Advanced techniques in amputation surgery and prosthetic technology in the lower extremity

Abstract

Bone-anchored implants give patients with unmanageable stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates. Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons. Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines. Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist–antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints. As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price. Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter-individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ankles (A-MPK/As) might succeed in uneven ground-walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way. Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor-controlled prosthetic components. Cite this article: EFORT Open Rev 2020;5:724-741. DOI: 10.1302/2058-5241.5.190070

Immediate rotationplasty for a severely crushed floating knee in a blast injury: A case report

“…Given that modern prosthesis techniques are quite advanced, if our patient had chosen AK amputation followed by bionic reconstruction combined with the beneficial effects of targeted muscle innervation and regenerative peripheral nerve interface [14] , a similar functional effect to rotationplasty might have been achieved. However, not every patient has the same access to cutting-edge technology or the ability to afford it.…”

Innovations in Pediatric Prosthetics

“…Several studies among adults with transfemoral amputations have shown improved prosthetic satisfaction, sitting comfort, mobility and reduced cost of energy while walking with BAP. 9,10 Several different implant systems are available globally; however, the OPRA TM Implant System (Integrum, Sweden) is currently the only system FDA approved for use in adults at the transfemoral level and available with humanitarian exemption for transhumeral amputees (Figure 2). Other designs have been used in the U.S. on a custom or experimental basis.…”

“…11 While most studies across the various available implants demonstrate improved quality of life with BAP, there remains a high infection rate. 10,[12][13][14] The feasibility of BAPs in growing children is unknown due to the risk of osseous overgrowth and implant infection. However, osseointegration can similarly be used to improve prosthesis use and function in skeletally mature adolescents with limb differences; this population should be considered for future clinical trials with BAP.…”

Remodeling of the Fibula Stump After Transtibial Amputation

“…The methods, techniques and results of transtibial amputations are well described in the available literature, [1][2][3][4][5][6][7][8][9] as well as the effect of local, due to neuroma, and phantom pain syndrome on the quality of life of patients. 8,9 Emphasis is placed on the excessive mobility of the residual fibula, its valgus deviation, pain syndrome on the outer surface of the residual limb, and difficulties or impossibility of prosthesis.…”