| 1. |
- Brånemark, Rickard, 1960, et al.
(författare)
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Biomechanical characterization of osseointegration: an experimental in vivo investigation in the beagle dog.
- 1998
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Ingår i: Journal of orthopaedic research : official publication of the Orthopaedic Research Society. - : Wiley. - 0736-0266. ; 16:1, s. 61-9
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Tidskriftsartikel (refereegranskat)abstract
- This study reports the results of torsion tests, pull-out tests, and lateral loading tests on osseointegrated commercially pure titanium fixtures. The tests were performed in vivo on six beagle dogs. Three fixtures, each with a diameter of 3.7 mm, were installed bilaterally in the tibia of each animal. The mean maximal pull-out load was 1.55 kN (n = 4), the mean maximal lateral transverse load was 0.21 kN (n = 2), the mean maximal lateral axial load was 0.18 kN (n = 2), the mean breakpoint torque was 0.31 Nm (n = 3), and the mean maximal torque was 0.43 Nm (n = 3). The torsion test revealed an almost immediate plastic deformation of the interface between the implant and bone; this indicates that although the contact between the bone and the implant is close, there is no strong bond, at least not in shear. The major transfer of load from the implant to the surrounding bone tissue must therefore depend on the design of the implant. A histological evaluation with measurements of the amount of bone in contact with the fixtures was performed. By the use of the histological and mechanical data, it is possible to estimate shear stresses in bone tissue (pull-out test) and in the interface (torque test). The mean maximal shear stress in bone tissue in the pull-out tests was 100 MPa (n = 4); the mean shear stress in the interface was 4.3 MPa (n = 3) in the torsion tests at the breakpoint torque and was 6.0 MPa (n = 3) at the maximal torque. It was also possible to estimate the shear modulus of elasticity in the pull-out and torque tests. The mean shear modulus in pull-out was 119 MPa (n = 4), and the mean apparent shear modulus in torsion was 9 kPa (n = 3) for an assumed interface thickness of 100 nm and was 86 kPa (n = 3) for an assumed interface thickness of 1,000 nm.
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| 2. |
- Brånemark, Rickard, 1960, et al.
(författare)
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Osseointegration and rigid fixation.
- 1992
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Ingår i: Rigid fixation of the craniomaxillofacoas skeleton. eds Yaremchuk MJ, Gruss JS, Manson PN.. - : Butterworts-Heinemann Publ. ; , s. 275-279
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 3. |
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| 4. |
- Jacobs, R, et al.
(författare)
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Evaluation of the psychophysical detection threshold level for vibrotactile and pressure stimulation of prosthetic limbs using bone anchorage or soft tissue support.
- 2000
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Ingår i: Prosthetics and orthotics international. - 0309-3646. ; 24:2, s. 133-42
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Tidskriftsartikel (refereegranskat)abstract
- In the present study the psychophysical detection threshold levels mechanical stimulation of 32 prosthetic limbs were determined. Prosthetic limbs were anchored to the bone by means of an implant (n=17) or supported by a socket enclosing the amputation stump (n=15). Detection threshold levels were assessed for pressure and vibratory stimulation of the prosthesis and the limb at the contralateral side (control). Following vibratory stimulation, thresholds were increased on an average 20% for socket prostheses. but approached those of the control for bone-anchored prostheses. For pressure stimulation, thresholds were increased up to 60% for socket prostheses and 40% for bone-anchored prostheses compared to the control. While bone-anchored prostheses yielded significantly lower threshold levels than socket prostheses, there was no significant difference between both treatments regarding pressure stimulation. Results were applicable to both upper and lower limb amputees. It could be concluded that detection thresholds for pressure and especially vibratory stimulation of prosthetic limbs were generally higher than for control limbs. The outcome was related to the prosthetic limb design with bone-anchored prostheses yielding better perception than socket prostheses.
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| 5. |
- Olsson, Rickard, 1959-, et al.
