Second-site prosthetic joint infection in patients with multiple prosthetic joints.

Science.gov (United States)

Clesham, Kevin; Hughes, Andrew J; O' hEireamhoin, Sven; Fleming, Catherine; Murphy, Colin G

2018-04-10

Prosthetic joint infections (PJIs) are among the most serious complications in arthroplasty. A second-site PJI in patients with multiple prosthetic joints increases morbidity, with many requiring further revision procedures. We aimed to establish why some patients with multiple joints develop second-site infections. Our institution's arthroplasty database was reviewed from 2004 to 2017. All PJIs were identified, and all patients with more than one prosthetic joint in situ were included. We recorded risk factors, causative organisms, number of procedures and length of stay. Forty-four patients meeting the criteria were identified. Four patients (9.1%) developed second-site infection. Eight patients (18.2%) developed re-infection of the primary PJI. Positive MRSA carrier status and PJI of a total knee replacement were associated with an increased risk of a second episode of infection. Patients who developed further infection had more frequent admission and longer lengths of stay than isolated PJIs. Higher morbidity and use of hospital resources are associated with this cohort of patients. PJIs in total knee replacements and positive MRSA status are associated with higher rates of second infection. Identifying this vulnerable cohort of patients at an early stage is critical to ensure measures are taken to reduce the risks of further infection.

Prosthetics / Limb Loss

Science.gov (United States)

... implant to encourage the sealing process. Implanting titanium prosthetic components avoids the need for a socket. But preventing bacterial invasion and infection is a key challenge, one that this research ...

Review of Prosthetic Joint Infection from Listeria monocytogenes.

Science.gov (United States)

Bader, Gilbert; Al-Tarawneh, Mohammed; Myers, James

2016-12-01

Prosthetic joint infection from Listeria monocytogenes is rare. We decided to shed light on this illness and review the reported cases to better understand its characteristics. We conducted a comprehensive review of the English literature using PubMed. We also included one case that we had managed. We found 25 cases of prosthetic joint infection from L. monocytogenes reported individually and a retrospective study of 43 cases of joint and bone listerial infection, including 34 with prosthetic joint infection, conducted in France. We have described their clinical and para-clinical features and tried to elaborate on the pathophysiology, treatment, and prevention. Prosthetic joint infection from L. monocytogenes is mainly late. Systemic inflammation may be absent. Although rare, it must be suspected in patients at high risk for both prosthetic joint and listerial infections. In addition, those patients must be instructed on appropriate preventive measures.

Pannus-related prosthetic valve dysfunction. Case report.

Science.gov (United States)

Moldovan, Maria-Sînziana; Bedeleanu, Daniela; Kovacs, Emese; Ciumărnean, Lorena; Molnar, Adrian

2016-01-01

Pannus-related prosthetic valve dysfunction, a complication of mechanical prosthetic valve replacement, is rare, with a slowly progressive evolution, but it can be acute, severe, requiring surgical reintervention. We present the case of a patient with a mechanical single disc aortic prosthesis, with moderate prosthesis-patient mismatch, minor pannus found on previous ultrasound examinations, who presented to our service with angina pain with a duration of 1 hour, subsequently interpreted as non-ST segment elevation myocardial infarction (NSTEMI) syndrome. Coronarography showed normal epicardial coronary arteries, an ample movement of the prosthetic disc, without evidence of coronary thromboembolism, and Gated Single-Photon Emission Computerized Tomography (SPECT) with Technetium (Tc)-99m detected no perfusion defects. Transthoracic echocardiography (TTE) evidenced a dysfunctional prosthesis due to a subvalvular mass; transesophageal echocardiography (TOE) showed the interference of this mass, with a pannus appearance, with the closure of the prosthetic disc. Under conditions of repeated angina episodes, under anticoagulant treatment, surgery was performed, with the intraoperative confirmation of pannus and its removal. Postoperative evolution was favorable. This case reflects the diagnostic and therapeutic management problems of pannus-related prosthetic valve dysfunction.

Passive prosthetic hands and tools: A literature review.

Science.gov (United States)

Maat, Bartjan; Smit, Gerwin; Plettenburg, Dick; Breedveld, Paul

2018-02-01

The group of passive prostheses consists of prosthetic hands and prosthetic tools. These can either be static or adjustable. Limited research and development on passive prostheses has been performed although many people use these prosthesis types. Although some publications describe passive prostheses, no recent review of the peer-reviewed literature on passive prostheses is available. Review the peer-reviewed literature on passive prostheses for replacement of the hand. Literature review. Four electronic databases were searched using a Boolean combination of relevant keywords. English-language articles relevant to the objective were selected. In all, 38 papers were included in the review. Publications on passive prosthetic hands describe their users, usage, functionality, and problems in activities of daily living. Publications on prosthetic tools mostly focus on sport, recreation, and vehicle driving. Passive hand prostheses receive little attention in prosthetic research and literature. Yet one out of three people with a limb deficiency uses this type of prosthesis. Literature indicates that passive prostheses can be improved on pulling and grasping functions. In the literature, ambiguous names are used for different types of passive prostheses. This causes confusion. We present a new and clear classification of passive prostheses. Clinical relevance This review provides information on the users of passive prosthetic hands and tools, their usage and the functionality. Passive prostheses receive very little attention and low appreciation in literature. Passive prosthetic hands and tools show to be useful to many unilateral amputees and should receive more attention and higher acceptance.

Validation of the prosthetic esthetic index

DEFF Research Database (Denmark)

Özhayat, Esben B; Dannemand, Katrine

2014-01-01

OBJECTIVES: In order to diagnose impaired esthetics and evaluate treatments for these, it is crucial to evaluate all aspects of oral and prosthetic esthetics. No professionally administered index currently exists that sufficiently encompasses comprehensive prosthetic esthetics. This study aimed...... to validate a new comprehensive index, the Prosthetic Esthetic Index (PEI), for professional evaluation of esthetics in prosthodontic patients. MATERIAL AND METHODS: The content, criterion, and construct validity; the test-retest, inter-rater, and internal consistency reliability; and the sensitivity...... furthermore distinguish between participants and controls, indicating sufficient sensitivity. CONCLUSION: The PEI is considered a valid and reliable instrument involving sufficient aspects for assessment of the professionally evaluated esthetics in prosthodontic patients. CLINICAL RELEVANCE...

Candida infection of a prosthetic shoulder joint

Energy Technology Data Exchange (ETDEWEB)

Lichtman, E.A.

1983-09-01

A heroin addict developed a Candida parapsilosis infection in a prosthetic shoulder joint. Radiographs showed loose fragments of cement with prosthetic loosening. The patient was treated with removal of the prosthesis and intravenous amphotericin B followed by oral ketoconazole.

Candida infection of a prosthetic shoulder joint

International Nuclear Information System (INIS)

Lichtman, E.A.; Veterans Administration Medical Center, New York

1983-01-01

A heroin addict developed a Candida parapsilosis infection in a prosthetic shoulder joint. Radiographs showed loose fragments of cement with prosthetic loosening. The patient was treated with removal of the prosthesis and intravenous amphotericin B followed by oral ketoconazole. (orig.)

Management of Prosthetic Joint Infection.

Science.gov (United States)

Tande, Aaron J; Gomez-Urena, Eric O; Berbari, Elie F; Osmon, Douglas R

2017-06-01

Although uncommon, prosthetic joint infection is a devastating complication. This challenging condition requires a coordinated management approach to achieve good patient outcomes. This review details the general principles to consider when managing patients with prosthetic joint infection. The different medical/surgical treatment strategies and how to appropriately select a strategy are discussed. The data to support each strategy are presented, along with discussion of antimicrobial strategies in specific situations. Copyright © 2017 Elsevier Inc. All rights reserved.

Which prosthetic foot to prescribe?

OpenAIRE

De Asha, AR; Barnett, CT; Struchkov, V; Buckley, JG

2017-01-01

Introduction: \\ud Clinicians typically use findings from cohort studies to objectively inform judgements regarding the potential (dis)advantages of prescribing a new prosthetic device. However, before finalising prescription a clinician will typically ask a patient to 'try out' a change of prosthetic device while the patient is at the clinic. Observed differences in gait when using the new device should be the result of the device’s mechanical function, but could also conceivably be due to pa...

Bruxism and prosthetic treatment: a critical review.

Science.gov (United States)

Johansson, Anders; Omar, Ridwaan; Carlsson, Gunnar E

2011-07-01

Based on the findings from available research on bruxism and prosthetic treatment published in the dental literature, an attempt was made to draw conclusions about the existence of a possible relationship between the two, and its clinical relevance. MEDLINE/PubMed searches were conducted using the terms 'bruxism' and 'prosthetic treatment', as well as combinations of these and related terms. The few studies judged to be relevant were critically reviewed, in addition to papers found during an additional manual search of reference lists within selected articles. Bruxism is a common parafunctional habit, occurring both during sleep and wakefulness. Usually it causes few serious effects, but can do so in some patients. The etiology is multifactorial. There is no known treatment to stop bruxism, including prosthetic treatment. The role of bruxism in the process of tooth wear is unclear, but it is not considered a major cause. As informed by the present critical review, the relationship between bruxism and prosthetic treatment is one that relates mainly to the effect of the former on the latter. Bruxism may be included among the risk factors, and is associated with increased mechanical and/or technical complications in prosthodontic rehabilitation, although it seems not to affect implant survival. When prosthetic intervention is indicated in a patient with bruxism, efforts should be made to reduce the effects of likely heavy occlusal loading on all the components that contribute to prosthetic structural integrity. Failure to do so may indicate earlier failure than is the norm. Copyright © 2011 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Graft-Sparing Strategy for Thoracic Prosthetic Graft Infection.

Science.gov (United States)

Uchino, Gaku; Yoshida, Takeshi; Kakii, Bunpachi; Furui, Masato

2018-04-01

 Thoracic prosthetic graft infection is a rare but serious complication with no standard management. We reported our surgical experience on graft-sparing strategy for thoracic prosthetic graft infection.  This study included patients who underwent graft-sparing surgery for thoracic prosthetic graft infection at Matsubara Tokushukai Hospital in Japan from January 2000 to October 2017.  There were 17 patients included in the analyses, with a mean age at surgery of 71.0 ± 10.5 years; 11 were men. In-hospital mortality was observed in five patients (29.4%).  Graft-sparing surgery for thoracic prosthetic graft infection is an alternative option particularly for early graft infection after hemiarch replacement. Georg Thieme Verlag KG Stuttgart · New York.

Echocardiographic evaluation of heart valve prosthetic dysfunction

Directory of Open Access Journals (Sweden)

Yuriy Ivaniv

2018-02-01

Full Text Available Patients with replaced heart valve submitted to echocardiographic examination may have symptoms related either to valvular malfunction or ventricular dysfunction from different causes. Clinical examination is not reliable in a prosthetic valve evaluation and the main information regarding its function could be obtained using different cardiac ultrasound modalities. This review provides a description of echocardiographic and Doppler techniques useful in evaluation of prosthetic heart valves. For the interpretation of echocardiography there is a need in special knowledge of prosthesis types and possible reasons of prosthetic function deterioration. Echocardiography allows to reveal valve thrombosis, pannus formation, vegetation and such complications of infective endocarditis as valve ring abscess or dehiscence. Transthoracic echocardiography requires different section plane angles and unconventional views. Transesophageal echocardiography is more often used than in native valve examination due to better visualization of prosthetic valve structure and function. Three-dimensional echocardiography could provide more detailed visual information especially in the assessment of paravalvular regurgitation or valve obstruction.

Prosthetic management of deciduous teeth

OpenAIRE

Bassil, Jean

2015-01-01

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária Introduction: Situations of single or multiple edentulous are not an exception during childhood. Prosthetic management is necessary in case of absence of replacing tooth or when its eruption is planned too far in time. Indications of prosthetic rehabilitation for children are multiple and rise from the etiologic factors caus...

100 top-cited scientific papers in limb prosthetics.

Science.gov (United States)

Eshraghi, Arezoo; Osman, Noor Azuan Abu; Gholizadeh, Hossein; Ali, Sadeeq; Shadgan, Babak

2013-11-17

Research has tremendously contributed to the developments in both practical and fundamental aspects of limb prosthetics. These advancements are reflected in scientific articles, particularly in the most cited papers. This article aimed to identify the 100 top-cited articles in the field of limb prosthetics and to investigate their main characteristics. Articles related to the field of limb prosthetics and published in the Web of Knowledge database of the Institute for Scientific Information (ISI) from the period of 1980 to 2012. The 100 most cited articles in limb prosthetics were selected based on the citation index report. All types of articles except for proceedings and letters were included in the study. The study design and level of evidence were determined using Sackett's initial rules of evidence. The level of evidence was categorized either as a systematic review or meta-analysis, randomized controlled trial, cohort study, case-control study, case series, expert opinion, or design and development. The top cited articles in prosthetics were published from 1980 to 2012 with a citation range of 11 to 90 times since publication. The mean citation rate was 24.43 (SD 16.7) times. Eighty-four percent of the articles were original publications and were most commonly prospective (76%) and case series studies (67%) that used human subjects (96%) providing level 4 evidence. Among the various fields, rehabilitation (47%), orthopedics (29%), and sport sciences (28%) were the most common fields of study. The study established that studies conducted in North America and were written in English had the highest citations. Top cited articles primarily dealt with lower limb prosthetics, specifically, on transtibial and transradial prosthetic limbs. Majority of the articles were experimental studies.

Responsiveness of the Prosthetic Esthetic Scale

DEFF Research Database (Denmark)

Øzhayat, Esben Boeskov

2017-01-01

Objectives The aim of the study was to evaluate the responsiveness of the Prosthetic Esthetic Index (PEI) in a population who received prosthetic replacements. Materials and methods Fifty-seven patients who received prosthetic replacement of at least one tooth by means of fixed or removable...... prosthesis were professionally esthetically evaluated using the PEI and the Dental Aesthetic Index (DAI) before and after treatment. The participants further evaluated their oral esthetics using the Oral Health Impact Profile Aesthetic (OHIP-Aes) and Orofacial Esthetic Index (OES). Responsiveness......-Aes and OES scores. The PEI was more consistent in responsiveness than the DAI. Conclusions The PEI shows sufficient responsiveness for use in longitudinal studies and for use as a follow-up measure in clinical practice. Clinical relevance The PEI can in a standardized manner monitor and document esthetic...

Stiffness and hysteresis properties of some prosthetic feet

OpenAIRE

van Jaarsveld, H.W.L.; Grootenboer, H.J.; de Vries, J.; Koopman, Hubertus F.J.M.

1990-01-01

A prosthetic foot is an important element of a prosthesis, although it is not always fully recognized that the properties of the foot, along with the prosthetic knee joint and the socket, are in part responsible for the stability and metabolic energy cost during walking. The stiffness and the hysteresis, which are the topics of this paper, are not properly prescribed, but could be adapted to improve the prosthetic walking performance. The shape is strongly related to the cosmetic appearance a...

