Effects of Prosthetic Socket Design on Residual Femur Motion Using Dynamic Stereo X-Ray - A Preliminary Analysis

Maikos, Jason; Chomack, John M; Loan, J. Peter; Bradley, Kathryn M.; D’Andrea, Susan E.

doi:10.3389/fbioe.2021.697651

Cited by 6 publications

(6 citation statements)

References 47 publications

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“…This pattern may be an effort to compensate for hip abductor weakness or to compensate for the soft tissue movement between the bone and the socket. It may also help counteract the nearly 2 cm of limb-socket axial displacement that occurs with conventional sockets to increase foot clearance during limb advancement and decrease the risk for a stumble or fall [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Changes in frontal plane kinematics over 12-months in individuals with the Percutaneous Osseointegrated Prosthesis (POP)

et al. 2023

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Background A bone-anchored prosthesis (BAP) eliminates the need for a conventional socket by attaching a prosthesis directly to the user’s skeleton. Currently, limited research addresses changes in gait mechanics post BAP implantation. Objective Examine changes in frontal plane movement patterns after BAP implantation. Methods Participants were individuals with unilateral transfemoral amputation (TFA) enrolled in the US Food and Drug Administration (FDA) Early Feasibility Study examining the Percutaneous Osseointegrated Prosthesis (POP). The participants completed overground gait assessments using their conventional socket and at 6-weeks, 12-weeks, 6-months, and 12-months following POP implantation. Statistical parameter mapping techniques were used in examining changes in frontal plane kinematics over the 12-months and differences with reference values for individuals without limb loss. Results Statistically significant deviations were found pre-implantation compared to reference values for hip and trunk angles during prosthetic limb stance phase, and for pelvis and trunk relative to the pelvis angles during prosthetic limb swing. At 6-weeks post-implantation, only the trunk angle demonstrated a statistically significant reduction in the percent of gait cycle with deviations relative to reference values. At 12-months post-implantation, results revealed frontal plane movements were no longer statistically different across the gait cycle for the trunk angle compared to reference values, and less of the gait cycle was statistically different compared to reference values for all other frontal plane patterns analyzed. No statistically significant within-participant differences were found for frontal plane movement patterns between pre-implantation and 6-weeks or 12-months post-implantation. Conclusions Deviations from reference values displayed prior to device implantation were reduced or eliminated 12-months post-implantation in all frontal plane patterns analyzed, while within-participant changes over the 12-month period did not reach statistical significance. Overall, the results suggest the transition to a BAP aided in normalizing gait patterns in a sample of relatively high functioning individuals with TFA.

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Section: Discussionmentioning

confidence: 99%

“…axial displacement that occurs with conventional sockets to increase foot clearance during limb advancement and decrease the risk for a stumble or fall [33,34].…”

Section: Plos Onementioning

confidence: 99%

Changes in frontal plane kinematics over 12-months in individuals with the Percutaneous Osseointegrated Prosthesis (POP)

et al. 2023

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“…Quantification of the 3D position and orientation of the residual limb has been previously described in detail [23]. In brief, the residual tibia will be tracked throughout the gait cycle, with the coordinate system defined in the CT space using a morphology-based coordinate systems adapted from previous studies [37,38].…”

Section: Quantification Of the Relative Motion Between The Residual B...mentioning

confidence: 99%

“…Digitally reconstructed radiographs (DRRs) created from participant-specific CT scans will be matched to the DSX images in the inline and offset views to calculate the 3D pose of the tibia (Figure 5) [18,41]. DRRs will be generated by positioning the segmented CT volume within a virtual x-ray system and projecting rays through it to create a simulated x-ray image [23].…”

Section: Data Processingmentioning

confidence: 99%

“…Currently, only 1 study performed a dynamic investigation of residual tibia motion in participants with transtibial limb loss [10], but the methods relied on subjective input and were time intensive, which can affect accuracy [22] and sample size. In individuals with transfemoral limb loss, Maikos et al [23] used DSX to compare 3D residual femur kinematics between 2 different prosthetic socket types. Gale et al [3] also used DSX for 3D markerless tracking of the residual femur for individuals with transfemoral limb loss during late swing and early stance to calculate the 6 DOF kinematics of the residual femur relative to the socket but did not include terminal stance.…”

Section: Introductionmentioning

confidence: 99%

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Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study

Maikos,

Chomack,

Herlihy

et al. 2024

JMIR Res Protoc

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Background Relative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. Objective This study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. Methods A lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. Results This study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. Conclusions The successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. International Registered Report Identifier (IRRID) DERR1-10.2196/57329

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The biomechanical influence of transtibial Bone-Anchored limbs during walking

Vinson,

Vandenberg,

Awad

et al. 2024

Journal of Biomechanics

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Effects of Prosthetic Socket Design on Residual Femur Motion Using Dynamic Stereo X-Ray - A Preliminary Analysis

Cited by 6 publications

References 47 publications

Changes in frontal plane kinematics over 12-months in individuals with the Percutaneous Osseointegrated Prosthesis (POP)

Changes in frontal plane kinematics over 12-months in individuals with the Percutaneous Osseointegrated Prosthesis (POP)

Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study

The biomechanical influence of transtibial Bone-Anchored limbs during walking

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