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Review Article

Technical Overview of Osseointegrated Transfemoral Prostheses: Orthopaedic Surgery and Implant Design Centered

[+] Author and Article Information
Andrii Maryniak

Center for Medical Education, Poznan University of Medical Sciences, Poznan, Poland
andre.maryniak@mail.utoronto.ca

Brock Laschowski

Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
brock.laschowski@mail.utoronto.ca

Jan Andrysek

Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
jan.andrysek@utoronto.ca

1Corresponding author.

ASME doi:10.1115/1.4039105 History: Received November 12, 2017; Revised January 16, 2018

Abstract

Bone-anchored prostheses represent a promising solution to numerous medical complications associated with conventional socket-suspended prostheses. The following technical overview was constructed for prospective engineers and orthopaedic surgeons interested in osseointegrated implants for transfemoral prosthesis-residuum interfacing. Existing osseointegrated implants comprise different biomaterial compositions (i.e., titanium alloy vs. cobalt-chromium-molybdenum alloy) and mechanical designs (i.e., screw-fixated vs. press-fixated devices). Perioperative systems of osseointegration surgery include: preoperative assessments (i.e., alongside inclusion and exclusion criteria); intraoperative procedures; and postoperative rehabilitation (i.e., static loading and dynamic gait rehabilitation). The intraoperative procedures involve: transecting and reorganizing the residual musculature; embedding the implant into the femoral intramedullary cavity; and coupling the osseointegrated implant to an external prosthesis (e.g., robotic device). Postoperative clinical evaluations have demonstrated significant biomechanical, psychological, and physiological improvements in patients using bone-anchored prostheses compared to conventional socket-suspended prostheses. Nevertheless, bacterial infections surrounding the skin-implant biointerface, often resulting from Staphylococcus aureus or other coagulase-negative staphylococci, remain a relatively frequent medical complication, which can culminate in periprosthetic osteomyelitis and/or implant extraction. The technical overview concludes with discussions of: the recent FDA Humanitarian Use Device designations; financial analyses between bone-anchored and socket-suspended prostheses; and applications of vibrotactile osseoperception for augmenting walking and balance feedback control.

Copyright (c) 2018 by ASME
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