Control method for prosthetic devices

Science.gov (United States)

Bozeman, Richard J., Jr. (Inventor)

1995-01-01

A control system and method for prosthetic devices is provided. The control system comprises a transducer for receiving movement from a body part for generating a sensing signal associated with that movement. The sensing signal is processed by a linearizer for linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part. The linearized sensing signal is normalized to be a function of the entire range of body part movement from the no-shrug position of the moveable body part. The normalized signal is divided into a plurality of discrete command signals. The discrete command signals are used by typical converter devices which are in operational association with the prosthetic device. The converter device uses the discrete command signals for driving the moveable portions of the prosthetic device and its sub-prosthesis. The method for controlling a prosthetic device associated with the present invention comprises the steps of receiving the movement from the body part, generating a sensing signal in association with the movement of the body part, linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part, normalizing the linear signal to be a function of the entire range of the body part movement, dividing the normalized signal into a plurality of discrete command signals, and implementing the plurality of discrete command signals for driving the respective moveable prosthesis device and its sub-prosthesis.

Tomographic and echocardiographic diagnosis of mitral prosthetic valve thrombosis

International Nuclear Information System (INIS)

Sainz Gonzalez de la Penna, Benito; Ramos Gutierrez, Luis Benito; Gonzalez Artiles, Iovank

2010-01-01

Despite the progress achieved in the design of mechanical prosthetic valves, prosthetic valve thrombosis remains a frequent cause of morbidity, usually due to incorrect anticoagulation. A patient was presented with mitral prosthetic thrombosis one year after implantation, who had been diagnosed by transthoracic transesophageal echocardiography imaging and 64-slice computed tomography. Thrombolytic therapy was successful and led to the satisfactory evolution of the patient

Prosthetic Consideration in Implant-supported Prosthesis: A Review of Literature.

Science.gov (United States)

Gowd, Manga Snigdha; Shankar, Thatapudi; Ranjan, Rajeev; Singh, Arpita

2017-06-01

Modern dentistry has changed tremendously with implant therapy. For the successful implant therapy, making a proper treatment plan considering both surgical and prosthetic part in mind is the key of success. Often practitioners tend to create a treatment plan overlooking the basic principles of prosthetic part. This present review has discussed various prosthetic consideration of implant-supported prosthesis. A step-by-step detailed prosthetic option with their indications has been discussed to help all dental implant practitioners in making of an optimal treatment plan for each case.

The role of vision processing in prosthetic vision.

Science.gov (United States)

Barnes, Nick; He, Xuming; McCarthy, Chris; Horne, Lachlan; Kim, Junae; Scott, Adele; Lieby, Paulette

2012-01-01

Prosthetic vision provides vision which is reduced in resolution and dynamic range compared to normal human vision. This comes about both due to residual damage to the visual system from the condition that caused vision loss, and due to limitations of current technology. However, even with limitations, prosthetic vision may still be able to support functional performance which is sufficient for tasks which are key to restoring independent living and quality of life. Here vision processing can play a key role, ensuring that information which is critical to the performance of key tasks is available within the capability of the available prosthetic vision. In this paper, we frame vision processing for prosthetic vision, highlight some key areas which present problems in terms of quality of life, and present examples where vision processing can help achieve better outcomes.

Antithrombotic Therapy in Patients with Prosthetic Heart Valves

Directory of Open Access Journals (Sweden)

Mohamed HA

2009-01-01

Full Text Available Patients with mechanical valve prostheses require a lifelong anticoagulant treatment. The combined use of Warfarin and low-dose aspirin appears to reduce the risk of valve thrombosis and systemic embolism at a low risk of bleeding. The management of women with prosthetic heart valves during pregnancy poses a particular challenge, as there are no available controlled clinical trials to provide guidelines for effective antithrombotic therapy. Oral anticoagulants, such as Warfarin, cause foetal embryopathy; unfractionated heparin and low-molecular-weight heparin have been reported to be ineffective in preventing thromboembolic complications.This article discusses the available data and the most recent guidelines in the antithrombotic management of patients with prosthetic valves, and antithrombotic therapy in various clinical situations such as pregnant women with prosthetic heart valves, and patients with prosthetic heart valves undergoing noncardiac surgery.

Amputation and Prosthetics

Science.gov (United States)

... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Amputation and Prosthetics Email to a friend * required ...

38 CFR 17.150 - Prosthetic and similar appliances.

Science.gov (United States)

2010-07-01

... appliances. 17.150 Section 17.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Prosthetic, Sensory, and Rehabilitative Aids § 17.150 Prosthetic and similar appliances... appliances including invalid lifts and therapeutic and rehabilitative devices, and special clothing made...

Viability of Controlling Prosthetic Hand Utilizing Electroencephalograph (EEG) Dataset Signal

Science.gov (United States)

Miskon, Azizi; A/L Thanakodi, Suresh; Raihan Mazlan, Mohd; Mohd Haziq Azhar, Satria; Nooraya Mohd Tawil, Siti

2016-11-01

This project presents the development of an artificial hand controlled by Electroencephalograph (EEG) signal datasets for the prosthetic application. The EEG signal datasets were used as to improvise the way to control the prosthetic hand compared to the Electromyograph (EMG). The EMG has disadvantages to a person, who has not used the muscle for a long time and also to person with degenerative issues due to age factor. Thus, the EEG datasets found to be an alternative for EMG. The datasets used in this work were taken from Brain Computer Interface (BCI) Project. The datasets were already classified for open, close and combined movement operations. It served the purpose as an input to control the prosthetic hand by using an Interface system between Microsoft Visual Studio and Arduino. The obtained results reveal the prosthetic hand to be more efficient and faster in response to the EEG datasets with an additional LiPo (Lithium Polymer) battery attached to the prosthetic. Some limitations were also identified in terms of the hand movements, weight of the prosthetic, and the suggestions to improve were concluded in this paper. Overall, the objective of this paper were achieved when the prosthetic hand found to be feasible in operation utilizing the EEG datasets.

Pre-prosthetic surgical alterations in maxillectomy to enhance the prosthetic prognoses as part of rehabilitation of oral cancer patient.

Science.gov (United States)

El Fattah, H; Zaghloul, A; Pedemonte, E; Escuin, T

2012-03-01

After maxillectomy, prosthetic restoration of the resulting defect is an essential step because it signals the beginning of patient's rehabilitation. The obturator used to restore the defect should be comfortable, restore adequate speech, deglutition, mastication, and be cosmetically acceptable, success will depend on the size and location of the defect and the quantity and integrity of the remaining structures, in addition to pre-prosthetic surgical preparation of defect site. Preoperative cooperation between the oncologist surgeon and the maxillofacial surgeon may allow obturation of a resultant defect by preservation of the premaxilla or the tuberosity on the defect side and maintaining the alveolar bone or teeth adjacent to the defect. This study evaluates the importance of pre-prosthetic surgical alterations at the time maxillectomy on the enhancement of the prosthetic prognoses as part of the rehabilitation of oral cancer patient. The study was carried out between 2003- 2008, on 66 cancer patients(41 male-25 female) age ranged from 33 to 72 years, at National Cancer Institute, Cairo University, whom underwent maxillectomy surgery to remove malignant tumor as a part of cancer treatment. Patients were divided in two groups. Group A: Resection of maxilla followed by preprosthetic surgical preparation. Twenty-four cancer patients (13 male - 11 female). Group B: Resection of maxilla without any preprosthetic surgical preparation. Forty-two cancer patients (28 male-14 female). Outcome variables measured included facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success and donor site morbidity were also studied. To improve the prosthetic restoration of maxillary defect resulting maxillary resection as part treatment of maxillofacial tumor depends on the close cooperation between prosthodontist and surgeon, by combination of pre-prosthetic

Rotationplasty with vascular reconstruction for prosthetic knee joint infection.

Science.gov (United States)

Fujiki, Masahide; Miyamoto, Shimpei; Nakatani, Fumihiko; Kawai, Akira; Sakuraba, Minoru

2015-01-01

Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option.

Control System for Prosthetic Devices

Science.gov (United States)

Bozeman, Richard J. (Inventor)

1996-01-01

A control system and method for prosthetic devices is provided. The control system comprises a transducer for receiving movement from a body part for generating a sensing signal associated with that of movement. The sensing signal is processed by a linearizer for linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part. The linearized sensing signal is normalized to be a function of the entire range of body part movement from the no-shrug position of the moveable body part through the full-shrg position of the moveable body part. The normalized signal is divided into a plurality of discrete command signals. The discrete command signals are used by typical converter devices which are in operational association with the prosthetic device. The converter device uses the discrete command signals for driving the moveable portions of the prosthetic device and its sub-prosthesis. The method for controlling a prosthetic device associated with the present invention comprises the steps of receiving the movement from the body part, generating a sensing signal in association with the movement of the body part, linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part, normalizing the linear signal to be a function of the entire range of the body part movement, dividing the normalized signal into a plurality of discrete command signals, and implementing the plurality of discrete command signals for driving the respective moveable prosthesis device and its sub-prosthesis.

Successful thrombolysis of aortic prosthetic valve thrombosis during ...

African Journals Online (AJOL)

Successful thrombolysis of aortic prosthetic valve thrombosis during first trimester of pregnancy. A Shukla, AP Raval, R Shah. Abstract. Prosthetic heart valve thrombosis during pregnancy is life-threatening. Standard surgical treatment using cardiopulmonary bypass carries high maternal and fetal complications. Here we ...

Welding of Prosthetic Alloys

Directory of Open Access Journals (Sweden)

Wojciechowska M.

2015-04-01

Full Text Available This paper presents the techniques of joining metal denture elements, used in prosthetic dentistry: the traditional soldering technique with a gas burner and a new technique of welding with a laser beam; the aim of the study was to make a comparative assessment of the quality of the joints in view of the possibility of applying them in prosthetic structures. Fractographic examinations were conducted along with tensile strength and impact strength tests, and the quality of the joints was assessed compared to the solid metal. The experiments have shown that the metal elements used to make dentures, joined by the technique which employs a laser beam, have better strength properties than those achieved with a gas burner.

Ten questions on prosthetic shoulder infection.

Science.gov (United States)

Pinder, Elizabeth M; Ong, Joshua Cy; Bale, R Stephen; Trail, Ian A

2016-07-01

Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes.

21 CFR 890.3025 - Prosthetic and orthotic accessory.

Science.gov (United States)

2010-04-01

... (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3025... intended for medical purposes to support, protect, or aid in the use of a cast, orthosis (brace), or prosthesis. Examples of prosthetic and orthotic accessories include the following: A pelvic support band and...

Undergraduate prosthetics and orthotics teaching methods: A baseline for international comparison.

Science.gov (United States)

Aminian, Gholamreza; O'Toole, John M; Mehraban, Afsoon Hassani

2015-08-01

Education of Prosthetics and Orthotics is a relatively recent professional program. While there has been some work on various teaching methods and strategies in international medical education, limited publication exists within prosthetics and orthotics. To identify the teaching and learning methods that are used in Bachelor-level prosthetics and orthotics programs that are given highest priority by expert prosthetics and orthotics instructors from regions enjoying a range of economic development. Mixed method. The study partly documented by this article utilized a mixed method approach (qualitative and quantitative methods) within which each phase provided data for other phases. It began with analysis of prosthetics and orthotics curricula documents, which was followed by a broad survey of instructors in this field and then a modified Delphi process. The expert instructors who participated in this study gave high priority to student-centered, small group methods that encourage critical thinking and may lead to lifelong learning. Instructors from more developed nations placed higher priority on student's independent acquisition of prosthetics and orthotics knowledge, particularly in clinical training. Application of student-centered approaches to prosthetics and orthotics programs may be preferred by many experts, but there appeared to be regional differences in the priority given to different teaching methods. The results of this study identify the methods of teaching that are preferred by expert prosthetics and orthotics instructors from a variety of regions. This treatment of current instructional techniques may inform instructor choice of teaching methods that impact the quality of education and improve the professional skills of students. © The International Society for Prosthetics and Orthotics 2014.

Rehabilitation and Prosthetic Services

Science.gov (United States)

... Review Resources AT Education Blind Rehab Chiropractic Service Polytrauma/TBI Prosthetics & Sensory Aids Recreation Therapy More Health ... Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues ...

Stiffness and hysteresis properties of some prosthetic feet

NARCIS (Netherlands)

van Jaarsveld, H.W.L.; Grootenboer, H.J.; de Vries, J.; Koopman, Hubertus F.J.M.

1990-01-01

A prosthetic foot is an important element of a prosthesis, although it is not always fully recognized that the properties of the foot, along with the prosthetic knee joint and the socket, are in part responsible for the stability and metabolic energy cost during walking. The stiffness and the

Successful Management of Prosthetic Valve Brucella Endocarditis with Antibiotherapy Alone

Directory of Open Access Journals (Sweden)

José Pedro Fonseca

2018-01-01

Full Text Available Objectives: To report a case of mechanical aortic prosthesis Brucella endocarditis successfully treated with antibiotics alone. Materials and methods: We describe a clinical case and present a review of the literature. Results: A 60-year-old female farmer with a mechanical aortic prosthetic valve presented with low back pain and fever. She was diagnosed with prosthetic valve Brucella mellitensis endocarditis and was cured with antibiotic therapy alone. Few cases of successfully treated prosthetic valve Brucella endocarditis without surgery have been reported. Conclusion: Prosthetic valve Brucella endocarditis usually requires surgical valve replacement. However, selected patients may be successfully treated with antibiotic therapy alone.

Cost analysis of debridement and retention for management of prosthetic joint infection.

Science.gov (United States)

Peel, T N; Dowsey, M M; Buising, K L; Liew, D; Choong, P F M

2013-02-01

Prosthetic joint infection remains one of the most devastating complications of arthroplasty. Debridement and retention of the prosthesis is an attractive management option in carefully selected patients. Despite this, there are no data investigating the cost of this management modality for prosthetic joint infections. The aim of this case-control study was to calculate the cost associated with debridement and retention for management of prosthetic joint infection compared with primary joint replacement surgery without prosthetic joint infection. From 1 January 2008 to 30 June 2010, there were 21 prosthetic joint infections matched to 42 control patients. Controls were matched to cases according to the arthroplasty site, age and sex. Cases had a greater number of unplanned readmissions (100% vs. 7.1%; p prosthetic joint infection the total cost, including index operation and costs of management of the prosthetic joint infection, was 3.1 times the cost of primary arthoplasty; the mean cost for cases was Australian dollars (AUD) $69,414 (±29,869) compared with $22,085 (±8147) (p prosthetic joint infections will also increase, placing significant burden on the health system. Our study adds significantly to the growing body of evidence highlighting the substantial costs associated with prosthetic joint infection. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

[Localized purpura revealing vascular prosthetic graft infection].

Science.gov (United States)

Boureau, A S; Lescalie, F; Cassagnau, E; Clairand, R; Connault, J

2013-07-01

Prosthetic graft infection after vascular reconstruction is a rare but serious complication. We report a case of infection occurring late after implantation of an iliofemoral prosthetic vascular graft. The Staphylococcus aureus infection was revealed by vascular purpura localized on the right leg 7 years after implantation of a vascular prosthesis. This case illustrates an uncommonly late clinical manifestation presenting as an acute infection 7 years after the primary operation. In this situation, the presentation differs from early infection, which generally occurs within the first four postoperative months. Diagnosis and treatment remain a difficult challenge because prosthetic graft infection is a potentially life-threatening complication. Morbidity and mortality rates are high. Here we detail specific aspects of the clinical and radiological presentation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Salmonella Typhimurium gastroenteritis leading to chronic prosthetic vascular graft infection.

