The Development of a Component to Improve the Loading Safety of Bone- Anchored Prostheses
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This may be the author’s version of a work that was submitted/accepted for publication in the following source: Pather, Shanthan, Epari, Devakara, Frossard, Laurent, Pearcy, Mark,& Burkett, Brendan (2015) The development of a component to improve the loading safety of bone- anchored prostheses. (Unpublished) This file was downloaded from: https://eprints.qut.edu.au/91432/ c Copyright 2015 [please consult the author] This work is covered by copyright. Unless the document is being made available under a Creative Commons Licence, you must assume that re-use is limited to personal use and that permission from the copyright owner must be obtained for all other uses. If the docu- ment is available under a Creative Commons License (or other specified license) then refer to the Licence for details of permitted re-use. It is a condition of access that users recog- nise and abide by the legal requirements associated with these rights. 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The development of a component to improve the loading safety of bone- anchored prostheses PhD Outline Shanthan Pather (1) Supervisor committee Dr Devakar Epari(1) : Principal Supervisor Adj/Prof Laurent Frossard (1,2) : Associate Supervisor Prof Mark Pearcy(1) : Associate Supervisor Prof Brendan Burkett (2) : Associate Supervisor (1) Queensland University of Technology, Brisbane, QLD, Australia (2) University of the Sunshine Coast, Maroochydore, QLD, Australia PhD candidature information Starting date: July, 2014 Expected data of completion: July, 2017 Funding: Australian Postgraduate Award (APA) scholarship Abstract rely on two critical components: the implant, and the percutaneous abutment or adapter, which forms the connection for the Use of socket prostheses external prosthetic system (Figure 1). Currently, for individuals with limb loss, the conventional method of attaching a prosthetic limb relies on a socket that fits over the residual limb.[1] However, there are a number of issues concerning the use of a socket (e.g., blisters, irritation, and discomfort) that result in dissatisfaction with socket prostheses, and ultimately a significant decrease in quality of life.[2-9] Bone-anchored prosthesis Alternatively, the concept of attaching artificial limbs directly to the skeletal system has been developed (bone anchored prostheses), as it alleviates many of the issues surrounding the conventional socket [10, 11] interface. Bone anchored prostheses Figure 1. Diagram of a bone anchored prosthetic system. Shanthan Pather 2015. PhD Outline The development of a component to improve the loading safety of bone-anchored prostheses improve the componentry in the system To date, an implant that screws into the long (Figure 2), to increase the overall safety bone of the residual limb has been the most during excessive loading events. [12, 13] common intervention. However, more recently, press-fit implants have been introduced and their use is increasing.[14-16] Several other devices are currently at various stages of development, particularly in Europe and the United States. [10, 17-32] Benefits of bone-anchored prostheses Several key studies have demonstrated that bone-anchored prostheses have major clinical benefits when compared to socket prostheses (e.g., quality of life [13], prosthetic use [6, 33], body image [34], hip range of motion [35], sitting comfort [36], ease of donning and doffing [6], osseoperception (proprioception) [37, 38], walking ability [33, 39]) and acceptable safety, in terms of implant stability [40] and infection [13, 41]. Additionally, this method of attachment allows amputees to participate in a wide range of daily activities for a substantially longer duration.[42-45] Overall, the system has demonstrated a significant enhancement [6, 13, 16, 33, 46] to quality of life. Figure 2. A complete bone-anchored prosthetic system, displaying the external components. Challenges of direct skeletal attachment However, due to the direct skeletal Aim and purposes attachment, serious injury and damage can The ultimate aim of this doctoral research is occur through excessive loading events such to improve the loading safety of bone- as during a fall (e.g., component damage, anchored prostheses, to reduce the peri-prosthetic fracture, hip dislocation, and incidence of injury and damage through femoral head fracture). [39, 42-45, 47-52] These the design of load restricting components, incidents are costly (e.g., replacement of enabling individuals fitted with the system components) and could require further to partake in everyday activities, with surgical interventions. Currently, these risks increased security and self-assurance. The are limiting the acceptance of bone- safety component will be designed to release anchored technology and the substantial or ‘fail’ external to the limb, in a way that improvement to quality of life that this protects the internal bone-implant interface, treatment offers. thus removing the need for restorative An in-depth investigation into these risks surgery and potential damage to the bone. highlighted a clear need to re-design and This requires detailed knowledge of the Shanthan Pather 2015. PhD Outline Page 2 of 8 The development of a component to improve the loading safety of bone-anchored prostheses loads typically experienced by the limb and participation, and quality of life: a an understanding of potential overload systematic review. Prosthet Orthot situations that might occur. Hence, a Int, 2012. 36(2): p. 145-58. comprehensive review of the loading 6. Hagberg, K., R. Branemark, B. literature surrounding bone anchored Gunterberg, and B. Rydevik, prostheses will be conducted as part of this Osseointegrated trans-femoral project, with the potential for additional amputation prostheses: Prospective experimental studies to address the gaps in results of general and condition- the literature. specific quality of life in 18 patients This information will be pivotal in at 2-year follow-up. Prosthetics and determining the specifications for the Orthotics International, 2008. 32(1): properties of the safety component, and the p. 29 - 41. bone-implant system.[39, 42-45, 47-64] 7. Deans, S.A., A.K. McFadyen, and The project will follow the Stanford P.J. Rowe, Physical activity and Biodesign process for the development of quality of life: A study of a lower- the safety component.[65] limb amputee population. Prosthet Orthot Int, 2008. 32(2): p. 186-200. 8. Hagberg, K. and R. Brånemark, References Consequences of non‐vascular trans‐ 1. Mak, A.F., M. Zhang, and D.A. femoral amputation: A survey of Boone, State-of-the-art research in quality of life, prosthetic use and lower-limb prosthetic biomechanics- problems. Prosthetics and Orthotics socket interface: a review. J Rehabil International, 2001. 25(3): p. 186- Res Dev, 2001. 38(2): p. 161-74. 194. 2. Meulenbelt, H.E., P.U. Dijkstra, 9. Zidarov, D., B. Swaine, and C. M.F. Jonkman, and J.H. Geertzen, Gauthier-Gagnon, Life habits and Skin problems in lower limb prosthetic profile of persons with amputees: a systematic review. lower-limb amputation during Disabil Rehabil, 2006. 28(10): p. rehabilitation and at 3-month follow- 603-8. up. Archives of Physical Medicine 3. Hanspal, R., K. Fisher, and R. and Rehabilitation, 2009. 90(11): p. Nieveen, Prosthetic socket fit 1953-1959. comfort score. Disability and 10. Pitkin, M., Design features of Rehabilitation, 2003. 25(22): p. implants for direct skeletal 1278-1280. attachment of limb prostheses. J 4. Shields, C., H. Thorp, G. 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