfort of transtibial prosthesis wearers using an affordable ethyl-vinyl acetate (EVA) roll-on (AERO) liner. Method: Fifteen unilateral transtibial prosthesis users wore patella tendon bearing (PTB) sockets with a polyethylene foam (PE-lite) liner were enrolled this study. AERO liners were provided to all participants. Six force sensors were applied to the residual limb to evaluate pressure distribution during treadmill walking, and the socket comfort score (SCS) was used to evaluate comfortability. Fourier transform infrared (FT-IR) spectroscopy was performed on the EVA and PE-lite liners. Results: Eleven participants used prefabricated AERO liners and four participants used custom-made AERO liners. The pressure distribution was analysed by the coefficient of variation (CV): PE-lite was 75.7±6.0 and AERO liner 83.3±4.1. Residual limb pressure was significantly decreased when using the AERO liner (p=.0007), with a large effect size (r=0.87). Mean SCS was 7.5±1.3 and 8.9±1.1 for PE-lite and AERO liner respectively. Conclusion: Better pressure distribution and comfort were observed when the participants used the AERO liner. AERO had a greater proportion of calcium carbonate (CaCO3). These findings suggest that the AERO liner is a better off-the-shelf option for persons using traditional prosthetic sockets and liners. [ABSTRACT FROM AUTHOR]

To assist an individual with an amputation in regaining daily quality of life, a 2SPU-RU type parallel mechanism was developed based on ankle biomechanics. The inverse kinematic analysis of this mechanism was performed using the vector method. Subsequently, the Jacobian matrices were analyzed. The dynamic model of the mechanism was then created based on the principle of virtual work, and its theoretical solution was compared with numerical results obtained in a simulation environment. Additionally, the validity of the dynamic model and the inverse kinematics was verified by comparing theoretical and simulation results for the movements of plantarflexion–dorsiflexion, eversion–inversion, and abduction–adduction during the gait cycle. [ABSTRACT FROM AUTHOR]

Various techniques have been proposed to manufacture prosthetic sockets, which are essential in improving the quality of life among amputees and individuals with special needs. However, the fabrication of prosthetics using the available approaches is uneconomical due to the type of materials utilized during the production, as well as the direct methods that use expensive materials to produce prosthetic parts. Considering this, it is crucial to enhance the direct methods by exploiting cost-effective materials to produce prosthetic parts with desirable behaviors. Therefore, this study aimed to compare the fatigue performance of below-knee (BK) prosthetic sockets manufactured using three different techniques: laminate, direct, and novel. The three sockets specimens were first manufactured. Specimen A was made via the direct method using 4 layers of carbon fiber as the reinforcement and AX140401 as the matrix. Specimen B was also fabricated via the lamination method using 4 layers of carbon fiber as the reinforcement and lamination resin + hardener acrylic as the matrix. Finally, specimen C was made via the direct novel method using 4 layers of carbon as the reinforcement, and the matrix was composed of 20% polyurethane resin (part A: resin, part B: hardener) + 80% acrylic. Subsequently, the pressure distribution at the contact point between the socket and the residual limb was analyzed using the FSOCKET device. Furthermore, the numerical analysis included the distribution of the stress and the highest internal pressure, the number of cycles ascertained through the utilization of the SOLIDWORKS software. Based on the results, the S-N curves for each specimen show that all three specimens behaved similarly. Using the F-socket, the pressure during the patient's walking cycle reached its highest point at 190 kPa. In addition, applying ground reaction force from the bottom of the direct, lamination, and novel BK prosthetic sockets demonstrated the pressure distribution of the part that reacts to the loading condition. The SOLIDWORKS program revealed from the pressure distribution of the three sockets measured a maximum internal pressure of 191 kPa, 193 kPa, and 191 kPa sequentially, which was close to the pressure within the F-socket. Besides, the number of cycles for the direct, lamination, and novel BK prosthetic sockets was 1,332,345, 1,202,345, and 1,203,567 cycles. In summary, all three specimens fabricated via the direct, lamination, and novel methods achieved similar fatigue performance of BK prosthetic sockets. So, the novel BK prosthetic socket wad designed in which fabricated using a new matrix material was considered acceptable, similar to specimens A and B. [ABSTRACT FROM AUTHOR]

BACKGROUND: The prosthetic foot is an essential component of the prosthetic limb used by people who suffer from amputation. The prosthetic foot or limb is expensive in developing countries and cannot be used by most people with special needs. OBJECTIVE: In this study, an uncomplicated prosthetic foot is designed that can be manufactured at low costs using 3D printer technology and can be provided to a wide range of amputees. The foot was designed using CAD software and analyzed using ANSES. METHODS: Carbon fiber material was chosen to be suitable for the manufacturing process using 3D printer technology. The selected material was tested in tensile and fatigue tests to determine its mechanical properties. The numerical analysis was carried out assuming the use of an artificial foot by a patient weighing 85 kg. RESULTS: The results showed that the material proposed for manufacturing has good mechanical properties for this application. The results of the engineering analysis also showed that the model has successfully passed the design process and is reliable for use by amputees. CONCLUSION: The success model designed in this study in the numerical analysis process gives reliability to the use of this design to manufacture the prosthetic foot. [ABSTRACT FROM AUTHOR]

Introduction: There are numerous ways to transfer the alignment of a lower-limb prosthesis that have been used and adapted over the last several decades. The proposed glass tracing alignment method (GTAM) allows for a convenient and rapid transfer of prosthetic alignment in the coronal and sagittal planes with minimal equipment requirements. Objective: The aim of this article is to share a novel method for coronal and sagittal plane prosthetic alignment transfer, which may be done with minimal time, materials, and expense. Materials and Methods: Prosthetic alignment may be transferred in part or in whole by tracing the prosthesis in both the coronal and sagittal planes. The prosthesis must first be stabilized on a surface that allows for the prosthetic foot to be traced and is adjacent to a wall surface that allows for tracing of the prosthesis proximal to the foot. The line of progression (LOP) of the prosthesis should be parallel to the edge of the table it is traced upon and in a vertical orientation when tracing the entire prosthesis in the sagittal plane. When tracing the coronal plane alignment, the foot should be oriented vertically and placed in the LOP. Sagittal and coronal tracings should include as much of the prosthesis as possible to insure the most accurate alignment transfer of components. The GTAM was developed to be a clinical complement to traditional alignment transfer methods, which may include use a vertical or horizontal prosthetic alignment transfer jig. Results: Use of the described alignment tracing technique allows for the rapid alignment transfer of prosthetic componentry for a variety of applications. Conclusions: The GTAM proposed is an easy way for a busy practitioner to certify that alignment transfers have been performed correctly or to preserve alignment when replacing elements of a prosthesis for clinical and/or research applications. [ABSTRACT FROM AUTHOR]