Science.gov (United States)

Cullinan, Milo; Clarke, Michael; Dallman, Tim; Peart, Steven; Wilson, Deborah; Weiand, Daniel

2017-08-01

Introduction. It is estimated up to 6 % of prosthetic vascular grafts become infected. Staphylococcus aureus is predominant in early infection and coagulase-negative staphylococci are predominant in late infections. Enterobacteriaceae cause 14-40 % of prosthetic vascular graft infections. This is, to our knowledge the first reported case of Salmonella gastroenteritis causing chronic prosthetic vascular graft infection (PVGI). Case presentation. A 57 years old lady presented with signs and symptoms of prosthetic vascular graft infection. Three years earlier, she had undergone a prosthetic axillo-femoral bypass graft for critical limb ischaemia. The infected prosthetic vascular graft was removed and Salmonella Typhimurium was isolated on culture. In the intervening period, Salmonella Typhimurium was isolated from a faecal specimen, collected during an episode of acute gastroenteritis. Whole-genome sequencing (WGS) showed that the respective Salmonella Typhimurium isolates differed by only a single nucleotide polymorphism (SNP). Salmonella Typhimurium was not isolated on culture of a faecal specimen collected five days following cessation of antimicrobial therapy. Six months after removal of the prosthetic graft, the patient remains under follow-up for her peripheral vascular disease, which currently requires no further surgical intervention. Conclusion. This case has clear implications for the management of chronic PVGI. It is vital to collect high-quality surgical specimens for microbiological analysis and empirical choices of antibiotics are unlikely to cover all potential pathogens. It may also be prudent to enquire about a history of acute gastroenteritis when assessing patients presenting with chronic PVGI.

Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia

Science.gov (United States)

Arifin, Nooranida; Hasbollah, Hasif Rafidee; Hanafi, Muhammad Hafiz; Ibrahim, Al Hafiz; Rahman, Wan Afezah Wan Abdul; Aziz, Roslizawati Che

2017-01-01

The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved. PMID:29386978

Prosthetic Status and Prosthetic Need Among the Patients Attending Various Dental Institutes of Ahmedabad and Gandhinagar District, Gujarat

OpenAIRE

Shah, Vrinda R.; Shah, Darshana N.; Parmar, Chaitanya H.

2012-01-01

The oral health being an integral part for the healthy living, necessity of disability limitation and rehabilitation in oral health has taken a paramount role. To assess the prosthetic status and to evaluate the prosthetic needs of the patients attending various institutes of Ahmedabad and Gandhinagar district. A total of 510 (264 males and 246 females) subjects at various dental institutes were examined in the study. A survey proforma was prepared with the help of WHO oral health assessment ...

Mechanical design and performance specifications of anthropomorphic prosthetic hands: a review.

Science.gov (United States)

Belter, Joseph T; Segil, Jacob L; Dollar, Aaron M; Weir, Richard F

2013-01-01

In this article, we set forth a detailed analysis of the mechanical characteristics of anthropomorphic prosthetic hands. We report on an empirical study concerning the performance of several commercially available myoelectric prosthetic hands, including the Vincent, iLimb, iLimb Pulse, Bebionic, Bebionic v2, and Michelangelo hands. We investigated the finger design and kinematics, mechanical joint coupling, and actuation methods of these commercial prosthetic hands. The empirical findings are supplemented with a compilation of published data on both commercial and prototype research prosthetic hands. We discuss numerous mechanical design parameters by referencing examples in the literature. Crucial design trade-offs are highlighted, including number of actuators and hand complexity, hand weight, and grasp force. Finally, we offer a set of rules of thumb regarding the mechanical design of anthropomorphic prosthetic hands.

Adaptive sports technology and biomechanics: prosthetics.

Science.gov (United States)

De Luigi, Arthur Jason; Cooper, Rory A

2014-08-01

With the technologic advances in medicine and an emphasis on maintaining physical fitness, the population of athletes with impairments is growing. It is incumbent upon health care practitioners to make every effort to inform these individuals of growing and diverse opportunities and to encourage safe exercise and athletic participation through counseling and education. Given the opportunities for participation in sports for persons with a limb deficiency, the demand for new, innovative prosthetic designs is challenging the clinical and technical expertise of the physician and prosthetist. When generating a prosthetic prescription, physicians and prosthetists should consider the needs and preferences of the athlete with limb deficiency, as well as the functional demands of the chosen sporting activity. The intent of this article is to provide information regarding the current advancements in the adaptive sports technology and biomechanics in the field of prosthetics, and to assist clinicians and their patients in facilitating participation in sporting activities. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Periprosthetic joint infection: are patients with multiple prosthetic joints at risk?

Science.gov (United States)

Jafari, S Mehdi; Casper, David S; Restrepo, Camilo; Zmistowski, Benjamin; Parvizi, Javad; Sharkey, Peter F

2012-06-01

Patients who present with a periprosthetic joint infection in a single joint may have multiple prosthetic joints. The risk of these patients developing a subsequent infection in another prosthetic joint is unknown. Our purposes were (1) to identify the risk of developing a subsequent infection in another prosthetic joint and (2) to describe the time span and organism profile to the second prosthetic infection. We retrospectively identified 55 patients with periprosthetic joint infection who had another prosthetic joint in place at the time of presentation. Of the 55 patients, 11 (20%) developed a periprosthetic joint infection in a second joint. The type of organism was the same as the first infection in 4 (36%) of 11 patients. The time to developing a second infection averaged 2.0 years (range, 0-6.9 years). Copyright © 2012 Elsevier Inc. All rights reserved.

Uncemented allograft-prosthetic composite reconstruction of the proximal femur

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Li Min

2014-01-01

Full Text Available Background: Allograft-prosthetic composite can be divided into three groups names cemented, uncemented, and partially cemented. Previous studies have mainly reported outcomes in cemented and partially cemented allograft-prosthetic composites, but have rarely focused on the uncemented allograft-prosthetic composites. The objectives of our study were to describe a surgical technique for using proximal femoral uncemented allograft-prosthetic composite and to present the radiographic and clinical results. Materials and Methods: Twelve patients who underwent uncemented allograft-prosthetic composite reconstruction of the proximal femur after bone tumor resection were retrospectively evaluated at an average followup of 24.0 months. Clinical records and radiographs were evaluated. Results: In our series, union occurred in all the patients (100%; range 5-9 months. Until the most recent followup, there were no cases with infection, nonunion of the greater trochanter, junctional bone resorption, dislocation, allergic reaction, wear of acetabulum socket, recurrence, and metastasis. But there were three periprosthetic fractures which were fixed using cerclage wire during surgery. Five cases had bone resorption in and around the greater trochanter. The average Musculoskeletal Tumor Society (MSTS score and Harris hip score (HHS were 26.2 points (range 24-29 points and 80.6 points (range 66.2-92.7 points, respectively. Conclusions: These results showed that uncemented allograft-prosthetic composite could promote bone union through compression at the host-allograft junction and is a good choice for proximal femoral resection. Although this technology has its own merits, long term outcomes are yet not validated.

Prosthetic implant treatment of the edentulous maxilla with overdenture.

Science.gov (United States)

Inversini, M

2006-10-01

The literature concerning the success of prosthetic implant treatment with maxillary overdenture is reviewed, and variables affecting treatment from the implant and prosthetic standpoint are analysed. Guidelines for the fabrication of maxillary overimplants comparable to those for mandibular overimplants are still lacking, as are evidence-based prosthetic design concepts. Individual methods and techniques have been described, but evaluation standards for the outcome of maxillary prosthetic-implant treatment are lacking or individually interpreted. The biomechanics involved in the proposed system are described, together with the advantages of telescopic crowns for the retention of removable partial prosthesis supported by maxillary implants. The positive influence, in terms of long-term prognosis, of the perio-protective design of removable partial prostheses supported by maxillary overimplants is also discussed. The proposed system not only provides stability, support and retention for removable partial prostheses supported by maxillary implants, but also enables implant survival rates to be improved, both for biomechanical reasons and due to improved oral hygiene. The simplification of fabrication procedures, repair, rebasing and re-operating also reduce the cost of follow-up and improve the cost/benefit ratio. However, additional studies are needed to clarify the number and most appropriate distribution of implants, as well as the most favourable prosthetic designs for maxillary overimplants.

Surgical-prosthetic treatment of large mandibular cysts

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Džambas Ljubiša D.

2003-01-01

Full Text Available This paper presents a combined surgical-prosthetic procedure of reconstructing mandibular bone defect in a 53 year old patient, following enucleation of a mandibular cyst (Cystectomy Partsch II. After a thorough diagnostic evaluation, a surgical procedure was planned with the particular attention to the nature of the disease, patient’s condition, size and extension of the cyst, tissue loss, and the possibilities of prosthetic management of a mandibular bone defect with partial postresection dental prosthesis. It is of great importance to point to the significance of teamwork of a maxillofacial surgeon and a specialist in prosthodontics. This kind of cooperation provided very effective and less risky soft tissue, as well as bone tissue regeneration (osteogenesis. The patient’s recovery was fast, and he could return to his daily activities and work without significant changes regarding quality of life after surgery and prosthetic treatment.

Prosthetics in Paediatric Dentistry

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Vulićević Zoran

2017-07-01

Full Text Available Premature loss of teeth in children may lead to both functional and esthetic problems. Missing teeth in both anterior and posterior regions may cause malfunctions in mastication and proper pronunciation. If the missing teeth are not replaced, further complications may occur, including adjacent tooth migration, loss of alveolar bone, and irregular occlusion. Considering the sensitive nature of children, loss of teeth may cause the development of insecurities and low self esteem problems. Due to dynamic nature of growth in children and adolescents, prosthetic appliances must not hinder development of orofacial system, and must meet adequate esthetic and functional standards. Dental prosthetic appliances in paediatrics must be planned with respect to the special conditions that led to tooth loss or damage. Multi-disciplinary approach is needed, under constant supervision of paediatric dentist and orthodontist, as well as regular checkups with clinical and radiographical examinations.

Custom-made laser-welded titanium implant prosthetic abutment.

Science.gov (United States)

Iglesia-Puig, Miguel A

2005-10-01

A technique to create an individually modified implant prosthetic abutment is described. An overcasting is waxed onto a machined titanium abutment, cast in titanium, and joined to it with laser welding. With the proposed technique, a custom-made titanium implant prosthetic abutment is created with adequate volume and contour of metal to support a screw-retained, metal-ceramic implant-supported crown.

Prosthetic Rehabilitation in Children: An Alternative Clinical Technique

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Nádia Carolina Teixeira Marques

2013-01-01

Full Text Available Complete and partial removable dentures have been used successfully in numerous patients with oligodontia and/or anodontia. However, there is little information in the literature regarding the principles and guidelines to prosthetic rehabilitation for growing children. This case report describes the management of a young child with oligodontia as well as the treatment planning and the prosthetic rehabilitation technique.

Mesofluidic controlled robotic or prosthetic finger

Science.gov (United States)

Lind, Randall F; Jansen, John F; Love, Lonnie J

2013-11-19

A mesofluidic powered robotic and/or prosthetic finger joint includes a first finger section having at least one mesofluidic actuator in fluid communication with a first actuator, a second mesofluidic actuator in fluid communication with a second actuator and a second prosthetic finger section pivotally connected to the first finger section by a joint pivot, wherein the first actuator pivotally cooperates with the second finger to provide a first mechanical advantage relative to the joint point and wherein the second actuator pivotally cooperates with the second finger section to provide a second mechanical advantage relative to the joint point.

Embodied prosthetic arm stabilizes body posture, while unembodied one perturbs it.

Science.gov (United States)

Imaizumi, Shu; Asai, Tomohisa; Koyama, Shinichi

2016-10-01

Senses of ownership (this arm belongs to me) and agency (I am controlling this arm) originate from sensorimotor system. External objects can be integrated into the sensorimotor system following long-term use, and recognized as one's own body. We examined how an (un)embodied prosthetic arm modulates whole-body control, and assessed the components of prosthetic embodiment. Nine unilateral upper-limb amputees participated. Four frequently used their prosthetic arm, while the others rarely did. Their postural sway was measured during quiet standing with or without their prosthesis. The frequent users showed greater sway when they removed the prosthesis, while the rare users showed greater sway when they fitted the prosthesis. Frequent users reported greater everyday feelings of postural stabilization by prosthesis and a larger sense of agency over the prosthesis. We suggest that a prosthetic arm maintains or perturbs postural control, depending on the prosthetic embodiment, which involves sense of agency rather than ownership. Copyright © 2016 Elsevier Inc. All rights reserved.

Fixed prosthetic treatment in patients with cleft lip and palate

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Bajevska Jagoda

2017-01-01

Full Text Available Introduction. The prosthetic treatment of patients with cleft palate includes various treatment options such as fixed partial dentures, removable partial prosthesis, etc. The type of prosthetic appliance is determined by the oral health of each individual and the circumstances. We presented three adult patients with the cleft lip and palate subjected to prosthetic treatment. Case report. From the possible prosthetic solutions according to the conditions in the oral cavity and the circumstances, fixed partial dentures veneered with composite or ceramic were chosen. A proper relationship between the teeth was reached with the fixed partial dentures, and function established, the phonetics improved and satisfying aesthetics effect accomplished improving the profile appearance of the patient’s face. Plastic surgery of the nose was performed after that. Conclusion. Multidisclipinary treatment is necessary for favourable long-term outcome in cleft lip and palate patients.

Prosthetic Mitral Valve Leaflet Escape

Science.gov (United States)

Kim, Darae; Hun, Sin Sang; Cho, In-Jeong; Shim, Chi-Young; Ha, Jong-Won; Chung, Namsik; Ju, Hyun Chul; Sohn, Jang Won

2013-01-01

Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well. PMID:23837121

Adapting to change: influence of a microprocessor-controlled prosthetic knee on gait adaptations

NARCIS (Netherlands)

Prinsen, Erik Christiaan

2016-01-01

Advancement in prosthetic knee design have led to the introduction of microprocessor-controlled prosthetic knees (MPKs). MPKs incorporate sensors that are able to measure prosthetic loading, the knee angle, and knee angular velocity. Based on the sensor information, MPKs determine the optimal level

Development of a 3D-Printed Robotic Prosthetic Arm

Energy Technology Data Exchange (ETDEWEB)

Gomez Martinez, M.; Garcia-Miquel, A.; Vidal Martinez, N.

2016-07-01

Current prostheses are not affordable to the general public. 3D printing technology may allow low-cost production of such devices, making them more readily accessible to people in need. This contribution presents the set-up and the considerations that have to be taken into account to develop a functional artificial upper limb prototype. The robotic prosthetic arm reported herein was produced entirely using 3D printing technology to demonstrate its feasibility on a limited budget. The project was developed to integrate two different functional modes: a prosthetic application and a remote application. The prosthetic application is intended to emulate existing prosthetic devices using myoelectric sensors. The remote application is conceived as a tool for prevention, by providing the general public with a device that could carry out activities that entail a risk of severe physical injury. This is achieved using a hand-tracking system that allows the robotic arm to copy the user’s movements remotely and in real time. The outcome of the validation tests has been considerably successful for both applications and the total costs are on target. (Author)

Image segmentation for enhancing symbol recognition in prosthetic vision.

Science.gov (United States)

Horne, Lachlan; Barnes, Nick; McCarthy, Chris; He, Xuming

2012-01-01

Current and near-term implantable prosthetic vision systems offer the potential to restore some visual function, but suffer from poor resolution and dynamic range of induced phosphenes. This can make it difficult for users of prosthetic vision systems to identify symbolic information (such as signs) except in controlled conditions. Using image segmentation techniques from computer vision, we show it is possible to improve the clarity of such symbolic information for users of prosthetic vision implants in uncontrolled conditions. We use image segmentation to automatically divide a natural image into regions, and using a fixation point controlled by the user, select a region to phosphenize. This technique improves the apparent contrast and clarity of symbolic information over traditional phosphenization approaches.