(författare)
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Production of osseointegrating (bone bonding) surfaces on titanium screws by laser melt disruption
- 2018
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Ingår i: Journal of Laser Applications. - Melville, NY : Laser Institute of America. - 1042-346X .- 1938-1387. ; 30:4
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Tidskriftsartikel (refereegranskat)abstract
- Several techniques can be used to modify implant surfaces in order to accelerate bone growth around titanium implants. One method is to generate a surface structure which stimulates bone growth and remodeling. This paper describes and explains a nonablative method for producing osseointegrating (structural and functional bone bonding) surfaces on titanium implants using laser processing. The focus is especially on surface texturing of dental implant screws, where the ability of a Nd:YAG laser to generate "splashy" surfaces covered in resolidified microscale droplets coated with nanoscale surface oxides is assessed. The surfaces produced were analyzed by a scanning electron microscope and energy dispersive x-ray spectroscopy. It is concluded that laser processing using Q-pulsed Nd:YAG lasers can generate surfaces which match the demands set by clinical experience. One important characteristic of the surfaces discussed here is that they involve overhanging features which are suitable for trapping red blood cells and which cannot be created by mechanical or chemical roughening techniques. © 2018 Laser Institute of America.
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| 6. |
- Benca, E., et al.
(författare)
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Patient-Specific Guides for Accurate and Precise Positioning of Osseointegrated Implants in Transfemoral Amputations: A Proof-of-Concept In Vitro Study
- 2023
-
Ingår i: Medicina-Lithuania. - : MDPI AG. - 1010-660X. ; 59:3
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: The treatment of transfemoral amputees using osseointegrated implants for prosthetic anchorage requires accurate implant positioning when using threaded bone-anchoring implants due to the curvature of the femur and the risk of cortical penetration in misaligned implants. This study investigated the accuracy and precision in implant positioning using additively manufactured case-specific positioning guides. Materials and Methods: The geometry and density distribution of twenty anatomic specimens of human femora were assessed in quantitative computed tomography (QCT) scanning. The imaging series were used to create digital 3D specimen models, preoperatively plan the optimal implant position and manufacture specimen-specific positioning guides. Following the surgical bone preparation and insertion of the fixture (threaded bone-anchoring element) (OPRA; Integrum AB, Molndal, Sweden), a second QCT imaging series and 3D model design were conducted to assess the operatively achieved implant position. The 3D models were registered and the deviations of the intraoperatively achieved implant position from the preoperatively planned implant position were analyzed as follows. The achieved, compared to the planned implant position, was presented as resulting mean hip abduction or adduction (A/A) and extension or flexion (E/F) and mean implant axis offset in medial or lateral (M/L) and anterior or posterior (A/P) direction measured at the most distal implant axis point. Results: The achieved implant position deviated from the preoperative plan by 0.33 +/- 0.33 degrees (A/A) and 0.68 +/- 0.66 degrees (E/F) and 0.62 +/- 0.55 mm (M/L) and 0.68 +/- 0.56 mm (A/P), respectively. Conclusions: Using case-specific guides, it was feasible to achieve not only accurate but also precise positioning of the implants compared to the preoperative plan. Thus, their design and application in the clinical routine should be considered, especially in absence of viable alternatives.
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| 7. |
- Benca, E., et al.
(författare)
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Thermal Effects during Bone Preparation and Insertion of Osseointegrated Transfemoral Implants
- 2021
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Ingår i: Sensors. - : MDPI AG. - 1424-8220. ; 21:18
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Tidskriftsartikel (refereegranskat)abstract
- Background: The preparation of bone for the insertion of an osseointegrated transfemoral implant and the insertion process are performed at very low speeds in order to avoid thermal damages to bone tissue which may potentially jeopardize implant stability. The aim of this study was to quantify the temperature increase in the femur at different sites and insertion depths, relative to the final implant position during the stepwise implantation procedure. Methods: The procedure for installation of the osseointegrated implant was performed on 24 femoral specimens. In one specimen of each pair, the surgery was performed at the clinically practiced speed, while the speed was doubled in the contralateral specimen. Six 0.075 mm K fine gauge thermocouples (RS Components, Sorby, UK) were inserted into the specimen at a distance of 0.5 mm from the final implant surface, and six were inserted at a distance of 1.0 mm. Results: Drilling caused a temperature increase of <2.5 degrees C and was not statistically significantly different for most drill sizes (0.002 < p < 0.845). The mean increase in temperature during thread tapping and implant insertion was <5.0 degrees C, whereas the speed had an effect on the temperature increase during thread tapping. Conclusions: Drilling is the most time-consuming part of the surgery. Doubling the clinically practiced speed did not generate more heat during this step, suggesting the speed and thus the time- and cost-effectiveness of the procedure could be increased. The frequent withdrawal of the instruments and removal of the bone chips is beneficial to prevent temperature peaks, especially during thread tapping.