Cardiovascular prosthetic devices, stents, prosthetic valves, heart-assist pumps, etc., operate in a wide regime of flows characterized by fluid dynamic flow structures, laminar and turbulent flows, unsteady flow patterns, vortices, and other flow disturbances. These flow disturbances cause shear stress, hemolysis, platelet activation, thrombosis, and other types of blood trauma, leading to neointimal hyperplasia, neoatherosclerosis, pannus overgrowth, etc. Couette-type blood-shearing devices are used to simulate and then clinically measure blood trauma, after which the results can be used to assist in the design of the cardiovascular prosthetic devices. However, previous designs for such blood-shearing devices do not cover the whole range of flow shear, Reynolds numbers, and Taylor numbers characteristic of all types of implanted cardiovascular prosthetic devices, limiting the general applicability of clinical data obtained by tests using different blood-shearing devices. This paper presents the key fluid dynamic parameters that must be met. Based on this, Couette device geometric parameters such as diameter, gap, flow rate, shear stress, and temperature are carefully selected to ensure that the device's Reynolds numbers, Taylor number, operating temperature, and shear stress in the gap fully represent the flow characteristics across the operating range of all types of cardiovascular prosthetic devices. The outcome is that the numerical data obtained from the presented device can be related to all such prosthetic devices and all flow conditions, making the results obtained with such shearing devices widely applicable across the field. Numerical simulations illustrate that the types of flow patterns generated in the blood-shearing device meet the above criteria. [ABSTRACT FROM AUTHOR]

AbstractRestoring mobility using prosthetic limbs anchored in custom sockets is the primary goal of amputee rehabilitation. The contact pressure at the stump-liner interface is critical for improving prosthetic socket design and enhancing amputee satisfaction and comfort. This study aimed to develop and optimize a new customized multicellular foam liner model by identifying the optimal configuration of the liner’s cells to achieve minimal contact pressure between the transtibial limb (stump) and the prosthetic interface while simultaneously minimizing the stump’s immersion in the foam liner. The study employed a multi-objective optimization using the NSGA-II genetic algorithm to optimize the material configurations of the liner cells. The objective function was based on a finite element (FE) model of the customized foam liner, composed of 40 cells, each using one of six foam materials with varying firmness. The optimization process yielded nine different configurations representing the Pareto front. Contact pressure and immersion, represented by displacement in the load direction, were reduced from 140 KPa and 9 mm to 10 KPa and less than 1 mm, respectively. The results obtained in this study motivate future clinical trials on the efficacy of customized multicellular foam liners. These findings provide in-depth insights into prosthesis design and customization, potentially leading to further development in the use of foam rather than silicone for liner manufacturing. [ABSTRACT FROM AUTHOR]

This study compares the prosthetic gait asymmetry in transfemoral amputees with varied femoral lengths to able-bodied participants in terms of temporal-spatial parameters and joint kinematics. Sixteen young and active transfemoral amputees with short and long residual limbs were divided into two groups and subjected to three-dimensional quantitative motion analysis through high definition optoelectronic cameras and force platform. The prosthetic gait of amputees was compared with those of 15 participants with normal gait to analyze the asymmetry. There was a significant difference in temporal-spatial gait parameters between the amputee groups in terms of intact limb stride length and swing time (p < 0. 0 0 5). The gait of amputees with long femoral lengths was with comparatively higher mean step length (0.31 versus 0.35 m), velocity (0.48 versus 0.44 m/s), and cadence (73.58 versus 66.62 steps/min) compared to short residual limbs, however these results are nonsignificant (p > 0. 0 5). Amputees and able-bodied participants differed significantly for all measured parameters (p < 0. 0 5). The amputees with short residual limbs had more variation in sagittal plane hip flexion at initial contact than long amputees and able-bodied subjects. Amputees with longer residual limbs demonstrated peak swing prosthetic hip flexion closer to able-bodied individuals. The frontal pelvic obliquity and sagittal pelvic tilt revealed more variance among amputees with shorter residual limbs than longer ones. This study will aid in identifying the underlying mechanism of gait asymmetry in transfemoral amputees in relation to residual femoral length and hence will pave a path for improving the knee and foot prosthetic components. [ABSTRACT FROM AUTHOR]

Introduction: Prosthetic liners are widely used for a variety of indications such as improving prosthetic socket fit and suspension. However, these are associated with complications affecting the skin, including skin rubs, breakdown, and ulceration. Methods and Discussion: We outline the splinting effect of prosthetic liners as a possible contributing factor that results in increased shear during joint motion and propose a simple liner donning technique to minimize these shear forces by spreading liner/skin tension over the whole range of motion of the proximal joint. Clinical Relevance: The proposed dynamic donning technique would minimize the risk of skin ulcerations and improve joint range of motion in prosthetic limb users. [ABSTRACT FROM AUTHOR]

Research addressing lower limb amputee gait and prosthetic design often focuses on men, despite female lower limb amputees having different risk factors and lower success with their prosthetics overall. It is widely agreed that sex differences exist in able-bodied gait, but research analyzing sex differences in amputee gait is rare. This study compared male and female transtibial amputee gait to ascertain potential sex differences. Forty-five transtibial amputees were asked to walk at their self-selected speed, and spatiotemporal gait data were obtained. Both the mean and variability metric of parameters were analyzed for 10 male and 10 female participants. For all participants, amputated limbs had a shorter stance time, longer swing time, and larger step length. Females had a 10% shorter stance time and 26% larger normalized step and stride length than males. Female participants also walked over 20% faster than male participants. Finally, significant interactions were found in the mean and variability metric of stride velocity, indicating greater variability in women. These findings suggest that sex differences exist in transtibial amputee gait, offering possible explanations for the different comorbidities experienced by female lower limb amputees. These results have major implications for female amputees and for sex-specific research, rehabilitation, and prosthetic design. [ABSTRACT FROM AUTHOR]

Introduction: The creation of synthetic reservoirs for bladder replacement has been limited by challenges of interfacing synthetic materials and native tissue. We sought to overcome this challenge by utilizing a novel bilayer silk fibroin scaffold (BLSF) as an intermediary toward the development of an acellular prosthetic reservoir. Methods: Under institutionally approved protocols, 3D-printed reservoirs were implanted in six juvenile female pigs after cystectomy. BLSF was attached to the in situ prosthetic reservoir serving as an intermediary to native ureteral and urethral tissue anastomoses. Our first protocol allowed four pigs to be survived up to 7 days, and the second protocol allowed two pigs to be survived for up to 1 year. At the first sign of functional decline or the end of the study period, the animals were euthanized, and kidneys, ureters, prosthetic bladder, and urethra were harvested en bloc for histopathology analysis. Results: The first two pigs had anastomotic urine leaks because of design flaws resulting in early termination. The third pig had acute renal failure resulting in early termination. The artificial bladder design was modified in subsequent iterations. The fourth pig survived for 7 days and, upon autopsy, had intact urethral and ureteral anastomoses. The fifth and sixth pigs survived for 11 and 12 weeks, respectively, before they were sacrificed because of failure to thrive. One animal developed an enteric fistula. The other animal had an intact anastomosis, and the BLFS was identified at the ureteral and urethral anastomoses on histopathologic analysis. Conclusions: Replacing the porcine bladder with a prosthetic bladder was achieved for up to 3 months, the second longest survival period for a nonbiologic bladder alternative. BLSF was used for the first time to create an interface between synthetic material and biologic tissue by allowing ingrowth of urothelium onto the acellular alloplastic bladder.