Implant salvage in breast reconstruction with severe peri-prosthetic infection.

Science.gov (United States)

Meybodi, Farid; Sedaghat, Negin; French, James; Keighley, Caitlin; Mitchell, David; Elder, Elisabeth

2017-12-01

Although treatment of mild peri-prosthetic infection in implant-based breast reconstruction results in high rates of resolution, successful management of severe peri-prosthetic infection remains a significant challenge. In this case series, a protocol utilizing a novel dressing - negative pressure wound therapy with instillation (NPWTi) - for the management of severe peri-prosthetic infection in breast reconstruction patients is described. This is an operative technique involving: (i) explantation of the breast prosthesis and application of the NPWTi dressing to the implant pocket; (ii) change of the NPWTi dressing; (iii) intraoperative fluid/tissue cultures; and (iv) reimplantation of the breast prosthesis when cultures yield no growth. This protocol was utilized in six cases of severe peri-prosthetic infection in five patients with immediate breast reconstruction for breast cancer or risk-reducing surgery. Cultures of fluid/tissue grew typical and/or unusual organisms. Only one case did not yield an organism. The hospital length of stay upon completion of the protocol ranged from 7-16 days (mean, 12 days). Successful implant salvage was achieved in five of six cases. The protocol was aborted in one case to allow for completion of adjuvant chemotherapy. Early findings from this case series suggest that in cases of severe peri-prosthetic infection this novel operative protocol may result in successful implant salvage for breast reconstruction patients. Further studies are needed to more fully elaborate the role of NPWTi to achieve implant salvage in challenging cases of peri-prosthetic infection. © 2015 Royal Australasian College of Surgeons.

Development of novel 3D-printed robotic prosthetic for transradial amputees.

Science.gov (United States)

Gretsch, Kendall F; Lather, Henry D; Peddada, Kranti V; Deeken, Corey R; Wall, Lindley B; Goldfarb, Charles A

2016-06-01

Upper extremity myoelectric prostheses are expensive. The Robohand demonstrated that three-dimensional printing reduces the cost of a prosthetic extremity. The goal of this project was to develop a novel, inexpensive three-dimensional printed prosthesis to address limitations of the Robohand. The prosthesis was designed for patients with transradial limb amputation. It is shoulder-controlled and externally powered with an anthropomorphic terminal device. The user can open and close all five fingers, and move the thumb independently. The estimated cost is US$300. After testing on a patient with a traumatic transradial amputation, several advantages were noted. The independent thumb movement facilitated object grasp, the device weighed less than most externally powered prostheses, and the size was easily scalable. Limitations of the new prosthetic include low grip strength and decreased durability compared to passive prosthetics. Most children with a transradial congenital or traumatic amputation do not use a prosthetic. A three-dimensional printed shoulder-controlled robotic prosthesis provides a cost effective, easily sized and highly functional option which has been previously unavailable. © The International Society for Prosthetics and Orthotics 2015.

Prosthetic prescription in the Netherlands: An interview with clinical experts

NARCIS (Netherlands)

Van Der Linde, H.; Geertzen, J.H.B.; Hofstad, C.J.; Van Limbeek, Jacques; Postema, K.

2004-01-01

In the process of guideline development for prosthetic prescription in the Netherlands the authors made a study of the daily clinical practice of lower limb prosthetics. Besides the evidence-based knowledge from literature the more implicit knowledge from clinical experts is of importance for

PLANNING OF IMPLANTO‐PROSTHETIC STRUCTURES IN TOTAL EDENTATION ACCORDING TO BIOMECHANICAL CRITERIA

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N. VASILE

2013-07-01

Full Text Available Scope of the study: Analysis of the biomechanical aspects of the implanto‐prosthetic structures for planning the treatment in cases of total edentation.Materials and method: The study was performed in the Clinics of Prosthetics and Oral Implantology, Military Emergency Hospital of Sibiu, on a group of mandibularly totally edentated patients. Planning of the implanto‐pros‐ thetic treatment had in view the peculiarities of total man‐ dibular edentation and observance of the biomechanical principles. Selection of the type of occlusion restoration considered the presence of parafunctions and the nature of the antagonistic arch. Special attention was paid to the direction and intensity of the forces acting in the region of the future prosthetic work. When bruxism was manifested, its preimplantary removal was compulsory.Results and discussion: In fixed prosthetic restaurati‐ ons applied on implants, distribuition of forces obviously depend on the quality of osteo‐acceptance, as well, and also on the elasticity degree of the prosthetic work. In the case of mobilized prosthetic restorations supported on implants, rigidization of implants from the anterior region of the mandible may be obtained by means of a bar. In decreasing order of their elasticity, the materials employed are: acrylate, composites, noble and seminoble alloys, other metals, ceramics. Ceramics confers maximum stability to implants, yet without redeeming the forces. For amortizing the forces and for a progressive charging of the implants, it is recommended that the first (temporary prosthetic restorations should be made of either acrylate or compo‐ sites.Conclusions. Observance of the occlusological princi‐ ples in cases of occlusal reconstruction represents the determining element which assures the osteo‐acceptance of implants and the integrity of prosthetic restaurations.

Myoelectric control of prosthetic hands: state-of-the-art review

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Geethanjali P

2016-07-01

Full Text Available Purushothaman Geethanjali School of Electrical Engineering Department of Control and Automation VIT University, Vellore, Tamil Nadu, India Abstract: Myoelectric signals (MES have been used in various applications, in particular, for identification of user intention to potentially control assistive devices for amputees, orthotic devices, and exoskeleton in order to augment capability of the user. MES are also used to estimate force and, hence, torque to actuate the assistive device. The application of MES is not limited to assistive devices, and they also find potential applications in teleoperation of robots, haptic devices, virtual reality, and so on. The myoelectric control-based prosthetic hand aids to restore activities of daily living of amputees in order to improve the self-esteem of the user. All myoelectric control-based prosthetic hands may not have similar operations and exhibit variation in sensing input, deciphering the signals, and actuating prosthetic hand. Researchers are focusing on improving the functionality of prosthetic hand in order to suit the user requirement with the different operating features. The myoelectric control differs in operation to accommodate various external factors. This article reviews the state of the art of myoelectric prosthetic hand, giving description of each control strategy. Keywords: EMG, assistive device, amputee, myoelectric control, electric powered, body ­powered, bioelectric signal control

Effects of a flat prosthetic foot rocker section on balance and mobility.

Science.gov (United States)

Hansen, Andrew; Nickel, Eric; Medvec, Joseph; Brielmaier, Steven; Pike, Alvin; Weber, Marilyn

2014-01-01

Previous studies have shown that the effective rocker shape of the physiologic ankle-foot system during standing and fore-aft swaying is much flatter than that used during walking, which indicates a more stable base of support for the standing/swaying activity. Previous work suggests that flat regions within the effective rocker shapes of prosthetic ankle-foot systems could provide enhanced stability for standing balance tasks. An experimental prosthetic foot was altered to provide three different flat region lengths within its effective rocker shape. It was hypothesized that longer flat regions of the effective rocker shape would lead to improved standing balance outcomes and reduced walking performance for unilateral transtibial prosthesis users. However, no significant changes were seen in the balance and mobility outcomes of 12 unilateral transtibial prosthesis users when using the three prosthetic foot conditions. Subjects in the study significantly preferred prosthetic feet with relatively low to moderate flat regions over those with long flat regions. All the subjects without loss of light touch or vibratory sensation selected the prosthetic foot with the shortest flat region. More work is needed to investigate the effects of prosthetic foot properties on balance and mobility of prosthesis users.

Vascular complications of prosthetic inter-vertebral discs.

Science.gov (United States)

Daly, Kevin J; Ross, E Raymond S; Norris, Heather; McCollum, Charles N

2006-10-01

Five consecutive cases of prosthetic inter-vertebral disc displacement with severe vascular complications on revisional surgery are described. The objective of this case report is to warn spinal surgeons that major vascular complications are likely with anterior displacement of inter-vertebral discs. We have not been able to find a previous report on vascular complications associated with anterior displacement of prosthetic inter-vertebral discs. In all five patients the prosthetic disc had eroded into the bifurcation of the inferior vena cava and the left common iliac vein. In three cases the aortic bifurcation was also involved. The fibrosis was so severe that dissecting out the arteries and veins to provide access to the relevant disc proved impossible. Formal division of the left common iliac vein and artery with subsequent repair was our solution. Anterior inter-vertebral disc displacement was associated with severe vascular injury. Preventing anterior disc displacement is essential in disc design. In the event of anterior displacement, disc removal should be planned with a Vascular Surgeon.

Initial Clinical Evaluation of the Modular Prosthetic Limb

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Briana N. Perry

2018-03-01

Full Text Available The Modular Prosthetic Limb (MPL was examined for its feasibility and usability as an advanced, dexterous upper extremity prosthesis with surface electromyography (sEMG control in with two individuals with below-elbow amputations. Compared to currently marketed prostheses, the MPL has a greater number of sequential and simultaneous degrees of motion, as well as wrist modularity, haptic feedback, and individual digit control. The MPL was successfully fit to a 33-year-old with a trans-radial amputation (TR01 and a 30-year-old with a wrist disarticulation amputation (TR02. To preserve anatomical limb length, we adjusted the powered degrees of freedom of wrist motion between users. Motor training began with practicing sEMG and pattern recognition control within the virtual integration environment (VIE. Prosthetic training sessions then allowed participants to complete a variety of activities of daily living with the MPL. Training and Motion Control Accuracy scores quantified their ability to consistently train and execute unique muscle-to-motion contraction patterns. Each user also completed one prosthetic functional metric—the Southampton Hand Assessment Procedure (SHAP for TR01 and the Jebsen-Taylor Hand Function Test (JHFT for TR02. Haptic feedback capabilities were integrated for TR01. TR01 achieved 95% accuracy at 84% of his VIE sessions. He demonstrated improved scores over a year of prosthetic training sessions, ultimately achieving simultaneous control of 13 of the 17 (76% attempted motions. His performance on the SHAP improved from baseline to final assessment with an increase in number of tasks achieved. TR01 also used vibrotactile sensors to successfully discriminate between hard and soft objects being grasped by the MPL hand. TR02 demonstrated 95% accuracy at 79% of his VIE sessions. He demonstrated improved scores over months of prosthetic training sessions, however there was a significant drop in scores initially following a mid

Structural Integration and Control of Peerless Human-like Prosthetic Hand

Science.gov (United States)

Dave, Ankit; Muthu, P.; Karthikraj, V.; Latha, S.

2018-04-01

Limb damage can create severe disturbance in movement and operative abilities wherein the prosthetic rehabilitation has the potential to replace function and enhance the quality of life. This paper presents a humanlike prosthetic hand using such unique design concept of hand model using artificial bones, ligaments, and tendons controlled using Arduino. Amongst various platforms available, Arduino is known for its adaptability, adoration and low cost. The design of prosthetic hand has a unique structure with all carpal, metacarpal, and phalanges which are bones of the hand. These bones are attached to each other following the pattern of human hand using the polymeric rubber as a functioning ligament. Furthermore, this structure of finger is driven by tendons attached to all fingers and passes through the ligaments working as pulley resulting in more degrees of freedom. The motor can twitch the tendons to achieve the action of fingers. Thus the servos, controlled by an Arduino, are used to regulate the movement mechanism of the prosthetic hand.

Control system and method for prosthetic devices

Science.gov (United States)

Bozeman, Richard J., Jr. (Inventor)

1992-01-01

A control system and method for prosthetic devices is provided. The control system comprises a transducer for receiving movement from a body part for generating a sensing signal associated with that movement. The sensing signal is processed by a linearizer for linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part. The linearized sensing signal is normalized to be a function of the entire range of body part movement from the no-shrug position of the movable body part through the full-shrug position of the movable body part. The normalized signal is divided into a plurality of discrete command signals. The discrete command signals are used by typical converter devices which are in operational association with the prosthetic device. The converter device uses the discrete command signals for driving the movable portions of the prosthetic device and its sub-prosthesis. The method for controlling a prosthetic device associated with the present invention comprises the steps of receiving the movement from the body part, generating a sensing signal in association with the movement of the body part, linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part, normalizing the linear signal to be a function of the entire range of the body part movement, dividing the normalized signal into a plurality of discrete command signals, and implementing the plurality of discrete command signals for driving the respective movable prosthesis device and its sub-prosthesis.

A computational method for comparing the behavior and possible failure of prosthetic implants

Energy Technology Data Exchange (ETDEWEB)

Nielsen, C.; Hollerbach, K.; Perfect, S.; Underhill, K.

1995-05-01

Prosthetic joint implants currently in use exhibit high Realistic computer modeling of prosthetic implants provides an opportunity for orthopedic biomechanics researchers and physicians to understand possible in vivo failure modes, without having to resort to lengthy and costly clinical trials. The research presented here is part of a larger effort to develop realistic models of implanted joint prostheses. The example used here is the thumb carpo-metacarpal (cmc) joint. The work, however, can be applied to any other human joints for which prosthetic implants have been designed. Preliminary results of prosthetic joint loading, without surrounding human tissue (i.e., simulating conditions under which the prosthetic joint has not yet been implanted into the human joint), are presented, based on a three-dimensional, nonlinear finite element analysis of three different joint implant designs.

Gonococcal Prosthetic Joint Infection.

Science.gov (United States)

Gassiep, Ian; Gilpin, Bradley; Douglas, Joel; Siebert, David

2017-01-01

Neisseria gonorrhoea is a common sexually transmitted infection worldwide. Disseminated gonococcal infection is an infrequent presentation and rarely can be associated with septic arthritis. Incidence of this infection is rising, both internationally and in older age groups. We present the first documented case of N. gonorrhoea prosthetic joint infection which was successfully treated with laparoscopic debridement and antimicrobial therapy.

Rehand: Realistic electric prosthetic hand created with a 3D printer.

Science.gov (United States)

Yoshikawa, Masahiro; Sato, Ryo; Higashihara, Takanori; Ogasawara, Tsukasa; Kawashima, Noritaka

2015-01-01

Myoelectric prosthetic hands provide an appearance with five fingers and a grasping function to forearm amputees. However, they have problems in weight, appearance, and cost. This paper reports on the Rehand, a realistic electric prosthetic hand created with a 3D printer. It provides a realistic appearance that is same as the cosmetic prosthetic hand and a grasping function. A simple link mechanism with one linear actuator for grasping and 3D printed parts achieve low cost, light weight, and ease of maintenance. An operating system based on a distance sensor provides a natural operability equivalent to the myoelectric control system. A supporter socket allows them to wear the prosthetic hand easily. An evaluation using the Southampton Hand Assessment Procedure (SHAP) demonstrated that an amputee was able to operate various objects and do everyday activities with the Rehand.

ORAL HYGIENE OF PROSTHETIC DENTURE USER IN KODINGARENG ISLAND

OpenAIRE

NUR, NURUL KUSUMADEWI S.KG

2008-01-01

Objectives:to determine the level of oral hygiene for prosthetic denture user, especially for full-denture in Kodingareng Island. This researchincluded the distribution level of prosthetic denture user based on age and education.Methods: the method that used in this research is observational descriptive withcross sectional-studyas the research design. Variable result of the research determined in to 3, those are bad, middle, and good. Result:the highest percentage o...

Design and Evaluation of a Prosthetic Knee Joint Using the Geared Five-Bar Mechanism.