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| 8. |
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| 9. |
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| 10. |
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| 11. |
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| 12. |
- Berlin, Örjan, 1948, et al.
(författare)
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OPRA Study: Preliminary 5 years results.
- 2015
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Ingår i: 6th international conference advances in orthopaedic osseointegration, Las Vegas, NV, USA 26-27 march..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 13. |
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| 14. |
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| 15. |
- Boström, Pontus, 1982, et al.
(författare)
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The SNARE protein SNAP23 and the SNARE-interacting protein Munc18c in human skeletal muscle are implicated in insulin resistance/type 2 diabetes.
- 2010
-
Ingår i: Diabetes. - : American Diabetes Association. - 1939-327X .- 0012-1797. ; 59:8, s. 1870-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Our previous studies suggest that the SNARE protein synaptosomal-associated protein of 23 kDa (SNAP23) is involved in the link between increased lipid levels and insulin resistance in cardiomyocytes. The objective was to determine whether SNAP23 may also be involved in the known association between lipid accumulation in skeletal muscle and insulin resistance/type 2 diabetes in humans, as well as to identify a potential regulator of SNAP23. RESEARCH DESIGN AND METHODS: We analyzed skeletal muscle biopsies from patients with type 2 diabetes and healthy, insulin-sensitive control subjects for expression (mRNA and protein) and intracellular localization (subcellular fractionation and immunohistochemistry) of SNAP23, and for expression of proteins known to interact with SNARE proteins. Insulin resistance was determined by a euglycemic hyperinsulinemic clamp. Potential mechanisms for regulation of SNAP23 were also investigated in the skeletal muscle cell line L6. RESULTS: We showed increased SNAP23 levels in skeletal muscle from patients with type 2 diabetes compared with that from lean control subjects. Moreover, SNAP23 was redistributed from the plasma membrane to the microsomal/cytosolic compartment in the patients with the type 2 diabetes. Expression of the SNARE-interacting protein Munc18c was higher in skeletal muscle from patients with type 2 diabetes. Studies in L6 cells showed that Munc18c promoted the expression of SNAP23. CONCLUSIONS: We have translated our previous in vitro results into humans by showing that there is a change in the distribution of SNAP23 to the interior of the cell in skeletal muscle from patients with type 2 diabetes. We also showed that Munc18c is a potential regulator of SNAP23.
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| 16. |
- Brånemark, Rickard, 1960, et al.
(författare)
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A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients.
- 2014
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Ingår i: The bone & joint journal. - 2049-4408. ; 96:1, s. 106-13
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Tidskriftsartikel (refereegranskat)abstract
- Patients with transfemoral amputation (TFA) often experience problems related to the use of socket-suspended prostheses. The clinical development of osseointegrated percutaneous prostheses for patients with a TFA started in 1990, based on the long-term successful results of osseointegrated dental implants. Between1999 and 2007, 51 patients with 55 TFAs were consecutively enrolled in a prospective, single-centre non-randomised study and followed for two years. The indication for amputation was trauma in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical procedure was used to introduce a percutaneous implant to which an external amputation prosthesis was attached. The assessment of outcome included the use of two self-report questionnaires, the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Short-Form (SF)-36. The cumulative survival at two years' follow-up was 92%. The Q-TFA showed improved prosthetic use, mobility, global situation and fewer problems (all p < 0.001). The physical function SF-36 scores were also improved (p < 0.001). Superficial infection was the most frequent complication, occurring 41 times in 28 patients (rate of infection 54.9%). Most were treated effectively with oral antibiotics. The implant was removed in four patients because of loosening (three aseptic, one infection). Osseointegrated percutaneous implants constitute a novel form of treatment for patients with TFA. The high cumulative survival rate at two years (92%) combined with enhanced prosthetic use and mobility, fewer problems and improved quality of life, supports the 'revolutionary change' that patients with TFA have reported following treatment with osseointegrated percutaneous prostheses. Cite this article: Bone Joint J 2014;96-B:106-13.