Abstract Background Group B streptococci (Streptococcus agalactiae) (GBS) is a rare cause of prosthetic joint infection (PJI) occurring in patients with comorbidities and seems to be associated with a poor outcome. Depiction of GBS PJI is scarce in the literature. Methods A retrospective survey in 2 referral centers for bone joint infections was done Patients with a history of PJI associated with GBS between 2014 and 2019 were included. A descriptive analysis of treatment failure was done. Risk factors of treatment failure were assessed. Results We included 61 patients. Among them, 41 had monomicrobial (67%) infections. The median duration of follow-up was 2 years (interquartile range 2.35) Hypertension, obesity, and diabetes mellitus were the most reported comorbidities (49%, 50%, and 36% respectively). Death was observed in 6 individuals (10%) during the initial management. The rate of success was 63% (26/41). Removal of the material was not associated with remission (p = 0.5). We did not find a specific antibiotic regimen associated with a better outcome. Conclusion The results show that S. agalactiae PJIs are associated with high rates of comorbidities and a high treatment failure rate with no optimal treatment so far.

Aims: Prior cost-effectiveness analyses on osseointegrated prosthesis for transfemoral unilateral amputees have analyzed outcomes in non-USA countries using generic quality of life instruments, which may not be appropriate when evaluating disease-specific quality of life. These prior analyses have also focused only on patients who had failed a socket-based prosthesis. The aim of the current study is to use a disease-specific quality of life instrument, which can more accurately reflect a patient’s quality of life with this condition in order to evaluate cost-effectiveness, examining both treatment-naïve and socket refractory patients. Methods: Lifetime Markov models were developed evaluating active healthy middle-aged male amputees. Costs of the prostheses, associated complications, use/non-use, and annual costs of arthroplasty parts and service for both a socket and osseointegrated (OPRA) prosthesis were included. Effectiveness was evaluated using the questionnaire for persons with a transfemoral amputation (Q-TFA) until death. All costs and Q-TFA were discounted at 3% annually. Sensitivity analyses on those cost variables which affected a change in treatment (OPRA to socket, or socket to OPRA) were evaluated to determine threshold values. Incremental cost-effectiveness ratios (ICERs) were calculated. Results: For treatment-naïve patients, the lifetime ICER for OPRA was $279/quality-adjusted life-year (QALY). For treatment-refractory patients the ICER was $273/QALY. In sensitivity analysis, the variable thresholds that would affect a change in the course of treatment based on cost (from socket to OPRA), included the following for the treatment-naïve group: yearly replacement components for socket > $8,511; cost yearly replacement parts OPRA < $1,758; and for treatment-refractory group: yearly replacement component for socket of > $12,467. Conclusion: The use of the OPRA prosthesis in physically active transfemoral amputees should be considered as a cost-effective alternative in both treatment-naïve and treatment-refractory socket prosthesis patients. Disease-specific quality of life assessments such as Q-TFA are more sensitive when evaluating cost-effectiveness. Cite this article: Bone Jt Open 2024;5(3):218–226.

PURPOSE: Little has been published about the process of decision-making between prosthetists and people with lower limb amputation (LLA). The purpose of this study is to identify decisions and factors influencing decision-making in prosthetic rehabilitation from the perspectives of prosthetists and prosthesis users, to identify barriers and opportunities for shared decision-making (SDM). METHODS: Qualitative semi-structured individual interviews were conducted with 13 prosthetists and 14 prosthesis users from three clinics in three states of the Rocky Mountain and Southwest regions of the United States. Transcripts were analyzed using thematic analysis. RESULTS: Four main themes were identified: perceived decision points, importance of relationship, balancing competing priorities, and experience. Contrasts between perceptions of prosthetists and prosthesis users were related to prosthesis design decisions, and the purpose of communication (e.g., goals for a prosthesis vs. goals informing prosthesis design). Both prosthetists and prosthesis users described balancing priorities that contribute to prosthetic rehabilitation decisions, and the role of experience for informing realistic expectations and preferences necessary for participating in decision-making. CONCLUSION: Opportunities for improving SDM between prosthetists and prosthesis users include (1) clarifying key rehabilitation decisions, (2) identifying the purpose of initial communications, (3) support for balancing priorities, and (4) utilizing experience to achieve informed preferences.IMPLICATIONS FOR REHABILITATIONMany people with lower limb amputation experience poor physical function and psychosocial outcomes, which may be further compounded by under informed prosthesis-user expectations for function with a prosthesis.Shared decision-making offers an opportunity for improving realistic prosthesis-user expectations, reducing healthcare costs, and improving prosthesis-user satisfaction and adherence to care plans.Opportunities for improving shared decision-making between prosthetists and prosthesis-users include (1) clarifying key rehabilitation decisions, (2) identifying the purpose of initial communications, (3) support for balancing priorities, and (4) utilizing experience to achieve informed preferences.

Background: Group B streptococci (Streptococcus agalactiae) (GBS) is a rare cause of prosthetic joint infection (PJI) occurring in patients with comorbidities and seems to be associated with a poor outcome. Depiction of GBS PJI is scarce in the literature. Methods: A retrospective survey in 2 referral centers for bone joint infections was done Patients with a history of PJI associated with GBS between 2014 and 2019 were included. A descriptive analysis of treatment failure was done. Risk factors of treatment failure were assessed. Results: We included 61 patients. Among them, 41 had monomicrobial (67%) infections. The median duration of follow-up was 2 years (interquartile range 2.35) Hypertension, obesity, and diabetes mellitus were the most reported comorbidities (49%, 50%, and 36% respectively). Death was observed in 6 individuals (10%) during the initial management. The rate of success was 63% (26/41). Removal of the material was not associated with remission (p = 0.5). We did not find a specific antibiotic regimen associated with a better outcome. Conclusion: The results show that S. agalactiae PJIs are associated with high rates of comorbidities and a high treatment failure rate with no optimal treatment so far. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nImplication for rehabilitationTo determine if falls perceived as significant by lower limb prosthesis (LLP) users were associated with fall circumstances and/or consequences.The circumstances and consequences of LLP users’ most significant fall in the past 12-months were collected using the Lower Limb Prosthesis User Fall Event Survey. Participants rated fall significance from 0 (not significant) to 10 (extremely significant), which was then dichotomized into “low” and “high”. Binary logistic regression was used to assess associations between fall significance and fall circumstances and consequences.Ninety-eight participants were included in the analysis. Five fall consequences were associated with greater significance: major injury (OR = 26.7, 95% CI: 1.6–459.6, p = 0.024), need to seek medical treatment (OR = 19.0, 95% CI: 1.1–329.8, p = 0.043), or allied-health treatment (OR = 18.2, 95% CI: 2.3–142.4, p = 0.006), decreased balance confidence (OR = 10.9, 95% CI: 2.4–49.3, p = 0.002), and increased fear of falling (OR = 7.5, 95% CI: 2.4–23.8, p = 0.001), compared to two fall circumstances: impact to the arm (OR = 5.0, 95% CI: 2.0–12.1, p = 0.001), and impact to the face, head, or neck (OR = 9.7, 95% CI: 1.2–77.4, p = 0.032).Significant falls were generally more associated with fall consequence than fall circumstances.Falls remain common, injurious, costly, and socially isolating events for lower limb prosthesis (LLP) users.Falls perceived as most significant by LLP users were associated with injury, reduced balance confidence, and increased fear-of-falling.Studying falls perceived by LLP users as significant may help reduce falls that matter most to LLP users.Falls remain common, injurious, costly, and socially isolating events for lower limb prosthesis (LLP) users.Falls perceived as most significant by LLP users were associated with injury, reduced balance confidence, and increased fear-of-falling.Studying falls perceived by LLP users as significant may help reduce falls that matter most to LLP users. [ABSTRACT FROM AUTHOR]