Science.gov (United States)

Sun, Yuanxi; Ge, Wenjie; Zheng, Jia; Dong, Dianbiao

2015-11-01

This paper presents the mechanical design, dynamics analysis and ankle trajectory analysis of a prosthetic knee joint using the geared five-bar mechanism. Compared with traditional four-bar or six-bar mechanisms, the geared five-bar mechanism is better at performing diverse movements and is easy to control. This prosthetic knee joint with the geared five-bar mechanism is capable of fine-tuning its relative instantaneous center of rotation and ankle trajectory. The centrode of this prosthetic knee joint, which is mechanically optimized according to the centrode of human knee joint, is better in the bionic performance than that of a prosthetic knee joint using the four-bar mechanism. Additionally, the stability control of this prosthetic knee joint during the swing and stance phase is achieved by a motor. By adjusting the gear ratio of this prosthetic knee joint, the ankle trajectories of both unilateral and bilateral amputees show less deviations from expected than that of the four-bar knee joint.

Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations.

Science.gov (United States)

Beck, Owen N; Taboga, Paolo; Grabowski, Alena M

2017-04-01

Inspired by the springlike action of biological legs, running-specific prostheses are designed to enable athletes with lower-limb amputations to run. However, manufacturer's recommendations for prosthetic stiffness and height may not optimize running performance. Therefore, we investigated the effects of using different prosthetic configurations on the metabolic cost and biomechanics of running. Five athletes with bilateral transtibial amputations each performed 15 trials on a force-measuring treadmill at 2.5 or 3.0 m/s. Athletes ran using each of 3 different prosthetic models (Freedom Innovations Catapult FX6, Össur Flex-Run, and Ottobock 1E90 Sprinter) with 5 combinations of stiffness categories (manufacturer's recommended and ± 1) and heights (International Paralympic Committee's maximum competition height and ± 2 cm) while we measured metabolic rates and ground reaction forces. Overall, prosthetic stiffness [fixed effect (β) = 0.036; P = 0.008] but not height ( P ≥ 0.089) affected the net metabolic cost of transport; less stiff prostheses reduced metabolic cost. While controlling for prosthetic stiffness (in kilonewtons per meter), using the Flex-Run (β = -0.139; P = 0.044) and 1E90 Sprinter prostheses (β = -0.176; P = 0.009) reduced net metabolic costs by 4.3-4.9% compared with using the Catapult prostheses. The metabolic cost of running improved when athletes used prosthetic configurations that decreased peak horizontal braking ground reaction forces (β = 2.786; P = 0.001), stride frequencies (β = 0.911; P < 0.001), and leg stiffness values (β = 0.053; P = 0.009). Remarkably, athletes did not maintain overall leg stiffness across prosthetic stiffness conditions. Rather, the in-series prosthetic stiffness governed overall leg stiffness. The metabolic cost of running in athletes with bilateral transtibial amputations is influenced by prosthetic model and stiffness but not height. NEW & NOTEWORTHY We measured the

Clinical Effectiveness of Using Aesthetic Fixed Prosthetic Appliances with Combined Occlusal Surface

OpenAIRE

Andrii Biben; Zinovii Ozhohan

2017-01-01

The objective of the research was to evaluate the clinical effectiveness of using aesthetic fixed prosthetic appliances with combined occlusal surface. Materials and methods. The study included 30 patients who were divided into 2 groups: Group I included 20 patients with combined occlusal surface of the crowns; Group II included 22 patients with ceramic occlusal surface of the crowns. The patients were observed 3, 6 and 12 months after prosthetic repair. Results. 6 months after prosthet...

Clinical Presentation, Risk Factors, and Outcomes of Hematogenous Prosthetic Joint Infection in Patients with Staphylococcus aureus Bacteremia.

Science.gov (United States)

Tande, Aaron J; Palraj, Bharath Raj; Osmon, Douglas R; Berbari, Elie F; Baddour, Larry M; Lohse, Christine M; Steckelberg, James M; Wilson, Walter R; Sohail, M Rizwan

2016-02-01

Staphylococcus aureus bacteremia is a life-threatening condition that may lead to metastatic infection, including prosthetic joint infection. To assess clinical factors associated with hematogenous prosthetic joint infection, we retrospectively reviewed all patients with a joint arthroplasty in place at the time of a first episode of S. aureus bacteremia over a 5-year period at our institution. Patients with postsurgical prosthetic joint infection without hematogenous prosthetic joint infection were excluded. There were 85 patients (143 arthroplasties) with either no prosthetic joint infection (n = 50; 58.8%) or hematogenous prosthetic joint infection in at least one arthroplasty (n = 35; 41.2%). The odds of hematogenous prosthetic joint infection was significantly increased among patients with community-acquired S. aureus bacteremia (odds ratio [OR] 18.07; 95% confidence interval [CI] 2.64-infinity; P = .001), as compared with nosocomial S. aureus bacteremia, in which there were no patients with hematogenous prosthetic joint infection. After adjusting for S. aureus bacteremia classification, the presence of ≥3 joint arthroplasties in place was associated with a nearly ninefold increased odds of hematogenous prosthetic joint infection as compared with those with 1-2 joint arthroplasties in place (OR 8.55; 95% CI 1.44-95.71; P = .012). All but one joint with prosthetic joint infection demonstrated at least one clinical feature suggestive of infection. There were 4 additional S. aureus prosthetic joint infections diagnosed during a median of 3.4 years of follow-up post hospitalization for S. aureus bacteremia. Prosthetic joint infection is frequent in patients with existing arthroplasties and concomitant S. aureus bacteremia, particularly with community-acquired S. aureus bacteremia and multiple prostheses. In contrast, occult S. aureus prosthetic joint infection without clinical features suggestive of prosthetic joint infection at the time of S. aureus bacteremia

Clinical characteristics, microbiology, and outcomes of prosthetic joint infection in Taiwan.

Science.gov (United States)

Tsai, Jen-Chih; Sheng, Wang-Huei; Lo, Wan-Yu; Jiang, Ching-Chuan; Chang, Shan-Chwen

2015-04-01

Prosthetic joint infection (PJI) after total knee or hip replacement is a devastating complication associated with substantial morbidity and economic cost. The incidence of prosthetic joint infection is increasing as the use of mechanical joint replacement increases. The treatment approach to prosthetic joint infection is based on different clinical situations such as a patient's comorbidities, epidemic microbiology data, and surgical procedures. The aim of our study was to understand clinical characteristics of prosthetic joint infection, the microbiology of the prosthetic joint infection, and the outcomes of different treatment strategies during 2006-2011. We retrospectively collected cases of prosthetic joint infection in the National Taiwan University Hospital between January 1, 2006 and December 31, 2011. The patients' characteristics, microbiology, outcomes, and factors associated with treatment success were recorded. One hundred and forty-four patients were identified as having PJI. Of these, 92 patients were entered into per-protocol analysis. Staphylococcus aureus was the most common causative organism (29.9%), followed by coagulase-negative Staphylococci (16.7%), and Enterococci (9.7%). The overall treatment success rate was 50%. Patients who received a two-stage revision had a better outcome, compared to patients who underwent other types of surgeries (70% vs. 32.7%, respectively; p < 0.001). In multivariate analysis, the two-stage revision was significantly associated with treatment success (odds ratio = 3.923, 95% confidence interval = 1.53-10.04). Our study demonstrates that Staphylococcus aureus was the most common causative organisms in PJI. Performing two-stage revisions was significantly associated with a better outcome. Copyright © 2013. Published by Elsevier B.V.

New developments in prosthetic arm systems

Directory of Open Access Journals (Sweden)

Vujaklija I

2016-07-01

Full Text Available Ivan Vujaklija,1 Dario Farina,1 Oskar C Aszmann2 1Institute of Neurorehabilitation Systems, Bernstein Focus Neurotechnology Göttingen, University Medical Center Göttingen, Georg-August University, Göttingen, Germany; 2Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria Abstract: Absence of an upper limb leads to severe impairments in everyday life, which can further influence the social and mental state. For these reasons, early developments in cosmetic and body-driven prostheses date some centuries ago, and they have been evolving ever since. Following the end of the Second World War, rapid developments in technology resulted in powered myoelectric hand prosthetics. In the years to come, these devices were common on the market, though they still suffered high user abandonment rates. The reasons for rejection were trifold – insufficient functionality of the hardware, fragile design, and cumbersome control. In the last decade, both academia and industry have reached major improvements concerning technical features of upper limb prosthetics and methods for their interfacing and control. Advanced robotic hands are offered by several vendors and research groups, with a variety of active and passive wrist options that can be articulated across several degrees of freedom. Nowadays, elbow joint designs include active solutions with different weight and power options. Control features are getting progressively more sophisticated, offering options for multiple sensor integration and multi-joint articulation. Latest developments in socket designs are capable of facilitating implantable and multiple surface electromyography sensors in both traditional and osseointegration-based systems. Novel surgical techniques in combination with modern, sophisticated hardware are enabling restoration of dexterous upper limb

A mechanism to compensate undesired stiffness in joints of prosthetic hands

NARCIS (Netherlands)

Smit, G.; Plettenbrug, D.H.; Van der Helm, F.C.T.

2014-01-01

Background: Cosmetic gloves that cover a prosthetic hand have a parasitic positive stiffness that counteracts the flexion of a finger joint. Objectives: Reducing the required input torque to move a finger of a prosthetic hand by compensating the parasitic stiffness of the cosmetic glove. Study

Granulicatella adiacens prosthetic hip joint infection after dental treatment.

Science.gov (United States)

Aweid, Osama; Sundararajan, Sabapathy; Teferi, Abraham

2016-06-01

Granulicatella adiacens is a Gram-positive bacteria and a normal component of oral flora. It is also found in dental plaques, endodontic abscesses and can rarely cause more serious infections. We describe a prosthetic hip joint infection in an 81-year-old fit and healthy man due to Granulicatella adiacens who underwent a prolonged dental intervention two days earlier without antibiotic prophylaxis. The infection was successfully treated with surgical intervention and a combination of antibiotics. The patient eventually succumbed to severe community-acquired pneumonia two months later. Current guidelines recommend avoidance of antibiotic prophylaxis prior to dental treatment in patients who have no co-morbidities and no prior operation on the index prosthetic joint. This case report indicates that infections of prosthetic joints may be associated with dental procedures even in fit and healthy patients without the recognized risk factors.

[Tuberculous prosthetic knee joint infection: a case report and literature review].

Science.gov (United States)

Lara-Oya, A; Liébana-Martos, M C; Rodríguez-Granger, J; Sampedro-Martínez, A; Aliaga-Martínez, L; Gutierrez-Fernández, J; Navarro-Marí, J M

2016-08-01

Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized. Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago. Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014. Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.

Control of a powered prosthetic device via a pinch gesture interface

Science.gov (United States)

Yetkin, Oguz; Wallace, Kristi; Sanford, Joseph D.; Popa, Dan O.

2015-06-01

A novel system is presented to control a powered prosthetic device using a gesture tracking system worn on a user's sound hand in order to detect different grasp patterns. Experiments are presented with two different gesture tracking systems: one comprised of Conductive Thimbles worn on each finger (Conductive Thimble system), and another comprised of a glove which leaves the fingers free (Conductive Glove system). Timing tests were performed on the selection and execution of two grasp patterns using the Conductive Thimble system and the iPhone app provided by the manufacturer. A modified Box and Blocks test was performed using Conductive Glove system and the iPhone app provided by Touch Bionics. The best prosthetic device performance is reported with the developed Conductive Glove system in this test. Results show that these low encumbrance gesture-based wearable systems for selecting grasp patterns may provide a viable alternative to EMG and other prosthetic control modalities, especially for new prosthetic users who are not trained in using EMG signals.

Prosthetic valve endocarditis caused by Staphylococcus capitis: report of 4 cases

Directory of Open Access Journals (Sweden)

Wada Yuko

2011-10-01

Full Text Available Abstract Although Staphylococcus capitis is considered to be a rare causative organism for prosthetic valve endocarditis, we report 4 such cases that were encountered at our hospital over the past 2 years. Case 1 was a 79-year-old woman who underwent aortic valve replacement with a bioprosthetic valve and presented with fever 24 days later. Transesophageal echocardiography revealed an annular abscess in the aorto-mitral continuity and mild perivalvular regurgitation. We performed emergency surgery 5 days after the diagnosis of prosthetic valve endocarditis was made. Case 2 was a 79-year-old woman presenting with fever 40 days after aortic valve replacement with a bioprosthesis. Transesophageal echocardiography showed vegetation on the valve, and she underwent urgent surgery 2 days after prosthetic valve endocarditis was diagnosed. In case 3, a 76-year-old man presented with fever 53 days after aortic valve replacement with a bioprosthesis. Vegetation on the prosthetic leaflet could be seen by transesophageal echocardiography. He underwent emergency surgery 2 days after the diagnosis of prosthetic valve endocarditis was made. Case 4 was a 68-year-old woman who collapsed at her home 106 days after aortic and mitral valve replacement with bioprosthetic valves. Percutaneous cardiopulmonary support was started immediately after massive mitral regurgitation due to prosthetic valve detachment was revealed by transesophageal echocardiography. She was transferred to our hospital by helicopter and received surgery immediately on arrival. In all cases, we re-implanted another bioprosthesis after removal of the infected valve and annular debridement. All patients recovered without severe complications after 2 months of antibiotic treatment, and none experienced re-infection during 163 to 630 days of observation. Since the time interval between diagnosis of prosthetic valve endocarditis and valve re-replacement ranged from 0 to 5 days, early surgical removal

LOW-MOLECULAR-WEIGHT HEPARIN TREATMENT FAILURE IN PREVENTION OF PROSTHETIC MITRAL VALVE THROMBOSIS

OpenAIRE

David Šuran; Vojko Kanič; Tatjana Golob Gulič; Husam Franjo Naji; Robert Lipovec

2009-01-01

Background Prosthetic heart valve thrombosis (PHVT) represents a dangerous postoperative complication following prosthetic heart valve replacement. Incidence varies according to different data from 0.5–4 % per year following mitral or aortic valve replacement in spite of adequate oral anticoagulation with coumarins. Case report We are presenting a case of prosthetic mitral valve thrombosis as a result of 6-month lowmolecular-weight heparin (LMWH) (nadroparine) treatment failure. Our pat...

Obtention of a prosthetic group for labelling of radioiodinated proteins

International Nuclear Information System (INIS)

Santos, Josefina da S.; Colturato, Maria Tereza; Araujo, Elaine B. de

2000-01-01

Antibodies and peptides labeled with radionuclides has been extensively used in radioimmunotherapy and radioimmunodetection. The principal problem with the use of radioiodinated proteins is the in vivo dehalogenation. The use of prosthetic groups for indirect labeling of proteins with radioiodine has showed to be useful on labeling proteins with greater in vivo stability. A procedure is described for the preparation of an radioiodinated prosthetic group (N-succinimidyl 4-radioiodine-benzoate-SIB), using procedure described by Stocklin et al, with the iodination of p-bromo-benzoic acid and subsequent reaction with TSTU. Preliminary labeling results showed that the prosthetic group can be obtained in a good yield. The coupling of the SIB to the protein will be studied using human IgG as protein model. (author)

A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa.

Science.gov (United States)

Ennion, Liezel; Johannesson, Anton

2018-04-01

There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. To explore therapists' experiences with providing pre-prosthetic rehabilitation in a rural setting. A qualitative descriptive approach was used to collect and analyse data. Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists' ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.