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| 17. |
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| 18. |
- Brånemark, Rickard, 1960, et al.
(författare)
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An in-vivo method for biomechanical characterization of bone-anchored implants.
- 1998
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Ingår i: Medical engineering & physics. - 1350-4533. ; 20:3, s. 216-9
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Tidskriftsartikel (refereegranskat)abstract
- Experimental equipment for in-vivo registrations of pull-out load vs displacement, applied torque vs angle of rotation, and lateral load vs lateral displacement has been developed. The set-up is designed for testing three implants inserted in a row and osseointegrated in, for instance, the proximal tibia of the beagle dog. The details of the set-up are described and considerations of the stress distributions are reported.
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| 19. |
- Brånemark, Rickard, 1960, et al.
(författare)
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Biomechanical and morphological studies on osseointegration in immunological arthritis in rabbits.
- 1997
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Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - 0284-4311. ; 31:3, s. 185-95
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Tidskriftsartikel (refereegranskat)abstract
- The biomechanics and morphology of the interface between bone tissue and threaded, commercially pure titanium implants were studied i an experimental model of monoarticular arthritis in New Zealand white rabbits (n = 8). Two of the eight rabbits died before evaluation. Immunisation with bovine serum albumin (BSA) and repeated intra-articular injections with BSA in one knee joint elicited an immune response and clinical signs of inflammation. The opposite joint was injected with saline. Three implants were inserted intra-articularly in the lateral femoral condyle in each joint. After a period of six weeks the stability of two of the three implants was evaluated by pull-out and torsion tests using a standardised biomechanical model. The rabbits were killed by perfusion fixation, and the implants and surrounding tissue were retrieved en bloc for histological analysis. The amount of bone, the degree of bone apposition, and the biomechanical evaluation showed that the absolute mechanical capacity of anchorage was not significantly reduced on the arthritic side compared with the control knees. These results indicate that it might be possible to obtain osseointegration in juxta-articular bone despite local joint inflammation.
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| 20. |
- Brånemark, Rickard, 1960, et al.
(författare)
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Biomechanical characterization of osseointegration during healing: an experimental in vivo study in the rat.
- 1997
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Ingår i: Biomaterials. - 0142-9612. ; 18:14, s. 969-78
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Tidskriftsartikel (refereegranskat)abstract
- This study reports torsion tests and pull-out tests on osseointegrated commercially pure titanium fixtures. The tests were performed in vivo on a total of 26 rats. Three fixtures with a diameter of 2.0 mm were installed bilaterally in the proximal tibia in each animal. The mechanical testing was performed immediately after installation, after 2, 4, 8 and 16 weeks of unloaded healing. The torsional strength started to increase after 4 weeks of unloaded healing and there was a significant increase with time during the initial 16 weeks. The pull-out load increased rapidly during the first 4 weeks; thereafter, a moderate increase occurred during the following 12 weeks. A histological evaluation was performed after 0, 4, 8 and 16 weeks. There were significant (P < 0.01) correlations between torque and percentage of bone in contact with the fixture, and between pull-out load and the bone thickness around the fixture (P < 0.001). Estimations of shear stresses and shear moduli in the bone tissue (pull-out test) and at the interface (torque test) indicated that the increase in bone volume around the implant substantially improved the mechanical capacity.