One of the major alternatives for lasting prosperity is the use of biodegradable natural fiber as reinforcements in the production of composites to tackle worldwide environmental problems. This study aims to address utilizing available and sustainable natural fibers to prevent injury to people engaged in the fabrication of prosthetic limb sockets while maintaining socket strength. An above-the-knee prosthetic socket of natural fiber-reinforced composites was prepared via the vacuum molding method. Linen, hemp, carbon, monofilament, and glass are the materials utilized. For assessing the degree of contact between the matrix and fibers, Fourier transform infrared (FTIR), scanning electron microscopy (SEM), differential scanning calorimetry (DSC), and tensile tests were utilized. The finding shows that no novel peak was seen in the FTIR, which indicates no new material was produced. It's related to the physical link between reinforcements and resin. SEM micrographs confirmed that the results corroborated those from the FTIR. DSC data indicated that as the number of layers rose, the glass transition temperature decreased, and mixing natural fibers with synthetics did not affect crystallization temperatures. The proposed tests have been conducted to characterize the interfacial strength, providing further information for the futuristic use of composites in various engineering applications. [ABSTRACT FROM AUTHOR]

A study was developed for a limb-different accessible video game controller that utilizes an electromyographic sensor to control gameplay actions. Data was collected from 50 college-aged student participants. This biofeedback-based serious game trains users in a virtual capacity, through the visualization of muscle contraction, via the movement of the video game character. The training platform has been developed to accompany the corresponding electromyographic actuated prosthetic arm device, leveraging the same control scheme to enable the translation of hand gesture states. This study evaluated the controller, user interface, and gameplay to identify training improvement outcomes and user satisfaction. Study participants were divided into two cohorts that differed in their intervention between the pre-test and post-test challenge course. Cohort one had a free play environment that encouraged learning through algorithmically generated track patterns and the use of powerups. In contrast, cohort two repeated the challenge mode, which was made up of a course of rings to jump through and focused on targeted muscle discretization via character jump heights correlated to muscle output. Data were collected to develop and validate training methods and identify overall game satisfaction and usability. The results of this study indicated an increase in the user's ability to be successful based on time on task with the intervention. The study also evaluated the usability and participant experience with the intervention. [ABSTRACT FROM AUTHOR]

The transtibial Prosthetic Socket serves as the primary connection between the residual limb of an amputee and the prosthesis. The socket must provide a secure and stable base for the amputee to bear their body weight and move around comfortably. Topological optimization is a process that aims to improve the mechanical properties of the prosthetic socket. It involves designing a structure that minimizes stress concentrations and maximizes strength while using the least amount of material. The objective of this study is to improve the parametric design of the transtibial socket prosthesis through topology optimization and determine the stress performance of 3D-printed transtibial sockets using static structural analysis. The method used is Finite Element Analysis (FEA) simulations of forces onto the socket during phases of walking on different topology-optimized socket designs and using the same material, which is ABS. Furthermore, the results were analyzed through static structural analysis using ANSYS software. The analysis revealed that a reduction in the weight of the model correlates with an increase in stress thus may contribute to material fatigue and reducing long term performance.

The primary goal of rehabilitation for individuals with lower limb amputation, particularly those with unilateral transfemoral amputation (uTFA), is to restore their ability to walk independently. Effective control of the center of pressure (COP) during gait is vital for maintaining balance and stability, yet it poses a significant challenge for individuals with uTFA. This study aims to study the COP during gait in individuals with uTFA and elucidate their unique compensatory strategies. This study involved 12 uTFA participants and age-matched non-disabled controls, with gait and COP trajectory data collected using an instrumented treadmill. Gait and COP parameters between the control limb (CL), prosthetic limb (PL), and intact limb (IL) were compared. Notably, the mediolateral displacement of COP in PL exhibited significant lateral displacement compared to the CL from 30% to 60% of the stance. In 20% to 45% of the stance, the COP forward speed of PL was significantly higher than that of the IL. Furthermore, during the initial 20% of the stance, the vertical ground reaction force of PL was significantly lower than that of IL. Additionally, individuals with uTFA exhibited a distinct gait pattern with altered duration of loading response, single limb support, pre-swing and swing phases, and step time. These findings indicate the adaptability of individuals with uTFA in weight transfer, balance control, and pressure distribution on gait stability. In conclusion, this study provides valuable insights into the unique gait dynamics and balance strategies of uTFA patients, highlighting the importance of optimizing prosthetic design, alignment procedures, and rehabilitation programs to enhance gait patterns and reduce the risk of injuries due to compensatory movements.

Objective: Here, we demonstrate the first successful use of static neural stimulation patterns for specific information content. These static patterns were derived by a model that was applied to a subject's own hippocampal spatiotemporal neural codes for memory. Approach: We constructed a new model of processes by which the hippocampus encodes specific memory items via spatiotemporal firing of neural ensembles that underlie the successful encoding of targeted content into short-term memory. A memory decoding model (MDM) of hippocampal CA3 and CA1 neural firing was computed which derives a stimulation pattern for CA1 and CA3 neurons to be applied during the encoding (sample) phase of a delayed match-to-sample (DMS) human short-term memory task. Main results: MDM electrical stimulation delivered to the CA1 and CA3 locations in the hippocampus during the sample phase of DMS trials facilitated memory of images from the DMS task during a delayed recognition (DR) task that also included control images that were not from the DMS task. Across all subjects, the stimulated trials exhibited significant changes in performance in 22.4% of patient and category combinations. Changes in performance were a combination of both increased memory performance and decreased memory performance, with increases in performance occurring at almost 2 to 1 relative to decreases in performance. Across patients with impaired memory that received bilateral stimulation, significant changes in over 37.9% of patient and category combinations was seen with the changes in memory performance show a ratio of increased to decreased performance of over 4 to 1. Modification of memory performance was dependent on whether memory function was intact or impaired, and if stimulation was applied bilaterally or unilaterally, with nearly all increase in performance seen in subjects with impaired memory receiving bilateral stimulation. Significance: These results demonstrate that memory encoding in patients with impaired memory function can be facilitated for specific memory content, which offers a stimulation method for a future implantable neural prosthetic to improve human memory. [ABSTRACT FROM AUTHOR]