Prosthetic design directives: Low-cost hands within reach.

Science.gov (United States)

Jones, G K; Rosendo, A; Stopforth, R

2017-07-01

Although three million people around the world suffer from the lack of one or both upper limbs 80% of this number is located within developing countries. While prosthetic prices soar with technology 3D printing and low cost electronics present a sensible solution for those that cannot afford expensive prosthetics. The electronic and control design of a low-cost prosthetic hand, the Touch Hand II, is discussed. This paper shows that sensorless techniques can be used to reduce design complexities, costs, and provide easier access to the electronics. A closing and opening finite state machine (COFSM) was developed to handle the actuated digit joint control state and a supervisory switching control scheme, used for speed and grip strength control. Three torque and speed settings were created to be preset for specific grasps. The hand was able to replicate ten frequently used grasps and grip some common objects. Future work is necessary to enable a user to control it with myoelectric signals (MESs) and to solve operational problems related to electromagnetic interference (EMI).

Anaerobic prosthetic joint infection.

Science.gov (United States)

Shah, Neel B; Tande, Aaron J; Patel, Robin; Berbari, Elie F

2015-12-01

In an effort to improve mobility and alleviate pain from degenerative and connective tissue joint disease, an increasing number of individuals are undergoing prosthetic joint replacement in the United States. Joint replacement is a highly effective intervention, resulting in improved quality of life and increased independence [1]. By 2030, it is predicted that approximately 4 million total hip and knee arthroplasties will be performed yearly in the United States [2]. One of the major complications associated with this procedure is prosthetic joint infection (PJI), occurring at a rate of 1-2% [3-7]. In 2011, the Musculoskeletal Infectious Society created a unifying definition for prosthetic joint infection [8]. The following year, the Infectious Disease Society of America published practice guidelines that focused on the diagnosis and management of PJI. These guidelines focused on the management of commonly encountered organisms associated with PJI, including staphylococci, streptococci and select aerobic Gram-negative bacteria. However, with the exception of Propionibacterium acnes, management of other anaerobic organisms was not addressed in these guidelines [1]. Although making up approximately 3-6% of PJI [9,10], anaerobic microorganisms cause devastating complications, and similar to the more common organisms associated with PJI, these bacteria also result in significant morbidity, poor outcomes and increased health-care costs. Data on diagnosis and management of anaerobic PJI is mostly derived from case reports, along with a few cohort studies [3]. There is a paucity of published data outlining factors associated with risks, diagnosis and management of anaerobic PJI. We therefore reviewed available literature on anaerobic PJI by systematically searching the PubMed database, and collected data from secondary searches to determine information on pathogenesis, demographic data, clinical features, diagnosis and management. We focused our search on five commonly

A clinical survey about commercial games in lower limb prosthetic rehabilitation.

Science.gov (United States)

Imam, Bita; Miller, William C; Finlayson, Heather C; Eng, Janice J; Jarus, Tal

2018-06-01

Despite the popularity of commercial games in lower limb prosthetic rehabilitation, data about their prevalence of use as well as therapists' perspectives about these games are still lacking. To learn about the prevalence of use of commercial games in lower limb prosthetic rehabilitation and therapists' perspectives about these games. Cross-sectional. An online survey was sent to physical and occupational therapists across prosthetic rehabilitation facilities in Canada. The survey had questions about the use of commercial games and therapists' perspectives. Data were collected from 82 therapists. Overall, 46.3% (38/82) reported that they use commercial games; of those, 94.7% (36/38) used the Nintendo Wii Fit. The most reported perceived benefits were the Wii Fit helping to improve weight shifting ( n = 76/82, 92.7%) and balance ( n = 75/82, 91.5%), and being motivating and complementing traditional therapy ( n = 75/82, 91.5%). The most reported perceived barriers/challenges were lack of time and familiarity with the games ( n = 58/82, 70.7%). Commercial games, particularly the Wii Fit, are commonly used in lower prosthetic rehabilitation in Canada. Most of the queried therapists view the Wii Fit positively. Knowledge translation activities and developing standard treatment protocols would be helpful in minimizing the barriers identified in this study. Clinical relevance The Wii Fit is prevalent in lower limb prosthetic rehabilitation in Canada and it is viewed positively by therapists as having the potential to improve balance and weight bearing, making rehabilitation more motivating, and complementing traditional therapy. Future studies should investigate the efficacy of the Wii Fit in prosthetic rehabilitation.

Quality Assessment of Prosthetic Rehabilitation Using Aesthetic Fixed Restorations

Directory of Open Access Journals (Sweden)

Zinovii Ozhohan

2018-04-01

Full Text Available The objective of the research was to study and assess the quality of prosthetic treatment using aesthetic fixed restorations. Materials and methods. The study included 79 patients without a comorbidity who underwent prosthetic rehabilitation. All the patients were divided into 3 groups: Group I included 25 patients with metal-plastic restorations; Group II comprised 34 patients with porcelain-fused-to-metal restorations; Group III consisted of 20 patients with a combined occlusal surface of prosthetic restorations. The patients were observed 6 months after prosthetic repair. Only patients with single molar and premolar crowns were examined. Bridge prostheses were not taken into account in order to eliminate the effect of masticatory force redistribution on the abutment crowns. Results. In Group I, 11 (44% patients were satisfied with the results of prosthetic treatment. In Group II, 25 (78.12% patients reported that they were satisfied with their treatment. In Group III, there were 17 (85% patients satisfied with their outcome. However, the patients’ complaints are often subjective and do not fully reflect the objective state of the dentoalveolar system. An objective examination revealed that in indirect restorations, marginal periodontium pathology is typical. Conclusions. Aesthetic fixed restorations with a combined occlusal surface have demonstrated good clinical results, even at long-term follow-up. Combining positive properties of two different construction materials, namely zirconium dioxide and ceramics, they reduce the risk of complications such as marginal periodontium pathology and chipping along the occlusal surface as well as contribute to minimal abrasion of the occlusal surfaces of the antagonistic teeth. We cannot recommend metal-plastic restorations due to their low clinical effectiveness, poor aesthetic qualities as well as a high level of marginal periodontium pathology.

Effect of Modifying Prosthetic Socket Base Materials by Adding Nanodiamonds

Directory of Open Access Journals (Sweden)

Lifang Ma

2015-01-01

Full Text Available The curing process of prosthetic socket base materials requires attention owing to a series of associated problems that are yet to be addressed and solved. However, to date, few relevant studies have been reported. In this paper, nanodiamonds modified with a silane coupling agent were dispersed into a prosthetic socket base material, and the performance of the modified base materials was investigated. Adding a predetermined amount of nanodiamonds to the prosthetic socket base material increased the glass transition temperature, improved the mechanical properties of the cured base material, and reduced the influence of the volatile gas formed during the curing process on the environment. With increasing nanodiamond contents, the glass transition temperature increased and the mechanical properties improved slightly. Owing to the high thermal conductivity of the nanodiamonds, the localized heat, as a result of the curing process, could be dissipated and released. Thus, adding nanodiamonds led to a more uniform temperature field forming in the curing system. This improved the curing process and reduced the formation of volatile monomers, thereby decreasing the adverse impact of the generated volatile gases on the environment. All of these provide a potential strategy for modifying prosthetic socket base materials.

Strength evaluation of prosthetic check sockets, copolymer sockets, and definitive laminated sockets.

Science.gov (United States)

Gerschutz, Maria J; Haynes, Michael L; Nixon, Derek; Colvin, James M

2012-01-01

A prosthesis encounters loading through forces and torques exerted by the person with amputation. International Organization for Standardization (ISO) standard 10328 was designed to test most lower-limb prosthetic components. However, this standard does not include prosthetic sockets. We measured static failure loads of prosthetic sockets using a modified ISO 10328 and then compared them with the criteria set by this standard for other components. Check socket (CS) strengths were influenced by thickness, material choice, and fabrication method. Copolymer socket (CP) strengths depended on thickness and fabrication methods. A majority of the CSs and all of the CPs failed to pass the ISO 10328 ductile loading criterion. In contrast, the strengths of definitive laminated sockets (DLs) were influenced more by construction material and technique. A majority of the DLs failed to pass the ISO 10328 brittle loading criterion. Analyzing prosthetic sockets from a variety of facilities demonstrated that socket performance varies considerably between and within facilities. The results from this article provide a foundation for understanding the quality of prosthetic sockets, some insight into possible routes for improving the current care delivered to patients, and a comparative basis for future technology.

Computed Tomography of Prosthetic Heart Valves

NARCIS (Netherlands)

Habets, J.

2012-01-01

Prosthetic heart valve (PHV) dysfunction is an infrequent but potentially life-threatening disease with a heterogeneous clinical presentation. Patients with PHV dysfunction clinically can present with symptoms of congestive heart failure (dyspnea, fatigue, edema), fever, angina pectoris, dizziness

Coronary artery assessment by multidetector computed tomography in patients with prosthetic heart valves

International Nuclear Information System (INIS)

Habets, Jesse; Mali, Willem P.T.M.; Budde, Ricardo P.J.; Brink, Renee B.A. van den; Uijlings, Ruben; Spijkerboer, Anje M.; Chamuleau, Steven A.J.

2012-01-01

Patients with prosthetic heart valves may require assessment for coronary artery disease. We assessed whether valve artefacts hamper coronary artery assessment by multidetector CT. ECG-gated or -triggered CT angiograms were selected from our PACS archive based on the presence of prosthetic heart valves. The best systolic and diastolic axial reconstructions were selected for coronary assessment. Each present coronary segment was scored for the presence of valve-related artefacts prohibiting coronary artery assessment. Scoring was performed in consensus by two observers. Eighty-two CT angiograms were performed on a 64-slice (n = 27) or 256-slice (n = 55) multidetector CT. Eighty-nine valves and five annuloplasty rings were present. Forty-three out of 1160 (3.7%) present coronary artery segments were non-diagnostic due to valve artefacts (14/82 patients). Valve artefacts were located in right coronary artery (15/43; 35%), left anterior descending artery (2/43; 5%), circumflex artery (14/43; 32%) and marginal obtuse (12/43; 28%) segments. All cobalt-chrome containing valves caused artefacts prohibiting coronary assessment. Biological and titanium-containing valves did not cause artefacts except for three specific valve types. Most commonly implanted prosthetic heart valves do not hamper coronary assessment on multidetector CT. Cobalt-chrome containing prosthetic heart valves preclude complete coronary artery assessment because of severe valve artefacts. circle Most commonly implanted prosthetic heart valves do not hamper coronary artery assessment circle Prosthetic heart valve composition determines the occurrence of prosthetic heart valve-related artefacts circle Bjoerk-Shiley and Sorin tilting disc valves preclude diagnostic coronary artery segment assessment. (orig.)

Evaluation of 3D printed anatomically scalable transfemoral prosthetic knee.

Science.gov (United States)

Ramakrishnan, Tyagi; Schlafly, Millicent; Reed, Kyle B

2017-07-01

This case study compares a transfemoral amputee's gait while using the existing Ossur Total Knee 2000 and our novel 3D printed anatomically scalable transfemoral prosthetic knee. The anatomically scalable transfemoral prosthetic knee is 3D printed out of a carbon-fiber and nylon composite that has a gear-mesh coupling with a hard-stop weight-actuated locking mechanism aided by a cross-linked four-bar spring mechanism. This design can be scaled using anatomical dimensions of a human femur and tibia to have a unique fit for each user. The transfemoral amputee who was tested is high functioning and walked on the Computer Assisted Rehabilitation Environment (CAREN) at a self-selected pace. The motion capture and force data that was collected showed that there were distinct differences in the gait dynamics. The data was used to perform the Combined Gait Asymmetry Metric (CGAM), where the scores revealed that the overall asymmetry of the gait on the Ossur Total Knee was more asymmetric than the anatomically scalable transfemoral prosthetic knee. The anatomically scalable transfemoral prosthetic knee had higher peak knee flexion that caused a large step time asymmetry. This made walking on the anatomically scalable transfemoral prosthetic knee more strenuous due to the compensatory movements in adapting to the different dynamics. This can be overcome by tuning the cross-linked spring mechanism to emulate the dynamics of the subject better. The subject stated that the knee would be good for daily use and has the potential to be adapted as a running knee.

The radiology of prosthetic heart valves

International Nuclear Information System (INIS)

Steiner, R.M.; Flicker, S.

1985-01-01

The development of prosthetic heart valves in the late 1950s ushered in a new era in the treatment of heart disease. The radiologist has an important role to play preoperatively in the diagnosis of valvular heart disease. Radiology is valuable in identification of the implanted prosthetic valve and recognition of complications associated with valve implantation. Radiologists must be familiar with the imaging techniques best suited to evaluate the function of the valve prosthesis in question. In this chapter the authors discuss the radiographic approach to the evaluation of the status of patients for valve replacement and the imaging problems peculiar to the types of valves in current use. The relative value of plain-film radiography, fluoroscopy, videorecording and cinerecording, and aortography is addressed, as well as the potential value of magnetic resonance imaging and subsecond dynamic computed tomography

Re-operation for aortic and mitral prosthetic dysfunctions.

Science.gov (United States)

Kaul, T K; Sastry, M R; Mercer, J L; Meade, J B

1985-01-01

The overall incidence of re-operation and prosthetic valve endocarditis was low in the present series as mechanical prostheses were used predominantly. The prosthetic dysfunctions were less frequent following the primary implantation with Bjork Shiley prostheses, but high operative risk was associated with the clotted Bjork Shiley prostheses. We also had unusual experience of strut fracture and sticking of Bjork Shiley discs in the closed position in both aortic and mitral positions. The early deaths were nil since the use of cardioplegic protection. Intra-operative bleeding due to adhesions can be minimised by using synthetic or heterologous pericardium during the primary operation.

Future Research Opportunities in Peri-Prosthetic Joint Infection Prevention.

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Berbari, Elie; Segreti, John; Parvizi, Javad; Berríos-Torres, Sandra I

Peri-prosthetic joint infection (PJI) is a serious complication of prosthetic joint arthroplasty. A better understanding and reversal of modifiable risk factors may lead to a reduction in the incidence of incisional (superficial and deep) and organ/space (e.g., PJI) surgical site infections (SSI). Recently, the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) published the Guideline for Prevention of Surgical Site Infection. This targeted update applies evidence-based methodology in drafting recommendations for potential strategies to reduce the risk of SSI both across surgical procedures and specifically in prosthetic joint arthroplasty. A panel of PJI content experts identified nine PJI prevention research opportunities based on both evidence gaps identified through the guideline development process (transfusion, immunosuppressive therapy, anticoagulation, orthopedic space suit, and biofilm) and expert opinion (anesthesia, operative room environment, glycemic control, and Staphylococcus aureus nasal screening and decolonization. This article offers a road map for PJI prevention research.

Experiences of providing prosthetic and orthotic services in Sierra Leone--the local staff's perspective.

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Magnusson, Lina; Ahlström, Gerd

2012-01-01

In Sierra Leone, West Africa, there are many people with disabilities in need of rehabilitation services after a long civil war. The aim of this qualitative study was to explore the experiences of prosthetic and orthotic service delivery in Sierra Leone from the local staff's perspective. Fifteen prosthetic and orthotic technicians working at all the rehabilitation centres providing prosthetic and orthotic services in Sierra Leone were interviewed. The interviews were transcribed and subjected to latent content analysis. One main theme emerged: sense of inability to deliver high-quality prosthetic and orthotic services. This main theme was generated from eight sub-themes: Desire for professional development; appraisals of work satisfaction and norms; patients neglected by family; limited access to the prosthetic and orthotic services available; problems with materials and machines; low public awareness concerning disabilities; marginalisation in society and low priority on the part of government. The findings illustrated traditional beliefs about the causes of disability and that the public's attitude needs to change to include and value people with disabilities. Support from international organisations was considered necessary as well as educating more prosthetic and orthotic staff to a higher level.