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| 21. |
- Brånemark, Rickard, 1960
(författare)
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Biomechanics and Osseointegration.
- 1991
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Ingår i: Osseointegration in skeletal reconstruction and joint replacement. eds. Brånemark P-I, Rydevik B, Skalak R. Aruba: The Institute for Applied Biotechnology.. ; , s. 159-160
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Bokkapitel (refereegranskat)
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| 22. |
- Brånemark, Rickard, 1960, et al.
(författare)
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Bone response to laser-induced micro- and nano-size titanium surface features.
- 2011
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Ingår i: Nanomedicine : nanotechnology, biology, and medicine. - : Elsevier BV. - 1549-9642 .- 1549-9634.
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Tidskriftsartikel (refereegranskat)abstract
- The present study explored whether laser-induced, site-specific implant surface modifications with micro- and nano-scale topography were able to promote bone formation. The aim was to evaluate the biomechanical and histological response to partly laser-modified titanium implants compared with machined implants. After an early 8-week healing period in rabbit tibia and femur, a 250% increase in removal torque was demonstrated for the partly laser-modified surface. Further, different fracture mechanisms were demonstrated for the two surfaces. Histologically, significantly more bone was found in direct contact with the laser-modified surface for the implants in the tibia sites, while a similar amount of bone tissue was observed in contact with the implant in the femoral sites. In conclusion, an improved bone-implant interface anchorage was promoted by an increase in micro- and nano-scale implant surface topography and surface oxide induced by topological laser treatment.
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| 23. |
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| 24. |
- Brånemark, Rickard, 1960
(författare)
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Direct skeletal fixation of limbs.
- 2015
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Ingår i: Prosthetic rehabilitation following war injury. London, UK 25 September 2015..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 25. |
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| 26. |
- Brånemark, Rickard, 1960, et al.
(författare)
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Osseointegrated Percutaneous Prosthetic System for the Treatment of Patients With Transfemoral Amputation: A Prospective Five-year Follow-up of Patient-reported Outcomes and Complications
- 2019
-
Ingår i: Journal of the American Academy of Orthopaedic Surgeons. - 1067-151X.
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Direct skeletal attachment of prostheses has previously been shown to improve patient-reported outcome (PRO) measures of individuals with transfemoral amputation (TFA) at 2-year follow-up. This prospective study reports the outcomes at 5-year follow-up. METHODS: A total of 51 patients (55 legs) with TFA were included in a prospective study. Complications, success rate, and PRO measures were followed for 5 years. RESULTS: The cumulative fixture survival rate at 5 years was 92%, and the revision-free survival rate was 45%. Thirty-four patients had 70 superficial infections. Eleven patients had 14 deep infections. Fifteen patients had mechanical complications. Four fixtures were removed (ie, one deep infection and three loosening). PRO measures showed significant improvements including more use of the prosthesis, better mobility, fewer issues, and improved physical health-related quality of life (all P < 0.0001) compared with baseline. CONCLUSION: Individuals with TFA at 5-year follow-up had significant improvement in PRO measures, but increases in deep infections and mechanical complications are concerning.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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| 27. |
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| 28. |
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| 29. |
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| 30. |
- Brånemark, Rickard, 1960
(författare)
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Ultrashort transhumeral amputation.
- 2015
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Ingår i: 6th international conference advances in orthopaedic osseointegration. March 26-27, 2015, Las Vegas, U.S..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 31. |
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| 32. |
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| 33. |
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| 34. |
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| 35. |
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| 36. |
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| 37. |
- Clemente, Francesco, et al.