While innovation is known to catalyse solutions to global sustainable development challenges, lack of engagement from stakeholders during conceptualisation and development may influence the degree of success of implementation. This paper presents a complete and novel engagement methodology, developed from value led business modelling approaches, for working with multi-sector stakeholders. The methodology can be used to determine barriers and facilitators to clinical practice innovations or translational research, within a country-specific context. The approach has then been applied in the Cambodian prosthetics and orthotics sector to provide a practice-based exemplar application of the framework. This approach seeks to ensure the suitability and sustainability of clinical practice and research programmes being implemented within a complex ecosystem. A theoretical basis, drawn from academic and business innovation sectors, has been consolidated and adapted for practical application to design, direct, and inform initiatives in low resource settings. The methods presented provide a way to both develop and articulate the mission, vision, and goals of any proposed change, and to effectively communicate these with stakeholders in a way that engages the personal and professional values that exist in their ecosystem. It provides a structured process through which meaningful conversations can happen, and a basis for relationship management with key stakeholders; intrinsic to enable a sustained legacy from research and development. The engagement from stakeholders during conceptualisation and throughout development can determine the success, or not, of any implementation and scale of innovation. This paper presents a conceptual stakeholder-led engagement methodology, developed from value led business modelling approaches, for determining barriers and facilitators to translational global healthcare research in a country-specific context, in this case the Cambodian prosthetics and orthotics sector. Subsequent research and development work in this area needs to carefully manage and negotiate influencing factors identified through the application of the described methodology, to ensure initiatives (whether research or wider national development work) are sustainable and successful. [ABSTRACT FROM AUTHOR]

The transtibial Prosthetic Socket serves as the primary connection between the residual limb of an amputee and the prosthesis. The socket must provide a secure and stable base for the amputee to bear their body weight and move around comfortably. Topological optimization is a process that aims to improve the mechanical properties of the prosthetic socket. It involves designing a structure that minimizes stress concentrations and maximizes strength while using the least amount of material. The objective of this study is to improve the parametric design of the transtibial socket prosthesis through topology optimization and determine the stress performance of 3D-printed transtibial sockets using static structural analysis. The method used is Finite Element Analysis (FEA) simulations of forces onto the socket during phases of walking on different topologyoptimized socket designs and using the same material, which is ABS. Furthermore, the results were analyzed through static structural analysis using ANSYS software. The analysis revealed that a reduction in the weight of the model correlates with an increase in stress thus may contribute to material fatigue and reducing long term performance. [ABSTRACT FROM AUTHOR]

AbstractElectromyography (EMG) signals are primarily used to control prosthetic hands. Classifying hand gestures efficiently with EMG signals presents numerous challenges. In addition to overcoming these challenges, a successful combination of feature extraction and classification approaches will improve classification accuracy. In the current work, convolutional neural network (CNN) features are used to reduce the redundancy problems associated with time and frequency domain features to improve classification accuracy. The features from the EMG signal are extracted using a CNN and are fed to the ‘k’ nearest neighbor (KNN) classifier with a different number of neighbors (1NN,3NN,5NN,and 7NN). It results in an ensemble of classifiers that are combined using a hard voting-based classifier. Based on the benchmark Ninapro DB4 database and CapgMyo database, the proposed framework obtained 91.3% classification accuracy on CapgMyo and 89.5% on Ninapro DB4. [ABSTRACT FROM AUTHOR]

Background: Cranioplasty is a routine neurosurgery treatment used to correct cranial vault abnormalities. Utilization of 3D printing technology in the field of cranioplasty involving the reconstruction of cranial defects emerged as an advanced possibility of anatomical reshaping. The transformative impact of patient-specific 3D printed implants, focuses on their remarkable accuracy, customization capabilities, and enhanced biocompatibility. Methods: The precise adaptation of implants to patient-specific anatomies, even in complex cases we presented, result in improved aesthetic outcomes and reduced surgical complications. The ability to create highly customized implants addresses the functional aspects of cranial defects and considers the psychological impact on patients. Results: By combining technological innovation with personalized patient care, 3D printed cranioplasty emerges as a transformative avenue in cranial reconstruction, ultimately redefining the standards of success in neurosurgery. Conclusion: 3D printing allows an excellent cranioplasty cosmesis achieved at a reasonable price without sacrificing patient outcomes. Wider implementation of this strategy can lead to significant healthcare cost savings. [ABSTRACT FROM AUTHOR]

This paper focused on the provision of an affordable and less weight prosthetic arm for the Zimbabwe an population. There search concentrated on improving the amputees' living standards by means of providing them with a useful artificial arm which can perform tasks as a normal human arm. The literature review was thoroughly done by investigating the latest prostatic arms available in the market. The V model o revolutionary prototyping was used in there search project to account for every component of the prosthetic limb. The V-model is a type of software development life cycle (SDLC)paradigm where processes run sequentially in a V-shape. The Ruoko bot is flexible and affordable thanthe current artificial prosthetic available. The prosthetic limb has an Arduino board which allows the useof an artificial intelligence algorithm to determine which signal of the brain's waves should be translated into bodily motion by anEEGheadband. [ABSTRACT FROM AUTHOR]

Objectives: Up-to-date literature regarding long-term success of implant rehabilitations after microvascular reconstructions with free fibula flap (FFF) is still very scarce. This study aimed to evaluate clinical outcomes, especially related to oral hygiene conditions, of patients rehabilitated with this technique. Materials and methods: A total of 25 patients who underwent maxillofacial reconstructive surgery with FFF were retrospectively evaluated for soft tissues conditions, oral hygiene habits, and implant survival and success, assessed with a mean follow-up of 6 (range 2–15) years after loading. Results: Fourteen patients received full-arch fixed prostheses and 11 removable bar-supported overdentures. At the follow-up evaluation, 52% of prostheses did not allow proper accessibility for oral hygiene. Overall prosthetic survival was 100%, and implant survival and success were respectively 93.6% and 72%. Prevalence of peri-implantitis was 29% at implant level and that at patient level 96%. Conclusions: Six-year clinical outcomes of this study reveal that poor oral hygiene practices and compliance by patients who underwent maxillofacial reconstruction with FFF are significantly associated with peri-implant disease. Clinical relevance: Findings of the present study underline the need by clinicians for a careful assessment, in reference to a specific implant therapy, of patient's prosthetic accessibility for oral hygiene procedures. [ABSTRACT FROM AUTHOR]

This study aimed to construct a decision aid to estimate the likelihood of independence with a prosthesis following rehabilitation for limb loss secondary to advanced ischaemia (acute or chronic limb threatening ischaemia) or diabetic foot disease (DFD). A secondary aim was to determine whether prosthetic independence is a surrogate marker of long term survival. A retrospective cohort study of a prospectively maintained database of unilateral amputations due to ischaemia or DFD entering rehabilitation between 2007 and 2020 was performed. Predictors of independent prosthetic mobility (IPM) were used in construction of the IPM prediction model, which underwent bootstrap internal and criterion validation through correlation with predictors of other measures of function: Timed Up and Go (TUG) and two minute walk test. Kaplan–Meier and Cox regression analyses were performed to address the secondary aim. Of the 771 patients included, only 49.9% of amputees achieved IPM. Independent negative predictors of IPM were age > 75 years, female sex, higher amputation level, active malignancy, cerebrovascular disease, end stage renal disease, and cognitive impairment. The model yielded high discrimination (C statistic 0.778), and internal validation was demonstrated with bootstrapping (C statistic 0.778), confirming no over optimism. There was a strong correlation between IPM, TUG, and two minute distance and their predictors, confirming strong criterion validity. The IPM group had a median survival of 93.7 (80.7, 105) months, whereas the non-IPM group fared worse with a median survival of 56.6 (48.5, 66.7) months (p <.001). An internally validated decision aid for estimating the likelihood of independence with a prosthesis after major amputation was constructed. A strong association between female sex and poorer prosthetic mobility was observed. Prosthetic function was shown to be a surrogate marker of long term survival. Future research will involve external validation studies to confirm the generalisability of the decision aid in clinical practice. [ABSTRACT FROM AUTHOR]