Capnocytophaga canimorsus: a rare case of conservatively treated prosthetic valve endocarditis.

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Jalava-Karvinen, Päivi; Grönroos, Juha O; Tuunanen, Helena; Kemppainen, Jukka; Oksi, Jarmo; Hohenthal, Ulla

2018-05-01

We describe a rare case of prosthetic valve endocarditis caused by the canine bacterium Capnocytophaga canimorsus in a male aged 73 years. The diagnosis of infective endocarditis was unequivocal, as it blood cultures were positive for C. canimorsus and vegetations were detected on transesophageal echocardiography; the modified Duke criteria were fulfilled. PET-CT showed intense 18 F-FDG uptake of the prosthetic valve area. The patient was treated with antibiotics alone (no surgery), and is now on life-long suppressive antibiotic therapy. To our knowledge, this is the third reported case of prosthetic valve endocarditis caused by C. canimorsus and the first one to have been treated conservatively. © 2018 APMIS. Published by John Wiley & Sons Ltd.

Mitral Prosthetic Valve Obstruction and Its Complications

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Rajesh Rajan

2015-12-01

Full Text Available Prosthetic Valve Obstruction (PVO is a serious complication which is associated with increased morbidity and mortality. This could result from thrombus formation, development of pannus, or a combination of both. Patients with this complication often present with symptoms and signs of heart failure, systemic embolism, acute cardiovascular collapse, and sudden death. Transesophageal echocardiography and cine fluoroscopy play a vital role in diagnosis of this potentially lethal condition. Herein, we reported a 56-year-old male patient who presented with severe heart failure and was found to have obstructed ATS27 bileaflet mitral prosthetic valve. Thrombolysis and redo surgery are two important options for treating this condition although guidelines for choosing between the two are not very definite.

Utilization of penile prosthesis and male incontinence prosthetics in Saudi Arabia

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Amjad Alwaal

2017-01-01

Conclusions: There is an increased utilization of penile prosthetics in Saudi Arabia. The private sector performs the majority of penile prosthesis procedures, and most of them are of the semirigid type. The governmental sector is more likely to perform inflatable penile prosthesis and male incontinence device procedures. Male incontinence prosthetics' use is very limited in Saudi Arabia.

Remote transient Lactobacillus animalis bacteremia causing prosthetic hip joint infection: a case report.

Science.gov (United States)

Somayaji, R; Lynch, T; Powell, J N; Gregson, D

2016-11-04

Lactobacillus spp. are uncommon pathogens in immunocompetent hosts, and even rarer causes of prosthetic device infections. A case of chronic hip prosthetic joint infection (PJI) caused by L. animalis is described. This occurred 5 years after a transient bacteremia with the same organism. Whole genome sequencing of both isolates proved this PJI infection resulted from this remote bacteremia. We document that prosthetic joint infections may be a consequence of bacteremia as much as 3 years before the onset of symptoms.

DME Prosthetics Orthotics, and Supplies Fee Schedule

Data.gov (United States)

U.S. Department of Health & Human Services — Durable Medical Equipment, Prosthetics-Orthotics, and Supplies Fee Schedule. The list contains the fee schedule amounts, floors, and ceilings for all procedure codes...

Occlusion properties of prosthetic contact lenses for the treatment of amblyopia.

Science.gov (United States)

Collins, Randall S; McChesney, Megan E; McCluer, Craig A; Schatz, Martha P

2008-12-01

The efficacy of opaque contact lenses as occlusion therapy for amblyopia has been established in the literature. Prosthetic contact lenses use similar tints to improve cosmesis in scarred or deformed eyes and may be an alternative in occlusion therapy. To test this idea, we determined the degree of vision penalization elicited by prosthetic contact lenses and their effect on peripheral fusion. We tested 19 CIBA Vision DuraSoft 3 Prosthetic soft contact lenses with varying iris prints, underprints, and opaque pupil sizes in 10 volunteers with best-corrected Snellen distance visual acuity of 20/20 or better in each eye. Snellen visual acuity and peripheral fusion using the Worth 4-Dot test at near were measured on each subject wearing each of the 19 lenses. Results were analyzed with 3-factor analysis of variance. Mean visual acuity through the various lenses ranged from 20/79 to 20/620. Eight lenses allowed preservation of peripheral fusion in 50% or more of the subjects tested. Iris print pattern and opaque pupil size were significant factors in determining visual acuity (p occlusion with prosthetic contact lenses a viable therapy for amblyopia. The degree of penalization can be varied and different iris print patterns and pupil sizes, using peripheral fusion, can be preserved with some lenses. Prosthetic contact lenses can be more cosmetically appealing and more tolerable than other amblyopia treatment modalities. These factors may improve compliance in occlusion therapy.

[Virtual Planning of Prosthetic Treatment of the Orbit].

Science.gov (United States)

Veit, Johannes A; Thierauf, Julia; Egner, Kornelius; Wiggenhauser, Paul Severin; Friedrich, Daniel; Greve, Jens; Schuler, Patrick J; Hoffmann, Thomas K; Schramm, Alexander

2017-06-01

Optimal positioning of bone-anchored implants in the treatment of patients with orbital prosthesis is challenging. The definition of implant axis as well as the positioning of the implants is important to prevent failures in prosthetic rehabilitation in these patients. We performed virtual planning of enossal implants at a base of a standard fan beam CT scan using the software CoDiagnostiX™ (DentalWings, Montréal, Canada). By 3D-printing a surgical guide for drilling and implant insertion was manufactured (Med-610™, Stratasys, Rehovot, Israel). An orbital exenteration was performed in a patient after shrinkage of the eyelids 20 years after enucleation and radiation of the orbit due to rhabdomyosarcoma. 4 Vistafix-3 implants (Cochlear™, Cochlea, Centennial, USA) were primarily inserted after resection with the help of the 3D-surgical guide. Prosthetic rehabilitation could be achieved as preplanned to a predictable result. The individual prosthesis of the orbit showed good functional and esthetic outcome. The virtual 3D-planning of endosseous implants for prosthetic orbital and periorbital reconstruction is easy to use and facilitates optimal placement of implants especially in posttherapeutically altered anatomic situations. © Georg Thieme Verlag KG Stuttgart · New York.

Development of inexpensive prosthetic feet for high-heeled shoes using simple shoe insole model.

Science.gov (United States)

Meier, Margrit R; Tucker, Kerice A; Hansen, Andrew H

2014-01-01

The large majority of prosthetic feet are aimed at low-heeled shoes, with a few models allowing a heel height of up to 5 cm. However, a survey by the American Podiatric Medical Association indicates that most women wear heels over 5 cm; thus, current prosthetic feet limit most female prosthesis users in their choice. Some prosthetic foot components are heel-height adjustable; however, their plantar surface shapes do not change to match the insole shapes of the shoes with different heel heights. The aims of the study were therefore (1) to develop a model that allows prediction of insole shape for various heel height shoes in combination with different shoe sizes and (2) to develop and field-test low-cost prototypes of prosthetic feet whose insole shapes were based on the new model. An equation was developed to calculate insole shapes independent of shoe size. Field testing of prototype prosthetic feet fabricated based on the equation was successful and demonstrated the utility of the equation.

Development of a prototype over-actuated biomimetic prosthetic hand.

Directory of Open Access Journals (Sweden)

Matthew R Williams

Full Text Available The loss of a hand can greatly affect quality of life. A prosthetic device that can mimic normal hand function is very important to physical and mental recuperation after hand amputation, but the currently available prosthetics do not fully meet the needs of the amputee community. Most prosthetic hands are not dexterous enough to grasp a variety of shaped objects, and those that are tend to be heavy, leading to discomfort while wearing the device. In order to attempt to better simulate human hand function, a dexterous hand was developed that uses an over-actuated mechanism to form grasp shape using intrinsic joint mounted motors in addition to a finger tendon to produce large flexion force for a tight grip. This novel actuation method allows the hand to use small actuators for grip shape formation, and the tendon to produce high grip strength. The hand was capable of producing fingertip flexion force suitable for most activities of daily living. In addition, it was able to produce a range of grasp shapes with natural, independent finger motion, and appearance similar to that of a human hand. The hand also had a mass distribution more similar to a natural forearm and hand compared to contemporary prosthetics due to the more proximal location of the heavier components of the system. This paper describes the design of the hand and controller, as well as the test results.

Prosthetic Hip Loosening Due to Brucellar Infection: Case Report and Literature Review

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Anis Tebourbi

2016-12-01

Full Text Available Context: Brucellosis is actually considered to be the commonest zoonotic infection worldwide; conversely prosthetic infection due to brucella is extremely rare. Although diagnostic is easily achieved, management of such situations is extremely challenging. Aims: To report the case of prosthetic hip loosening due to brucellar infection, discuss management manners and to summarize data about 19 cases reported in the literature. Methods: We report the case of a 73-year-old woman with brucellar prosthetic hip loosening treated with 2-stage exchange of the prosthesis and prolonged double antibiotherapy Results: At two years follow up the patient is pain free with total functional recovery and no clinical and radiographic signs of prosthetic loosening Conclusions: Brucella should be evocated as a cause of total joint arthroplasty infection especially in patients from endemic regions and with occupational exposure. Antibiotic treatment alone can be followed if there are no signs of implant loosening. Tow stage revision should be considered in other cases.

Virtual Control of Prosthetic Hand Based on Grasping Patterns and Estimated Force from Semg

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Zhu Gao-Ke

2016-01-01

Full Text Available Myoelectric prosthetic hands aim to serve upper limb amputees. The myoelectric control of the hand grasp action is a kind of real-time or online method. Thus it is of great necessity to carry on a study of online prosthetic hand electrical control. In this paper, the strategy of simultaneous EMG decoding of grasping patterns and grasping force was realized by controlling a virtual multi-degree-freedom prosthetic hand and a real one-degree-freedom prosthetic hand simultaneously. The former realized the grasping patterns from the recognition of the sEMG pattern. The other implemented the grasping force from sEMG force decoding. The results show that the control method is effective and feasible.

Remote transient Lactobacillus animalis bacteremia causing prosthetic hip joint infection: a case report

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R. Somayaji

2016-11-01

Full Text Available Abstract Background Lactobacillus spp. are uncommon pathogens in immunocompetent hosts, and even rarer causes of prosthetic device infections. Case presentation A case of chronic hip prosthetic joint infection (PJI caused by L. animalis is described. This occurred 5 years after a transient bacteremia with the same organism. Whole genome sequencing of both isolates proved this PJI infection resulted from this remote bacteremia. Conclusions We document that prosthetic joint infections may be a consequence of bacteremia as much as 3 years before the onset of symptoms.

In vitro adherence of bacteria to prosthetic grafting materials

International Nuclear Information System (INIS)

Brewer, A.R.; Stromberg, B.V.

1990-01-01

Adherence of bacteria to prosthetic grafting material is thought to play an important role in the ultimate development of prosthetic infections. To evaluate the role of bacterial adherence in the initiation and colonization of prosthetic materials, Proplast II, Gore-Tex, and silicone were evaluated for adherence of Escherichia coli and Staphylococcus aureus. Bacteria were radiolabeled and incubated with the study material. Adherence was determined by scintillation. Adherence to Proplast II and Gore-Tex reached a maximum at approximately 45 minutes of incubation and demonstrated a detachment phenomenon with E. coli. Similar results were noted with S. aureus, but with a maximal attachment at approximately 30 minutes. Interestingly, bacterial attachment to silicone continued to increase throughout the time of the incubation. In addition, adherence of S. aureus was at a faster rate than E. coli. Attachment of bacteria is a multifactorial process. However, the PTFE graft demonstrates a slower rate of attachment, lower total number of attached bacteria, and faster detachment. The importance of this phenomenon may help explain the foreign body effect of increased susceptibility to infection of foreign materials

Exophiala (Wangiella dermatitidis Prosthetic Aortic Valve Endocarditis and Prosthetic Graft Infection in an Immune Competent Patient

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Jay S. Berger

2017-01-01

Full Text Available Exophiala (Wangiella dermatitidis is an emerging dematiaceous fungus associated with high mortality rates and is a rare cause of endocarditis. We describe the first case of E. dermatitidis endocarditis of a prosthetic aortic valve and aortic graft in an immune competent patient with no clear risk factors of hematological acquisition.

Combined computed tomography and fluorodeoxyglucose positron emission tomography in the diagnosis of prosthetic valve endocarditis: a case series.

Science.gov (United States)

Bartoletti, Michele; Tumietto, Fabio; Fasulo, Giovanni; Giannella, Maddalena; Cristini, Francesco; Bonfiglioli, Rachele; Raumer, Luigi; Nanni, Cristina; Sanfilippo, Silvia; Di Eusanio, Marco; Scotton, Pier Giorgio; Graziosi, Maddalena; Rapezzi, Claudio; Fanti, Stefano; Viale, Pierluigi

2014-01-13

The diagnosis of prosthetic valve endocarditis is challenging. The gold standard for prosthetic valve endocarditis diagnosis is trans-esophageal echocardiography. However, trans-esophageal echocardiography may result in negative findings or yield images difficult to differentiate from thrombus in patients with prosthetic valve endocarditis. Combined computed tomography and fluorodeoxyglucose positron emission tomography is a potentially promising diagnostic tool for several infectious conditions and it has also been employed in patients with prosthetic valve endocarditis but data are still scant. We reviewed the charts of 6 patients with prosthetic aortic valves evaluated for suspicion of prosthetic valve endocarditis, at two different hospital, over a 3-year period. We found 3 patients with early-onset PVE cases and blood cultures yielding Pseudomonas aeruginosa, Staphylococcus epidermidis and Staphylococcus lugdunensis, respectively; and 3 late-onset cases in the remaining 3 patients with isolation in the blood of Streptococcus bovis, Candida albicans and P. aeruginosa, respectively. Initial trans-esophageal echocardiography was negative in all the patients, while fluorodeoxyglucose positron emission tomography showed images suspicious for prosthetic valve endocarditis. In 4 out of 6 patients valve replacement was done with histology confirming the prosthetic valve endocarditis diagnosis. After an adequate course of antibiotic therapy fluorodeoxyglucose positron emission tomography showed resolution of prosthetic valve endocarditis in all the patients. Our experience confirms the potential role of fluoroseoxyglucose positron emission tomography in the diagnosis and follow-up of prosthetic valve endocarditis.

Diagnostic performance of FDG PET or PET/CT in prosthetic infection after arthroplasty: a meta-analysis

International Nuclear Information System (INIS)

Jin, H.; Yuan, L.; Li, C.; Kan, Y.; Yang, J.; Hao, R.