(författare)
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Touch and Hearing Mediate Osseoperception
- 2017
-
Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7
-
Tidskriftsartikel (refereegranskat)abstract
- Osseoperception is the sensation arising from the mechanical stimulation of a bone-anchored prosthesis. Here we show that not only touch, but also hearing is involved in this phenomenon. Using mechanical vibrations ranging from 0.1 to 6 kHz, we performed four psychophysical measures (perception threshold, sensation discrimination, frequency discrimination and reaction time) on 12 upper and lower limb amputees and found that subjects: consistently reported perceiving a sound when the stimulus was delivered at frequencies equal to or above 400 Hz; were able to discriminate frequency differences between stimuli delivered at high stimulation frequencies (similar to 1500 Hz); improved their reaction time for bimodal stimuli (i.e. when both vibration and sound were perceived). Our results demonstrate that osseoperception is a multisensory perception, which can explain the improved environment perception of bone-anchored prosthesis users. This phenomenon might be exploited in novel prosthetic devices to enhance their control, thus ultimately improving the amputees' quality of life.
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| 38. |
- Clites, Tyler R., et al.
(författare)
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Caprine Models of the Agonist-Antagonist Myoneural Interface Implemented at the Above- and Below-Knee Amputation Levels
- 2019
-
Ingår i: Plastic and reconstructive surgery. - 1529-4242. ; 144
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Traditional approaches to amputation are not capable of reproducing the dynamic muscle relationships that are essential for proprioceptive sensation and joint control. In this study, the authors present two caprine models of the agonist-antagonist myoneural interface (AMI), a surgical approach designed to improve bidirectional neural control of a bionic limb. The key advancement of the AMI is the surgical coaptation of natively innervated agonist-antagonist muscle pairs within the residual limb. METHODS: One AMI was surgically created in the hindlimb of each of two African Pygmy goats at the time of primary transtibial amputation. Each animal was also implanted with muscle electrodes and sonomicrometer crystals to enable measurement of muscle activation and muscle state, respectively. Coupled agonist-antagonist excursion in the agonist-antagonist myoneural interface muscles was measured longitudinally for each animal. Fibrosis in the residual limb was evaluated grossly in each animal as part of a planned terminal procedure. RESULTS: Electromyographic and muscle state measurements showed coupled agonist-antagonist motion within the AMI in the presence of both neural activation and artificial muscle stimulation. Gross observation of the residual limb during a planned terminal procedure revealed a thin fibrotic encapsulation of the AMI constructs, which was not sufficient to preclude coupled muscle excursion. CONCLUSIONS: These findings highlight the AMI's potential to provide coupled motion of distal agonist-antagonist muscle pairs preserved during below- or above-knee amputation at nearly human scale. Guided by these findings, it is the authors' expectation that further development of the AMI architecture will improve neural control of advanced limb prostheses through incorporation of physiologically relevant muscle-tendon proprioception.
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| 39. |
- Dumas, Raphael, et al.
(författare)
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Gait analysis of transfemoral amputees: errors in inverse dynamics are substantial and depend on prosthetic design
- 2017
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Ingår i: IEEE transactions on neural systems and rehabilitation engineering. - 1534-4320. ; 25:6, s. 679-685
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Tidskriftsartikel (refereegranskat)abstract
- Quantitative assessments of prostheses performances rely more and more frequently on gait analysis focusing on prosthetic knee joint forces and moments computed by inverse dynamics. However, this method is prone to errors, as demonstrated in comparison with direct measurements of these forces and moments. The magnitude of errors reported in the literature seems to vary depending on prosthetic components. Therefore, the purposes of this study were (A) to quantify and compare the magnitude of errors in knee joint forces and moments obtained with inverse dynamics and direct measurements on ten participants with transfemoral amputation during walking and (B) to investigate if these errors can be characterised for different prosthetic knees. Knee joint forces and moments computed by inverse dynamics presented substantial errors, especially during the swing phase of gait. Indeed, the median errors in percentage of the moment magnitude were 4% and 26% in extension/flexion, 6% and 19% in adduction/abduction as well as 14% and 27% in internal/external rotation during stance and swing phase, respectively. Moreover, errors varied depending on the prosthetic limb fitted with mechanical or microprocessor-controlled knees. This study confirmed that inverse dynamics should be used cautiously while performing gait analysis of amputees. Alternatively, direct measurements of joint forces and moments could be relevant for mechanical characterising of components and alignments of prosthetic limbs.
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| 40. |
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| 41. |
- Earley, Eric, 1989, et al.