The pylon is an essential part of lower limb prosthetics. It is usually made of titanium, aluminum, and steel. However, it is expensive and difficult to be available in developing countries, especially for children who suffer from amputation. Moreover, they constantly need new pylon pieces during close periods due to the growth and increase in the child's length. This study aims to design an adjustable pylon that can change in length to suit the increase in the length of the healthy leg of the child without the need for a new pylon and reduce the economic cost. In this study, an adjustable pylon model was designed using the CAD software (Solid work) and work to manufacture the pylon from low-cost materials (carbon fiber filament) capable of bearing the amputee's weight, and manufacturing printed parts by using additive manufacturing technical (CREALITY CR20 3D printer). The results showed that the pylon is successful in design and strength as it bears the patient's weight without any failure or buckling, and the proof that the maximum amount of stress generated is 27.8 MPa, which is far from the value of the yield stress. The design of the adjustable pylon prototype offers good strength and ability to bear the patient weight, reducing the cost and time of manufacturing. [ABSTRACT FROM AUTHOR]

Abstract Background The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced community participation. This paper reviews adjustable socket designs, as they have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure. Methods Systematic literature and patent searches were conducted across multiple databases to identify articles and patents that discussed adjustable prosthetic sockets. The patents were used to find companies, organisations, and institutions who currently sell adjustable sockets or who are developing devices. Results 50 literature articles and 63 patents were identified for inclusion, representing 35 different designs used in literature and 16 commercially available products. Adjustable sockets are becoming more prevalent with 73% of publications (literature, patents, and news) occurring within the last ten years. Two key design characteristics were identified: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length), and surface form (conformable, rigid multi-DOF, and rigid single DOF). Inflatable bladders contributed to 40% of literature used designs with only one identified commercially available design (n = 16) using this approach. Whereas circumferential adjustment designs covered 75% of identified industry designs compared to only 36% of literature devices. Clinical studies were generally small in size and only 17.6% of them assessed a commercially available socket. Discussion There are clear differences in the design focus taken by industry and researchers, with justification for choice of design and range of adjustment often being unclear. Whilst comfort is often reported as improved with an adjustable socket, the rationale behind this is not often discussed, and small study sizes reduce the outcome viability. Many adjustable sockets lack appropriate safety features to limit over or under tightening, which may present a risk of tissue damage or provide inadequate coupling, affecting function and satisfaction. Furthermore, the relationship between design and comfort or function are rarely investigated and remain a significant gap in the literature. Finally, this review highlights the need for improved collaboration between academia and industry, with a strong disconnect observed between commercial devices and published research studies.

To assist an individual with an amputation in regaining daily quality of life, a 2SPU-RU type parallel mechanism was developed based on ankle biomechanics. The inverse kinematic analysis of this mechanism was performed using the vector method. Subsequently, the Jacobian matrices were analyzed. The dynamic model of the mechanism was then created based on the principle of virtual work, and its theoretical solution was compared with numerical results obtained in a simulation environment. Additionally, the validity of the dynamic model and the inverse kinematics was verified by comparing theoretical and simulation results for the movements of plantarflexion–dorsiflexion, eversion–inversion, and abduction–adduction during the gait cycle.

Cardiovascular prosthetic devices, stents, prosthetic valves, heart-assist pumps, etc., operate in a wide regime of flows characterized by fluid dynamic flow structures, laminar and turbulent flows, unsteady flow patterns, vortices, and other flow disturbances. These flow disturbances cause shear stress, hemolysis, platelet activation, thrombosis, and other types of blood trauma, leading to neointimal hyperplasia, neoatherosclerosis, pannus overgrowth, etc. Couette-type blood-shearing devices are used to simulate and then clinically measure blood trauma, after which the results can be used to assist in the design of the cardiovascular prosthetic devices. However, previous designs for such blood-shearing devices do not cover the whole range of flow shear, Reynolds numbers, and Taylor numbers characteristic of all types of implanted cardiovascular prosthetic devices, limiting the general applicability of clinical data obtained by tests using different blood-shearing devices. This paper presents the key fluid dynamic parameters that must be met. Based on this, Couette device geometric parameters such as diameter, gap, flow rate, shear stress, and temperature are carefully selected to ensure that the device’s Reynolds numbers, Taylor number, operating temperature, and shear stress in the gap fully represent the flow characteristics across the operating range of all types of cardiovascular prosthetic devices. The outcome is that the numerical data obtained from the presented device can be related to all such prosthetic devices and all flow conditions, making the results obtained with such shearing devices widely applicable across the field. Numerical simulations illustrate that the types of flow patterns generated in the blood-shearing device meet the above criteria.

Vision loss from diseases of the outer retina, such as age-related macular degeneration, is among the leading causes of irreversible blindness in the world today. The goal of retinal prosthetics is to replace the photo-sensing function of photoreceptors lost in these diseases with optoelectronic hardware to electrically stimulate patterns of retinal activity corresponding to vision. To enable high-resolution retinal prosthetics, the scale of stimulating electrodes must be significantly decreased from current designs; however, this reduces the amount of stimulating current that can be delivered. The efficacy of subretinal stimulation at electrode sizes suitable for high visual acuity retinal prosthesis are not well understood, particularly within the safe charge injection limits of electrode materials. Here, we measure retinal ganglion cell (RGC) responses in a mouse model of blindness to evaluate the stimulation efficacy of 10, 20, and 30 μm diameter iridium oxide electrodes within the electrode charge injection limits, focusing on measures of charge threshold and dynamic range. Stimulation thresholds were lower for smaller electrodes, but larger electrodes could elicit a greater dynamic range of spikes and recruited more ganglion cells within charge injection limits. These findings suggest a practical lower limit for planar electrode size and indicate strategies for maximizing stimulation thresholds and dynamic range.

Aims: Focal knee arthroplasty is an attractive alternative to knee arthroplasty for young patients because it allows preservation of a large amount of bone for potential revisions. However, the mechanical behaviour of cartilage has not yet been investigated because it is challenging to evaluate in vivo contact areas, pressure, and deformations from metal implants. Therefore, this study aimed to determine the contact pressure in the tibiofemoral joint with a focal knee arthroplasty using a finite element model. Methods: The mechanical behaviour of the cartilage surrounding a metal implant was evaluated using finite element analysis. We modelled focal knee arthroplasty with placement flush, 0.5 mm deep, or protruding 0.5 mm with regard to the level of the surrounding cartilage. We compared contact stress and pressure for bone, implant, and cartilage under static loading conditions. Results: Contact stress on medial and lateral femoral and tibial cartilages increased and decreased, respectively, the most and the least in the protruding model compared to the intact model. The deep model exhibited the closest tibiofemoral contact stress to the intact model. In addition, the deep model demonstrated load sharing between the bone and the implant, while the protruding and flush model showed stress shielding. The data revealed that resurfacing with a focal knee arthroplasty does not cause increased contact pressure with deep implantation. However, protruding implantation leads to increased contact pressure, decreased bone stress, and biomechanical disadvantage in an in vivo application. Conclusion: These results show that it is preferable to leave an edge slightly deep rather than flush and protruding. Cite this article: Bone Joint Res 2023;12(8):497–503.

