Effect of load on the bone around bone-anchored amputation prostheses

Stenlund, Patrik; Trobos, Margarita; Lausmaa, Jukka; Brånemark, Rickard; Thomsen, Peter; Palmquist, Anders

doi:10.1002/jor.23352

Cited by 36 publications

(30 citation statements)

References 49 publications

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“…2 b) was added to induce a nanoporous structure for improved osseointegration. 15 In addition to the design changes, the surgical technique for lower limb amputations was modified to implant the fixture 20 mm countersunk into the bone to address the problem of distal bone resorption, which was sometimes observed when the fixture was placed flush with the distal bone end, 60 , 72 , 75 and to reduce the risk of infection in the bone-fixture interface. 73 Because a fixture failure requires a major surgical intervention, the system was designed to ensure that the abutment and abutment screw fracture before the fixture, or the bone, should the system be exposed to excessive loads, as these components are more easily replaced than the fixture.…”

Section: Resultsmentioning

confidence: 99%

Biomechanical Characterisation of Bone-anchored Implant Systems for Amputation Limb Prostheses: A Systematic Review

et al. 2018

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Bone-anchored limb prostheses allow for the direct transfer of external loads from the prosthesis to the skeleton, eliminating the need for a socket and the associated problems of poor fit, discomfort, and limited range of movement. A percutaneous implant system for direct skeletal attachment of an external limb must provide a long-term, mechanically stable interface to the bone, along with an infection barrier to the external environment. In addition, the mechanical integrity of the implant system and bone must be preserved despite constant stresses induced by the limb prosthesis. Three different percutaneous implant systems for direct skeletal attachment of external limb prostheses are currently clinically available and a few others are under investigation in human subjects. These systems employ different strategies and have undergone design changes with a view to fulfilling the aforementioned requirements. This review summarises such strategies and design changes, providing an overview of the biomechanical characteristics of current percutaneous implant systems for direct skeletal attachment of amputation limb prostheses.

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Section: Resultsmentioning

confidence: 99%

Biomechanical Characterisation of Bone-anchored Implant Systems for Amputation Limb Prostheses: A Systematic Review

et al. 2018

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“…Stenlund et al 21 reoperation to replace the entire implant will increase. 22 Our study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

Comparative Finite Element Analysis of Osseointegration System in Trans-Radial Amputation: A Proposal of New Design

Lee

Jeoung

Kim

et al. 2020

Preprint

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Introduction: Conventional osseointegration systems have been applied in patients requiring trans-humeral and trans-femoral amputations. However, the application of these systems to trans-radial amputations is limited by the small diameter of the radius and ulna. Our study aimed to compare the biomechanical stability of a novel osseointegration system with that of a conventional system used in trans-radial amputations using a finite element(FE) models.Methods: We established three-dimensional FE models of trans-radial amputations, which were osseointegrated with both the novel and conventional systems. External loads were applied to the FE models with compressive force and tensile force along the long axis, horizontal shear force, and vertical shear force. The maximum equivalent stress(MES) and the distribution of stress through the radius and ulna was evaluated.Results : The MES of the radius and ulna was higher in the conventional system when compressive, tensile, and vertical shear forces were applied. However, when the horizontal shear force was applied, the opposite result was found. The distribution of stress was more effective in the novel system.Conclusion : Three-dimensional FE modeling showed that the novel system enables to have a lower stress level and a more even distribution of stress for osseointegration in trans-radial amputations.

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“…A total of 36 implant-bone models were prepared, taking into account the variable length of implants from the range of 75 mm to 130 mm (with an increment of 5 mm) and a diameter from 19 mm to 21 mm (with an increment of 1 mm). Additionally, appropriate immersion in bone tissues of the threaded implant, reported in the literature, was also considered [33, 34]. The analysed constructional parameters correspond to the implants that were lately used in clinical conditions [7, 8].…”

Section: Methodsmentioning

confidence: 99%

The Influence of Geometry of Implants for Direct Skeletal Attachment of Limb Prosthesis on Rehabilitation Program and Stress-Shielding Intensity

Prochor

Sajewicz

2019

BioMed Research International

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The purpose of the research was to evaluate the influence of selected parameters of the implants for bone anchored prostheses on possibility of conducting static load bearing exercises and stress-shielding intensity. A press-fit implant, a threaded implant, and the proposed design were compared using the finite element method. For the analyses two features were examined: diameter (19.0 – 21.0 mm) and length (75.0 – 130.0 mm). To define the possibility of conducting rehabilitation exercises the micromotion of implants while axial loading with a force up to 1000 N was examined to evaluate the changes at implant-bone interface. The stress-shielding intensity was estimated by bone mass loss over 60 months. The results suggest that, in terms of micromotion generated during rehabilitation exercises, the threaded (max. micromotion of 16.00 μm) and the proposed (max. micromotion of 45.43 μm) implants ensure low and appropriate micromotion. In the case of the press-fit solution the load values should be selected with care, as there is a risk of losing primary stabilisation. The allowed forces (that do not stimulate the organism to generate fibrous tissue) were approx. 140 N in the case of the length of 75 mm, increasing up to 560 N, while using the length of 130 mm. Moreover, obtained stress-shielding intensities suggest that the proposed implant should provide appropriate secondary stability, similar to the threaded solution, due to the low bone mass loss during long-term use (improving at the same time more bone remodelling in distal Gruen zones, by providing lower bone mass loss by approx. 13% to 20% in dependency of the length and diameter used). On this basis it can be concluded that the proposed design can be an appropriate alternative to commercially used implants.

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Effect of load on the bone around bone-anchored amputation prostheses

Cited by 36 publications

References 49 publications

Biomechanical Characterisation of Bone-anchored Implant Systems for Amputation Limb Prostheses: A Systematic Review

Biomechanical Characterisation of Bone-anchored Implant Systems for Amputation Limb Prostheses: A Systematic Review

Comparative Finite Element Analysis of Osseointegration System in Trans-Radial Amputation: A Proposal of New Design

The Influence of Geometry of Implants for Direct Skeletal Attachment of Limb Prosthesis on Rehabilitation Program and Stress-Shielding Intensity

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