(författare)
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Cutting Edge Bionics in Highly Impaired Individuals: A Case of Challenges and Opportunities
- 2024
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Ingår i: IEEE Transactions on Neural Systems and Rehabilitation Engineering. - 1558-0210 .- 1534-4320. ; 32, s. 1013-1022
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Tidskriftsartikel (refereegranskat)abstract
- Highly impaired individuals stand to benefit greatly from cutting-edge bionic technology, however concurrent functional deficits may complicate the adaptation of such technology. Here, we present a case in which a visually impaired individual with bilateral burn injury amputation was provided with a novel transradial neuromusculoskeletal prosthesis comprising skeletal attachment via osseointegration and implanted electrodes in nerves and muscles for control and sensory feedback. Difficulties maintaining implant hygiene and donning and doffing the prosthesis arose due to his contralateral amputation, ipsilateral eye loss, and contralateral impaired vision necessitating continuous adaptations to the electromechanical interface. Despite these setbacks, the participant still demonstrated improvements in functional outcomes and the ability to control the prosthesis in various limb positions using the implanted electrodes. Our results demonstrate the importance of a multidisciplinary, iterative, and patient-centered approach to making cutting-edge technology accessible to patients with high levels of impairment.
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| 42. |
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| 43. |
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| 44. |
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| 45. |
- Farina, D., et al.
(författare)
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Toward higher-performance bionic limbs for wider clinical use
- 2021
-
Ingår i: Nature Biomedical Engineering. - : Springer Science and Business Media LLC. - 2157-846X. ; 7:4, s. 473-85
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Tidskriftsartikel (refereegranskat)abstract
- Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs. This Perspective argues that technologies for the neural interfacing of robotic devices with the body that have been clinically tested in humans should be leveraged toward the creation of a new generation of high-performance bionic limbs.
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| 46. |
- Ferencz, S., et al.
(författare)
-
[A new method for prothetisation of vascular patients with lower limb amputation: initial experiences with osseointegration technique.]
- 2009
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Ingår i: Magyar Sebészet. - 0025-0295. ; 62:5, s. 293-7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction/Aims: Prostheses use for lower limb amputees is difficult, while the socket is hard, the prosthesis is heavy. Drawbacks of conventional prosthesis are mainly associated with the socket, therefore osseointegration technique is a promising solution, since it doesn't require a socket. Our aim was to introduce this technique in Hungary and extend indication for vascular patients. Methods: The method includes two operative and one rehabilitation phases: during first operation a titanium screw is fixed into the femoral bone marrow cavity, this connects to an abutment, which also penetrates the skin, making a direct connection between the femur and the prosthesis during the second intervention. During rehabilitation the patient makes loading exercises and learns to walk with new prosthesis. Results: This method was launched in Hungary in 2005. Two female amputees were operated on initially, their second surgery was performed in 2006 (when titanium screw was applied in the male patients, as well). Incorporation of titanium screw was exquisite, and rehabilitation was successful. One of our male patients died eight months after his first operation due to myocardial infarction. Conclusion: Based on our experiences, the osseointegration technique facilitates rehabilitation of vascular patients for prostheses use. Adequate follow-up and stable vascular diseases are not contraindications, although further clinical trials are needed to determine its indication.
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| 47. |
- Forsberg, Jonatan, et al.
(författare)
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Osseointegration: Surgical Management
- 2016
-
Ingår i: Atlas of Amputations and Limb Deficiencies. 4th edition. Joseph Ivan Krajbich, Michael S. Pinzur, Benjamin K. Potter, & Phillip M. Stevens (eds.). - Rosemont : American Academy of Orthopaedic Surgeons. - 9781625524379
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Bokkapitel (refereegranskat)
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| 48. |
- Frossard, Laurent Alain, et al.
(författare)
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Load on osseointegrated fixation of a transfemoral amputee during a fall: loading, descent, impact and recovery analysis.