Abstract Background Canine prostheses have been commercially available for many years but are still in early stages of research, development, and clinical application. Objective To prospectively investigate mid‐term clinical outcomes of partial limb amputation with a socket prosthesis (PLASP) in canine patients via a descriptive prospective clinical case series and to describe a clinical protocol for PLASP. Methods Client‐owned dogs (n = 12) with distal limb pathology for which total limb amputation was recommended were enrolled. Partial limb amputation was performed and a socket prosthesis was moulded and fitted to the limb. Complications, clinical follow‐up, and objective gait analysis (OGA) were recorded for at least 6 months. An online survey was completed by owners after study completion. Results Ten dogs with thoracic limb pathology and two with pelvic limb pathology were included. The most common site of amputation was mid‐radius (n = 5). Eleven of 12 dogs demonstrated quadrupedal gait on OGA with mean per cent body weight distribution (%BWD) of 26% on thoracic limb prostheses and a %BWD of 16% for the one pelvic limb prosthesis that OGA data were available for. Complications included prosthesis suspension difficulties (n = 5), pressure sores (4), bursitis (4), postoperative infection (3), prosthesis aversion (2), dermatitis (1), and owner noncompliance (1). Two owners elected to discontinue prosthesis use. Conclusions PLASP allowed restoration of quadrupedal gait patterns in most patients. Owners reported overall positive satisfaction, though a high complication rate was observed. PLASP should be considered in select cases as an alternative to total limb amputation for dogs with distal limb pathology.

Aims: Computer-assisted 3D preoperative planning software has the potential to improve postoperative stability in total hip arthroplasty (THA). Commonly, preoperative protocols simulate two functional positions (standing and relaxed sitting) but do not consider other common positions that may increase postoperative impingement and possible dislocation. This study investigates the feasibility of simulating commonly encountered positions, and positions with an increased risk of impingement, to lower postoperative impingement risk in a CT-based 3D model. Methods: A robotic arm-assisted arthroplasty planning platform was used to investigate 11 patient positions. Data from 43 primary THAs were used for simulation. Sacral slope was retrieved from patient preoperative imaging, while angles of hip flexion/extension, hip external/internal rotation, and hip abduction/adduction for tested positions were derived from literature or estimated with a biomechanical model. The hip was placed in the described positions, and if impingement was detected by the software, inspection of the impingement type was performed. Results: In flexion, an overall impingement rate of 2.3% was detected for flexed-seated, squatting, forward-bending, and criss-cross-sitting positions, and 4.7% for the ankle-over-knee position. In extension, most hips (60.5%) were found to impinge at or prior to 50° of external rotation (pivoting). Many of these impingement events were due to a prominent ischium. The mean maximum external rotation prior to impingement was 45.9° (15° to 80°) and 57.9° (20° to 90°) prior to prosthetic impingement. No impingement was found in standing, sitting, crossing ankles, seiza, and downward dog. Conclusion: This study demonstrated that positions of daily living tested in a CT-based 3D model show high rates of impingement. Simulating additional positions through 3D modelling is a low-cost method of potentially improving outcomes without compromising patient safety. By incorporating CT-based 3D modelling of positions of daily living into routine preoperative protocols for THA, there is the potential to lower the risk of postoperative impingement events. Cite this article: Bone Jt Open 2023;4(6):416–423.

ObjectiveHere, we demonstrate the first successful use of static neural stimulation patterns for specific information content. These static patterns were derived by a model that was applied to a subject’s own hippocampal spatiotemporal neural codes for memory.ApproachWe constructed a new model of processes by which the hippocampus encodes specific memory items via spatiotemporal firing of neural ensembles that underlie the successful encoding of targeted content into short-term memory. A memory decoding model (MDM) of hippocampal CA3 and CA1 neural firing was computed which derives a stimulation pattern for CA1 and CA3 neurons to be applied during the encoding (sample) phase of a delayed match-to-sample (DMS) human short-term memory task.Main resultsMDM electrical stimulation delivered to the CA1 and CA3 locations in the hippocampus during the sample phase of DMS trials facilitated memory of images from the DMS task during a delayed recognition (DR) task that also included control images that were not from the DMS task. Across all subjects, the stimulated trials exhibited significant changes in performance in 22.4% of patient and category combinations. Changes in performance were a combination of both increased memory performance and decreased memory performance, with increases in performance occurring at almost 2 to 1 relative to decreases in performance. Across patients with impaired memory that received bilateral stimulation, significant changes in over 37.9% of patient and category combinations was seen with the changes in memory performance show a ratio of increased to decreased performance of over 4 to 1. Modification of memory performance was dependent on whether memory function was intact or impaired, and if stimulation was applied bilaterally or unilaterally, with nearly all increase in performance seen in subjects with impaired memory receiving bilateral stimulation.SignificanceThese results demonstrate that memory encoding in patients with impaired memory function can be facilitated for specific memory content, which offers a stimulation method for a future implantable neural prosthetic to improve human memory.

BACKGROUND: Residual limb discomfort and injury is a common experience for people living with lower limb amputation. Frequently, inadequate load distribution between the prosthetic device and the residual limb is the root cause of this issue. To advance our understanding of prosthetic interface fit, tools are needed to evaluate the mechanical interaction at the prosthetic interface, allowing interface designs to be evaluated and optimised. OBJECTIVES: Present a methodology report designed to facilitate comprehension of the mechanical interaction between the prosthetic interface and the residual limb. As a pilot study, this methodology is used to compare a hands-on and hands-off interface for a single transtibial prosthesis user using secondary Magnetic Resonance Imaging (MRI) data. METHODOLOGY: MRI data of the residual limb while wearing a prosthetic interface is segmented into a hard tissue and a skin surface model. These models are exported as stereolithography (STL) files. Two methods are used to analyse the interface designs. Firstly, CloudCompare software is used to compute the nearest vertex on the skin surface for every vertex on the compiled internal bony surface for both interface types. Secondly, CloudCompare software is used to compare registered skin surfaces of the residual limb while wearing the hands-on and hands-off interfaces. FINDINGS: The maximum and minimum nearest distances between the internal bony surface and skin surface were similar between interface types. However, the distribution of nearest distances was different. When comparing the skin surface while wearing both interfaces, where the fit is more compressive can be visualized. For the dataset used in this study, the classic features of a hands-on Patella Tendon Bearing interface and hands-off pressure cast interface could be identified. CONCLUSION: The methodology presented in this report may give researchers a further tool to better understand how interface designs affect the soft tissues of the residual limb. Layman's Abstract If a person loses all or part of their leg because of injury or disease, they may use a replacement limb to help them walk again. The replacement limb is attached to their remaining leg using a rigid shell and flexible liner. Sometimes, the skin, muscles, and other tissues of their remaining leg are damaged while wearing the replacement limb. Often, this is because the replacement limb fits poorly to their remaining leg. In order to design replacement limbs that do not cause injury, a better understanding of replacement limb fit is required. In this study, a method to understand how replacement limbs deform remaining limb skin, muscles, and other tissues, is presented. 3D medical images are taken of a person’s remaining leg while they wear two different types of replacement limbs. These images are processed into 3D models and then analysed to investigate deformation. Firstly, deformation of the remaining leg, caused by the replacement limb, is calculated based on the distance between the bone surface and skin surface of the remaining leg. Secondly, the shape of the outer surface of the remaining leg while wearing the different replacement limbs is compared. When this method was used to compare the remaining leg of a person while wearing two different types of replacement limb, using previously acquired medical 3D images, differences in the shape of the remaining limb were found. This method may be useful to help design better replacement limbs that do not cause injury in the future. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/42196/32357 How To Cite: Arnstein T, Buis A. Methodology to investigate effect of prosthetic interface design on residual limb soft tissue deformation. Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.7. https://doi.org/10.33137/cpoj.v6i1.42196 Corresponding Author: Arjan Buis, PhD Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland. E-Mail: arjan.buis@strath.ac.uk ORCID ID: https://orcid.org/0000-0003-3947-293X

