Evaluation of Mechanical Loads on an Osseointegrated Implant During Locomotor Activities of Daily Living
Abstract
Individuals with lower extremity amputations (ILEA) experience decreased functionality and quality of life due to their missing limb and tissue, with the method of prosthesis attachment largely influencing the quality of life of the individual. Currently, there are two ways a prosthesis can be attached to the residual limb, either with a socket or a bone anchored or osseointegrated (OI) implant. While ILEA with OI prostheses currently represent only a small percentage of ILEA, research largely indicates that ILEA with a OI prosthesis have better overall functionality and performance across a variety of survey or clinical metrics when compared to a socket-based prosthesis, ostensibly due to the direct skeletal attachment created by the OI implant. Because of the functional and performance increase with an OI prosthesis, and the current clinical trials, it is likely that an increased number of ILEA will request and undergo the OI surgery as time passes. And while an OI prosthesis largely increases the quality of life and performance of the ILEA during day-to-day life due to the direct skeletal attachment of the prosthesis, it is equally likely that the direct skeletal attachment introduces unique biomechanical concerns and problems for the ILEA due to the high force and vibration that transfers directly to the residual limb from the prosthesis’ contact with the ground. Previous research indicates there is a risk for disastrous injuries such as bone fractures around the implant ostensibly due to high force transferred to the bone through the implant. In addition, long-term exposure to vibration in the workplace has previously been associated with various cumulative tissue traumas, including overuse and back injuries, and neural and cardiovascular damage in the tissue. However, despite the possibility of disastrous and cumulative tissue injuries in an ILEA with an OI prosthesis, the force and vibration transferred to the tissue has largely been unstudied in ILEA for a variety of day-to-day activities. In addition, ILEA with an OI prosthesis commonly have activity restrictions or recommendations such as not being able to run with their prosthesis, ostensibly because of the high force generated during the prosthesis’ contact with the ground. However, these restrictions in activity are largely established without quantitative data. Therefore, because ILEA are likely to be exposed to more direct force and vibration amplitudes with an OI prosthesis, it is imperative that the force and vibration during activities of daily life be investigated to support the long-term health of these individuals, while maintaining the higher function and quality of life associated with the OI prosthesis. The proposed project aims to investigate the force and vibration at to the OI implant and tissue of an ILEA to characterize the unique biomechanical concerns associated with this attachment method, while maintaining the higher quality of life and performance afforded by an OI prosthesis. This proposal plans to study the population most at risk for exposure to high force and vibration trauma, ILEA with a direct skeletal fixation, an OI implant, as this population has been shown to have increased quality of life and better performance during day-to-day prosthesis use. In particular, the proposal aims to determine the force and vibration during activities of daily living, including variable speed walking, obstacle clearance, stair ascent and descent, side stepping, and the Timed Up and Go. By identifying the transferred force and vibration at the OI implant abutment and residual limb of the ILEA during these activities, biomechanical concerns can begin to be characterized. Due to the promising performance of the OI prosthesis and the likelihood of a fast population expansion within the United States with the clinical trials, it is imperative that evidence-based clinical guidelines be established to assist clinicians and medical staff with addressing t
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110423
Entities
People
- Jae Kun Shim
Organizations
- United States Army
- University of Maryland