- 2010
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Ingår i: Prosthetics and orthotics international. - : Ovid Technologies (Wolters Kluwer Health). - 1746-1553 .- 0309-3646. ; 34:1, s. 85-97
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Tidskriftsartikel (refereegranskat)abstract
- Falling represents a health risk for lower limb amputees fitted with an osseointegrated fixation mainly because of the potential damage to the fixation. The purpose of this study was to characterize a real forward fall that occurred inadvertently to a transfemoral amputee fitted with an osseointegrated fixation while attending a gait measurement session to assess the load applied on the residuum. The objective was to analyze the load applied on the fixation with an emphasis on the sequence of events, the pattern and the magnitude of the forces and moments. The load was measured directly at 200 Hz using a six-channel transducer. Complementary video footage was also studied. The fall was divided into four phases: Loading (240 ms), descent (620 ms), impact (365 ms) and recovery (2495 ms). The main impact forces and moments occurred 870 ms and 915 ms after the heel contact, and corresponded to 133% BW and 17 % BWm, or 1.2 and 11.2 times the maximum forces and moments applied during the previous steps of the participant, respectively. This study provided key information to engineers and clinicians facing the challenge to design equipment, and rehabilitation and exercise programs to restore safely the locomotion of lower limb amputees.
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| 49. |
- Frossard, L., et al.
(författare)
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Apparatus for monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation: a proof-of-concept study
- 2010
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Ingår i: Gait & Posture. - : Elsevier BV. - 1879-2219 .- 0966-6362. ; 31:2, s. 223-228
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this proof-of-concept study was to determine the relevance of direct measurements to monitor the load applied on the osseointegrated fixation of transfemoral amputees during static load bearing exercises. The objectives were (A) to introduce an apparatus using a three-dimensional load transducer, (B) to present a range of derived information relevant to clinicians, (C) to report on the outcomes of a pilot study and (D) to compare the measurements from the transducer with those from the current method using a weighing scale. One transfemoral amputee fitted with an osseointegrated implant was asked to apply 10 kg, 20 kg, 40 kg and 80 kg on the fixation, using self-monitoring with the weighing scale. The loading was directly measured with a portable kinetic system including a six-channel transducer, external interface circuitry and a laptop. As the load prescribed increased from 10 kg to 80 kg, the forces and moments applied on and around the antero-posterior axis increased by four-fold anteriorly and 14-fold medially, respectively. The forces and moments applied on and around the medio-lateral axis increased by nine-fold laterally and 16-fold from anterior to posterior, respectively. The long axis of the fixation was overloaded and underloaded in 17% and 83% of the trials, respectively, by up to + or - 10%. This proof-of-concept study presents an apparatus that can be used by clinicians facing the challenge of improving basic knowledge on osseointegration, for the design of equipment for load bearing exercises and for rehabilitation programs.
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| 50. |
- Frossard, L., et al.
(författare)
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Load applied on bone-anchored transfemoral prosthesis: Characterization of a prosthesis-A pilot study
- 2013
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Ingår i: Journal of Rehabilitation Research and Development. - : Journal of Rehabilitation Research & Development. - 0748-7711. ; 50:5, s. 619-634
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of this study were to (1) record the inner-prosthesis loading during activities of daily living (ADLs), (2) present a set of variables comparing loading data, and (3) provide an example of characterization of two prostheses. The load was measured at 200 Hz using a multi-axial transducer mounted between the residuum and the knee of an individual with unilateral transfemoral amputation fitted with a bone-anchored prosthesis. The load was measured while using two different prosthetic knees, mechanical (PRO1) and microprocessor-controlled (PRO2), during six ADLs. The characterization of the prostheses was achieved using a set of variables split into four categories, including temporal characteristics, maximum loading, loading slopes, and impulse. Approximately 360 gait cycles were analyzed for each prosthesis. PRO I showed a cadence improved by 19% and 7%, a maximum force on the long axis reduced by 11% and 19%, and an impulse reduced by 32% and 15% during descent of incline and stairs compared with PRO2, respectively. This work confirmed that the proposed apparatus and characterization can reveal how changes of prosthetic components are translated into inner-prosthetic loading.
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