Modeling and Cross-Sectional Analysis of Movement Quality with Osseointegrated Prostheses
Abstract
Loss of a lower limb and consequently walking with a prosthetic limb presents a variety of challenges that may affect the individual’s risk for future health problems. The method of prosthesis attachment has a large influence on quality of life for individuals with limb loss, and potential a large influence on their mobility and their walking gaits. Currently, there are two ways a prosthesis can be attached to an amputated limb for individuals who have lost their limb above the knee: a traditional socket prosthesis where the prosthesis attaches compliantly to the body by wrapping a socket around the amputated limb or an osseointegrated prosthesis attached rigidly by anchoring the prosthesis attachment directly to the remaining bone of the amputated limb. Osseointegration has mostly been used as a secondary alternative for individuals who have a poor outcome with socket-based prostheses first, and studies to date on walking gaits in individuals before and after osseointegration suggest that it allows for smaller deviations in hip and pelvis motions and more efficient gait when walking. These existing pre- vs. post-osseointegration surgery data support the effectiveness of osseointegration as a treatment for a particular population (individuals with poor outcomes using a traditional prosthesis), but it is difficult to draw general conclusions on the biomechanical effectiveness of osseointegrated prostheses from these data because they are limited to this particular population who often have low physical function and are affected by complicating factors such as the success of the surgery and the rehabilitation. Due to its suspected benefits, osseointegration is soon expected to become a more popular option for treating limb loss in high-functioning individuals. However, there is little scientific data supporting the benefits of osseointegration for these individuals, making it difficult to recommend with confidence. This gap in knowledge is important because osseointegration involves irreversible surgery that could limit future options for revision. We therefore propose two complementary studies to better isolate the effect of the rigid bone-anchored interface of an osseointegrated prosthesis vs. the compliant socket-based interface of a traditional prosthesis on walking gait. We will first examine the mechanics and energetics of walking in high-functioning individuals with above-knee limb loss and compare these variables between users of osseointegrated prostheses and users of socket-based prostheses. By focusing on high-functioning individuals, this comparison will provide a novel perspective on the benefits of osseointegration for key clinical outcomes such as symmetry, efficiency, and knee joint loading when walking, in the absence of the complicating factors from the existing pre- vs. post-surgery data. The comparison between user groups will give a unique look at osseointegration, but still may not strictly isolate the effect of the prosthesis. Individuals with limb loss are a highly variable group and even groups of high-functioning individuals could have differences that affect their walking independent of whether they have osseointegration or not. To address this issue, we will also perform a second study using computer modeling and simulation of human movement to truly isolate the effect of the prosthesis interface. In our recent research, we have developed state-of-the-art computer models of the human body. Virtual surgeries can be performed on the model to assign it prostheses with various properties, and we have validated the ability of the model to perform realistic simulations of walking with an above-knee prosthesis. By having precise control over all variables of the model and simulation, such as muscle strength and other fitness-related variables, the subjective goal of the walking movement, and properties of the prosthesis other than osseointegration, we can generate simulations of walking with a larg
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310103
Entities
People
- Ross Miller
Organizations
- United States Army
- University of Maryland