Transcutaneous, Distal Femoral, Intramedullary Attachment for Above-the-Knee Prostheses: An Endo-Exo Device

Aschoff, Horst‐Heinrich; Kennon, Robert; Keggi, John M.; Rubin, Lee E.

doi:10.2106/jbjs.j.00806

Cited by 120 publications

(133 citation statements)

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“…If this attachment strength can be achieved in the human situation, this particular POP design would likely be bone sparing in the event of revision surgeries that require implant removal. This is in comparison to another implant design in which the porous coating is used along the entire length of the implant [2], which can result in excessive bone loss when revised. Bone hypertrophy and remodeling followed Wolff's law [18,22,23] and was serendipitously displayed due to the availability of limited number of sizes.…”

Section: Discussionmentioning

confidence: 99%

“…1B), and the intraosseous transcutaneous amputation prosthesis (ITAP) in England (Fig. 1C) [17] [2].…”

Section: Introductionmentioning

confidence: 99%

“…While the OPRA design uses a threaded titanium alloy cylinder that is screwed into the reamed medullary canal [11], the endo-exo femur prosthesis is a cobalt-chrome shaft curved to accommodate the anterior femoral bow (which provides rotational stability) with a cast-structured tripod outer layer for bone ingrowth [2]. To supplement rotational stability, the intramedullary component of the ITAP is a fluted titanium alloy cylinder [17] (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…They also attempt to conserve the host bone tissue and minimize stress shielding to avoid any adverse bone adaptation. Although good medium-term survival rates have been reported for these European implants [2,11], to our knowledge, there has only been one publication that used sequential radiographic evaluation of patients to attempt to ascertain the effect of skeletal docking on bone remodeling over extended time [19]. Without serial clinical radiographic followup, it is impossible to determine whether the design objectives of limiting physiologic bone resorption and implant loosening are being met over the life of the implant [19].…”

Section: Introductionmentioning

confidence: 99%

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Radiographic Evaluation of Bone Adaptation Adjacent to Percutaneous Osseointegrated Prostheses in a Sheep Model

Jeyapalina

Beck

Bachus

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Percutaneous osseointegrated prostheses (POPs) are being investigated as an alternative to conventional socket suspension and require a radiographic followup in translational studies to confirm that design objectives are being met. Questions/purposes In this 12-month animal study, we determined (1) radiographic signs of osseointegration and (2) radiographic signs of periprosthetic bone hypertrophy and resorption (adaptation) and (3) confirmed them with the histologic evidence of host bone osseointegration and adaptation around a novel, distally porous-coated titanium POP with a collar. Methods A POP device was designed to fit the right metacarpal bone of sheep. Amputation and implantation surgeries (n = 14) were performed, and plane-film radiographs were collected quarterly for 12 months. Radiographs were assessed for osseointegration (fixation) and bone adaptation (resorption and hypertrophy). The cortical wall and medullary canal widths were used to compute the cortical index and expressed as a percentage. Based on the cortical index changes and histologic evaluations, bone adaptation was quantified. Results Radiographic data showed signs of osseointegration including those with incomplete seating against the collar attachment. Cortical index data indicated distal cortical wall thinning if the collar was not seated distally. When implants were bound proximally, bone resorbed distally and the diaphyseal cortex hypertrophied. Conclusions Histopathologic evidence and cortical index measurements confirmed the radiographic indications of adaptation and osseointegration. Distal bone loading,

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Section: Discussionmentioning

confidence: 99%

“…1B), and the intraosseous transcutaneous amputation prosthesis (ITAP) in England (Fig. 1C) [17] [2].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiographic Evaluation of Bone Adaptation Adjacent to Percutaneous Osseointegrated Prostheses in a Sheep Model

Jeyapalina

Beck

Bachus

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Rickard developed a textured long-bone fixture modified from his father's dental screw design and began an osseointegration program for those with limb loss in Sweden in the 1990s [3]. Subsequently, Horst Aschoff in Germany developed a press-fit implant for transcutaneous osseointegration [2]. Initial progress was slow, and setbacks and treatment failures common, until Brånemark's team adopted a standardized treatment protocol [6]; likewise, Aschoff's design has been modified twice to transition the transcutaneous portion of the implant from a porous interface to a polished design, resulting in a dramatic reduction in skin complications and infection rates.…”

mentioning

confidence: 99%

From Bench to Bedside: A Perfect Fit? Osseointegration Can Improve Function for Patients with Amputations

Potter

2016

Clinical Orthopaedics &Amp; Related Research

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Cortical Bone Response to the Presence of Load‐Bearing Percutaneous Osseointegrated Prostheses

Jeyapalina

Beck

Bachus

et al. 2012

The Anatomical Record

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Although the current percutaneous osseointegrated (OI) prosthetic attachment systems are novel clinical treatments for patients with limb loss, there have only been limited translational studies undertaken to date. To bridge this knowledge gap, from a larger study group of 86 animals that were implanted with a novel percutaneous OI implant construct, 33 sheep were randomly selected from the 0-, 3-, 6-, 9-and 12-month groups for histomorphometric analyses of periprosthetic cortical bone tissue. At necropsy, implanted and nonimplanted limbs were harvested and processed for the evaluation of cortical bone porosity and mineral apposition rate (MAR). The data showed a maximum increase in bone porosity within the first 3 months following implantation and then a progressive reduction in porosity to the baseline steady-state (''Time 0'') value by 12 months. The data further verified that the MAR increased during the first 6 months of implantation, reaching a plateau between 6 and 9 months, followed by a progressive decline to the baseline steady state. It was concluded that clinical load bearing and falls precautions, taken during the first 3-6 months following percutaneous OI device implantation surgery, could greatly limit bone fractures during this vulnerable time of increasing cortical bone porosity. Anat Rec, 295:1437Rec, 295: -1445Rec, 295: , 2012. V C 2012 Wiley Periodicals, Inc. † Key words: percutaneous osseointegrated prosthesis; sheep amputation model; mineral apposition rate; porosity; back-scattered electron imagingOver the past two decades, the percutaneous osseointegrated (OI) skeletal docking of artificial limbs has been introduced as an alternative to the historic sockettype prosthetic attachment systems for patients with limb loss. As this OI system allows ground reaction forces to be directly transmitted to the skeletal system, it improves gait symmetry, allows osseoperception, and increases prosthesis comfort and wear-time for the patient (Hagberg et al

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Transcutaneous, Distal Femoral, Intramedullary Attachment for Above-the-Knee Prostheses: An Endo-Exo Device

Cited by 120 publications

References 0 publications

Radiographic Evaluation of Bone Adaptation Adjacent to Percutaneous Osseointegrated Prostheses in a Sheep Model

Radiographic Evaluation of Bone Adaptation Adjacent to Percutaneous Osseointegrated Prostheses in a Sheep Model

From Bench to Bedside: A Perfect Fit? Osseointegration Can Improve Function for Patients with Amputations

Cortical Bone Response to the Presence of Load‐Bearing Percutaneous Osseointegrated Prostheses

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