There is currently no consensus regarding what outcome domains to measure following lower limb prosthetic rehabilitation. Prosthetic users have a unique insight into important outcome domains, little is currently known about their critical viewpoint. A total of 37 participants who underwent lower limb amputation in the last five years were recruited from UK limb fitting centres and social media. Data were collected using focus groups and interviews and analysed using reflexive thematic analysis. Five themes were identified. 1) The ability to participate in important activities, 2) how participants were able to undertake these activities, i.e., independently, with ease, safely and with minimal equipment. 3) A comfortable, easy-to-use prosthesis, 4) the importance of managing pain and finally, 5) adjusting and accepting their new normal. These five themes, or outcome domains, did not exist in isolation, but appeared to interact with each other, contributing to, or inhibiting the participant's holistic sense of recovery. Understanding important outcome domains that define what recovery means to people following amputation can help to inform domain consensus, as well as direct the focus of rehabilitation. Domain consensus would guide the selection of measurement tools that evaluate prosthetic interventions in a meaningful way. There is currently no consensus around which outcome domains should be measured following prosthetic rehabilitation. Outcome domains of importance from a patient's perspective focus on participation in important activities, prosthesis comfort, pain management, and acceptance of their new normal. Identifying these domains can help direct the focus of rehabilitation as well as inform outcome measurement practice. The interrelated nature of these domains suggests the need for a physical and psychosocial multi-domain approach to outcome measurement in prosthetic rehabilitation, with patient priorities at its centre. [ABSTRACT FROM AUTHOR]

Background: The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced community participation. This paper reviews adjustable socket designs, as they have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure. Methods: Systematic literature and patent searches were conducted across multiple databases to identify articles and patents that discussed adjustable prosthetic sockets. The patents were used to find companies, organisations, and institutions who currently sell adjustable sockets or who are developing devices. Results: 50 literature articles and 63 patents were identified for inclusion, representing 35 different designs used in literature and 16 commercially available products. Adjustable sockets are becoming more prevalent with 73% of publications (literature, patents, and news) occurring within the last ten years. Two key design characteristics were identified: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length), and surface form (conformable, rigid multi-DOF, and rigid single DOF). Inflatable bladders contributed to 40% of literature used designs with only one identified commercially available design (n = 16) using this approach. Whereas circumferential adjustment designs covered 75% of identified industry designs compared to only 36% of literature devices. Clinical studies were generally small in size and only 17.6% of them assessed a commercially available socket. Discussion: There are clear differences in the design focus taken by industry and researchers, with justification for choice of design and range of adjustment often being unclear. Whilst comfort is often reported as improved with an adjustable socket, the rationale behind this is not often discussed, and small study sizes reduce the outcome viability. Many adjustable sockets lack appropriate safety features to limit over or under tightening, which may present a risk of tissue damage or provide inadequate coupling, affecting function and satisfaction. Furthermore, the relationship between design and comfort or function are rarely investigated and remain a significant gap in the literature. Finally, this review highlights the need for improved collaboration between academia and industry, with a strong disconnect observed between commercial devices and published research studies. [ABSTRACT FROM AUTHOR]

Robotics is a popular branch of Machine Learning that has grown the interest of researchers for many years. Machine learning is used for developing various robotic systems which find their applications in different sectors specially in medical domain. This paper shows how robotics have evolved over the years and how robots are helping doctors as a medical assistant in their everyday work like surgeries, medical imaging, healthcare, manufacturing Prosthetics and patients aids, rehabilitation etc. Even major surgeries like Eye Surgery, Heart Surgery, Soft Surgery Operations, Abdominal Surgeries, and Orthopaedics etc. can be done by medical robots to make life easier for both doctors and patients. The main reasons of increasing robotic helps in healthcare sector are (a) robots are tireless, (b) they don't take stress, (c) their hand never shakes, (d) can do repetitive work effortlessly, (e) can perform precise surgeries. Here, we have reviewed few of robotics application in medical field and discussed all the merits, demerits and future aspects in this regards. [ABSTRACT FROM AUTHOR]

Persons with lower limb loss (PwLLL) must self-manage their residual limb and their prosthesis to prevent self-management related complications (SMRC). However, the experience of PwLLL as it relates to self-management has not been reported. Thus, the purpose of this study was to explore the experience of self-management from the perspective of PwLLL, prosthetists, and physical therapists. This study had a qualitative design. Twenty-three participants were interviewed (PwLLL = 10, prosthetists = 7, physical therapists = 6). Interviews were transcribed and then coded using constant comparison. Four prominent themes were developed from the transcripts: (1) embodying the duty of self-management, (2) being a vigilant self-advocate, (3) setting goals collaboratively, and (4) making informed decisions. Each of the four themes were influenced by the health beliefs of the PwLLL, specifically motivation and presence of an internal locus of control. Clinicians should emphasize the therapeutic relationship, including open communication, collaborative goal setting, and promoting an internal locus of control in interactions with PwLLL, as it may play a role in decreasing SMRC and improving clinical outcomes. Self-management is a crucial aspect of preventing secondary complications associated with limb loss and prosthesis use. Self-management requires an internal locus of control, problem-solving abilities, and foundational knowledge Clinicians can promote self-management through collaborative goal setting and systematic education. [ABSTRACT FROM AUTHOR]

Introduction: As the utilization of total shoulder arthroplasty (TSA) increases, it is essential to identify risk factors associated with postoperative complications. Urinary tract infection (UTI) is one such example. Our objective is to identify whether UTI is associated with increased rates of prosthetic joint infection (PJI) and determine whether its treatment reduces PJI rates. Methods: Patients who underwent primary TSA for glenohumeral osteoarthritis between 2010 and 2019 with minimum two-year follow-up were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were stratified into two cohorts: those with preoperative UTI within two weeks of TSA and those without. The preoperative UTI cohort was stratified into those treated and those untreated prior to TSA. Univariate and multivariable analyses were performed. Results: Following multivariable analysis, there were significantly higher odds of postoperative anemia, pulmonary embolism, and death in the UTI cohort. Comparing treated to untreated UTI, there were no significant differences in multivariable analysis for any 90-day medical or two-year surgical complications. Discussion: This study showed that UTI was not associated with increased rates of PJI. UTI was, however, associated with postoperative medical complications that surgeons should be aware of. [ABSTRACT FROM AUTHOR]