2014-01-01

The purpose of this study was to systematically review and perform a meta-analysis of published data regarding the diagnostic performance of positron emission tomography (PET) or PET/computed tomography (PET/CT) in prosthetic infection after arthroplasty. A comprehensive computer literature search of studies published through May 31, 2012 regarding PET or PET/CT in patients suspicious of prosthetic infection was performed in PubMed/MEDLINE, Embase and Scopus databases. Pooled sensitivity and specificity of PET or PET/CT in patients suspicious of prosthetic infection on a per prosthesis-based analysis were calculated. The area under the receiver-operating characteristic (ROC) curve was calculated to measure the accuracy of PET or PET/CT in patients with suspicious of prosthetic infection. Fourteen studies comprising 838 prosthesis with suspicious of prosthetic infection after arthroplasty were included in this meta-analysis. The pooled sensitivity of PET or PET/CT in detecting prosthetic infection was 86% (95% confidence interval [CI] 82-90%) on a per prosthesis-based analysis. The pooled specificity of PET or PET/CT in detecting prosthetic infection was 86% (95% CI 83-89%) on a per prosthesis-based analysis. The area under the ROC curve was 0.93 on a per prosthesis-based analysis. In patients suspicious of prosthetic infection, FDG PET or PET/CT demonstrated high sensitivity and specificity. FDG PET or PET/CT are accurate methods in this setting. Nevertheless, possible sources of false positive results and influcing factors should kept in mind.

Diagnostic performance of FDG PET or PET/CT in prosthetic infection after arthroplasty: a meta-analysis.

Science.gov (United States)

Jin, H; Yuan, L; Li, C; Kan, Y; Hao, R; Yang, J

2014-03-01

The purpose of this study was to systematically review and perform a meta-analysis of published data regarding the diagnostic performance of positron emission tomography (PET) or PET/computed tomography (PET/CT) in prosthetic infection after arthroplasty. A comprehensive computer literature search of studies published through May 31, 2012 regarding PET or PET/CT in patients suspicious of prosthetic infection was performed in PubMed/MEDLINE, Embase and Scopus databases. Pooled sensitivity and specificity of PET or PET/CT in patients suspicious of prosthetic infection on a per prosthesis-based analysis were calculated. The area under the receiver-operating characteristic (ROC) curve was calculated to measure the accuracy of PET or PET/CT in patients with suspicious of prosthetic infection. Fourteen studies comprising 838 prosthesis with suspicious of prosthetic infection after arthroplasty were included in this meta-analysis. The pooled sensitivity of PET or PET/CT in detecting prosthetic infection was 86% (95% confidence interval [CI] 82-90%) on a per prosthesis-based analysis. The pooled specificity of PET or PET/CT in detecting prosthetic infection was 86% (95% CI 83-89%) on a per prosthesis-based analysis. The area under the ROC curve was 0.93 on a per prosthesis-based analysis. In patients suspicious of prosthetic infection, FDG PET or PET/CT demonstrated high sensitivity and specificity. FDG PET or PET/CT are accurate methods in this setting. Nevertheless, possible sources of false positive results and influcing factors should kept in mind.

Rapidly growing non-tuberculous mycobacteria infection of prosthetic knee joints: A report of two cases.

Science.gov (United States)

Kim, Manyoung; Ha, Chul-Won; Jang, Jae Won; Park, Yong-Beom

2017-08-01

Non-tuberculous mycobacteria (NTM) cause prosthetic knee joint infections in rare cases. Infections with rapidly growing non-tuberculous mycobacteria (RGNTM) are difficult to treat due to their aggressive clinical behavior and resistance to antibiotics. Infections of a prosthetic knee joint by RGNTM have rarely been reported. A standard of treatment has not yet been established because of the rarity of the condition. In previous reports, diagnoses of RGNTM infections in prosthetic knee joints took a long time to reach because the condition was not suspected, due to its rarity. In addition, it is difficult to identify RGNTM in the lab because special identification tests are needed. In previous reports, after treatment for RGNTM prosthetic infections, knee prostheses could not be re-implanted in all cases but one, resulting in arthrodesis or resection arthroplasty; this was most likely due to the aggressiveness of these organisms. In the present report, two cases of prosthetic knee joint infection caused by RGNTM (Mycobacterium abscessus) are described that were successfully treated, and in which prosthetic joints were finally reimplanted in two-stage revision surgery. Copyright © 2017 Elsevier B.V. All rights reserved.

Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity : Rehabilitation process and prosthetics. Part 2

NARCIS (Netherlands)

Geertzen, Jan; van der Linde, Harmen; Rosenbrand, Kitty; Conradi, Marcel; Deckers, Jos; Koning, Jan; Rietman, Hans S.; van der Schaaf, Dick; van der Ploeg, Rein; Schapendonk, Johannes; Schrier, Ernst; Duijzentkunst, Rob Smit; Spruit-van Eijk, Monica; Versteegen, Gerbrig; Voesten, Harrie

2015-01-01

Background: A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis

Quality of life after maxillectomy and prosthetic obturator rehabilitation.

Science.gov (United States)

Chigurupati, Radhika; Aloor, Neelam; Salas, Richard; Schmidt, Brian L

2013-08-01

Surgical resection of midface neoplasms and subsequent reconstruction have been shown to have significant negative effects on quality of life (QOL). The purpose of this pilot study was to assess individuals' health-related QOL after maxillectomy and reconstruction with a prosthetic obturator. The QOL of 25 of 43 patients who underwent maxillectomy and prosthetic obturator reconstruction at the University of California-San Francisco was assessed using 3 questionnaires: University of Washington Quality of Life version 4 (UWQOL), Obturator Functioning Scale (OFS), and Mental Health Inventory (MHI). The response rate to the QOL questionnaires was 92% (23 of 25 patients). Time elapsed from maxillectomy and prosthetic obturator reconstruction to the QOL survey response ranged from 0.3 to 6.6 years (mean, 2.7 years; standard deviation [SD], 1.9 years). The post-treatment mean QOL scores were 77.3 (SD, 13.6) for UWQOL, 72.0 (SD, 12.6) for OFS, and 4.5 (SD, 0.9) for Mental Health Inventory. Individuals who received adjuvant radiation scored lower for speech and appearance (OFS, P = .05, P = .03, respectively) as well as for saliva and overall QOL (UWQOL, P = .02, P = .08, respectively). There was a strong correlation between QOL scores in OFS and UWQOL questionnaires (r = 0.78, P maxillectomy and prosthetic obturator reconstruction. There is further need for a multicenter trial with a larger sample to identify how factors affecting QOL of patients after maxillectomy might influence the choice of reconstruction. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

A Statistical Perspective on Running with Prosthetic Lower-Limbs: An Advantage or Disadvantage?

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Hossein Hassani

2014-11-01

Full Text Available Technological developments have led to the increased use of carbon fiber and prosthetic lower-limbs in running events at the Paralympic Games. This study aims to exploit a series of statistical techniques in order to prepare a response to the vital question of whether utilizing prosthetic feet can affect an athletes ability when running competitively at the Paralympics Games by comparing both within and between different classifications. The study also considers the differences between running on biological limbs and prosthetic lower-limbs from a mechanical point of view. The results from the male 100 m, 200 m and 400 m at the 2012 London Paralympic Games have been the source of this investigation. The investigation provides statistical evidence to propose that the number of prosthetic limbs used and the structure of such limbs have a significant impact on the outcome of track events at the Paralympic Games.

Diagnostic flowcharts in osteomyelitis, spondylodiscitis and prosthetic joint infection

International Nuclear Information System (INIS)

Jutte, P.; Lazzeri, E.; Sconfienza, L. M.; Cassar-Pullicino, V.; Trampuz, A.; Petrosillo, N.; Signore, A.

2014-01-01

Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnose and to treat. Structured diagnostic workup may very well improve the accuracy and speed of diagnosis, thereby improving the outcome since treatment may very well be more successful and less harmful if timely management is started. Literature shows no uniform advise on diagnosis. The EANM organized a consensus meeting with representatives from the involved disciplines in order to develop common flowcharts for the diagnosis of osteomyelitis, spondylodiscitis and prosthetic joint infections. In this report the proceedings of this consensus meeting, including the proposed flowcharts for diagnosis, are published.

Mobility function of a prosthetic knee joint with an automatic stance phase lock.

Science.gov (United States)

Andrysek, Jan; Klejman, Susan; Torres-Moreno, Ricardo; Heim, Winfried; Steinnagel, Bryan; Glasford, Shane

2011-06-01

There is a need for a prosthetic knee joint design that is technologically and functionally appropriate for use in developing countries. To develop and clinically evaluate a new type of stance phase controlled prosthetic knee joint that provides stance phase stability without inhibiting swing phase flexion. A crossover repeated measures study design comparing the new knee joint to the participant's conventional low- or high-end prosthetic knee joint. The new knee joint was fitted to fourteen individuals aged 15 to 67 years with unilateral lower limb amputations. Walk tests were performed to measure walking speed. Energy expenditure was estimated using the physiological cost index (PCI). Walking speeds with the new knee joint were on average 0.14 m/s faster than conventional low-end knees (p < 0.0001), but 0.07 m/s slower than conventional high-end prosthetic knees (p = 0.008). The PCI was similar across all three knee joint technologies (p = 0.276). Mobility function with the new knee joint, in terms of walking speed, was more closely matched to high-end than low-end prosthetic knee joints. Therefore, given its relatively simple design, the new stance phase control mechanism may offer a functional and cost effective solution for active transfemoral amputees. This paper describes a new type of prosthetic knee joint mechanism that is intended to be cost-effective while providing high-level stance phase function to active individuals with a transfemoral amputation. Initial clinical testing suggests that the new knee joint may have some functional advantages over existing technologies in this category.

Prosthetics socket that incorporates an air splint system focusing on dynamic interface pressure.

Science.gov (United States)

Razak, Nasrul Anuar Abd; Osman, Noor Azuan Abu; Gholizadeh, Hossein; Ali, Sadeeq

2014-08-01

The interface pressure between the residual limb and prosthetic socket has a significant effect on an amputee's satisfaction and comfort. This paper presents the design and performance of a new prosthetic socket that uses an air splint system. The air splint prosthetic socket system was implemented by combining the air splint with a pressure sensor that the transhumeral user controls through the use of a microcontroller. The modular construction of the system developed allows the FSR pressure sensors that are placed inside the air splint socket to determine the required size and fitting for the socket used. Fifteen transhumeral amputees participated in the study. The subject's dynamic pressure on the socket that's applied while wearing the air splint systems was recorded using F-socket transducers and microcontroller analysis. The values collected by the F-socket sensor for the air splint prosthetic socket system were determined accordingly by comparing the dynamic pressure applied using statically socket. The pressure volume of the air splint fluctuated and was recorded at an average of 38 kPa (2.5) to 41 kPa (1.3) over three hours. The air splint socket might reduce the pressure within the interface of residual limb. This is particularly important during the daily life activities and may reduce the pain and discomfort at the residual limb in comparison to the static socket. The potential development of an auto-adjusted socket that uses an air splint system as the prosthetic socket will be of interest to researchers involved in rehabilitation engineering, prosthetics and orthotics.

Development of inexpensive prosthetic feet for high-heeled shoes using simple shoe insole model

OpenAIRE

Margrit R. Meier, PhD; Kerice A. Tucker, BSc; Andrew H. Hansen, PhD

2014-01-01

The large majority of prosthetic feet are aimed at low-heeled shoes, with a few models allowing a heel height of up to 5 cm. However, a survey by the American Podiatric Medical Association indicates that most women wear heels over 5 cm; thus, current prosthetic feet limit most female prosthesis users in their choice. Some prosthetic foot components are heel-height adjustable; however, their plantar surface shapes do not change to match the insole shapes of the shoes with different heel height...

A global perspective on mechanical prosthetic heart valve thrombosis: Diagnostic and therapeutic challenges

Science.gov (United States)

Gürsoy, Mustafa Ozan; Kalçık, Macit; Yesin, Mahmut; Karakoyun, Süleyman; Bayam, Emrah; Gündüz, Sabahattin; Özkan, Mehmet

2016-01-01

Prosthetic valve thrombosis is one of the major causes of primary valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of leaflet immobilization, cause of underlying pathology (thrombus versus pannus or both), and whether thrombolytic therapy attempt in the patient would be successful or surgery is needed. Current guidelines for the management of prosthetic valve thrombosis lack definitive class I recommendations due to lack of randomized controlled trials, and usually leave the choice of treatment to the clinician’s experience. In this review, we aimed to summarize the pathogenesis, diagnosis, and management of mechanical prosthetic valve thrombosis. PMID:28005024

Echocardiographic Evaluation of Tricuspid Prosthetic Valves: An Update

Directory of Open Access Journals (Sweden)

Dimitrios Maragiannis, MD, FASE, FACC

2016-05-01

Full Text Available This review focuses on the diagnostic value of novel echocardiographic techniques and the clinical application of recently described algorithms to assess tricuspid prosthetic valve function.

Prosthetic hip joint infection due to Campylobacter fetus.

OpenAIRE

Bates, C J; Clarke, T C; Spencer, R C

1994-01-01

A case of postoperative prosthetic hip joint infection due to Campylobacter fetus subsp. fetus is described. Difficulties in isolation and antimicrobial susceptibility testing of this organism are discussed.

Finite element analysis of the contact interface between trans-femoral stump and prosthetic socket.

Science.gov (United States)

Zhang, Linlin; Zhu, Ming; Shen, Ling; Zheng, Feng

2013-01-01

Transfemoral amputees need prosthetic devices after amputation surgery, and the interface pressure between the residual limb and prosthetic socket has a significant effect on an amputee's satisfaction and comfort. The purpose of this study was to build a nonlinear finite element model to investigate the interface pressure between the above-knee residual limb and its prosthetic socket. The model was three-dimensional (3D) with consideration of nonlinear boundary conditions. Contact analysis was used to simulate the friction conditions between skin and the socket. The normal stresses up to 80.57 kPa at the distal end of the soft tissue. The longitudinal and circumferential shear stress distributions at the limb-socket interface were also simulated. This study explores the influences of load transfer between trans-femoral residual limb and its prosthetic socket.

Experimental measurement of flexion-extension movement in normal and corpse prosthetic elbow joint.

Science.gov (United States)

TarniŢă, Daniela; TarniŢă, DănuŢ Nicolae

2016-01-01

This paper presents a comparative experimental study of flexion-extension movement in healthy elbow and in the prosthetic elbow joint fixed on an original experimental bench. Measurements were carried out in order to validate the functional morphology and a new elbow prosthesis type ball head. The three-dimensional (3D) model and the physical prototype of our experimental bench used to test elbow endoprosthesis at flexion-extension and pronation-supination movements is presented. The measurements were carried out on a group of nine healthy subjects and on the prosthetic corpse elbow, the experimental data being obtained for flexion-extension movement cycles. Experimental data for the two different flexion-extension tests for the nine subjects and for the corpse prosthetic elbow were acquired using SimiMotion video system. Experimental data were processed statistically. The corresponding graphs were obtained for all subjects in the experimental group, and for corpse prosthetic elbow for both flexion-extension tests. The statistical analysis has proved that the flexion angles of healthy elbows were significantly close to the values measured at the prosthetic elbow fixed on the experimental bench. The studied elbow prosthesis manages to re-establish the mobility for the elbow joint as close to the normal one.

The effect of prosthetic foot push-off on mechanical loading associated with knee osteoarthritis in lower extremity amputees.

Science.gov (United States)

Morgenroth, David C; Segal, Ava D; Zelik, Karl E; Czerniecki, Joseph M; Klute, Glenn K; Adamczyk, Peter G; Orendurff, Michael S; Hahn, Michael E; Collins, Steven H; Kuo, Art D

2011-10-01

Lower extremity amputation not only limits mobility, but also increases the risk of knee osteoarthritis of the intact limb. Dynamic walking models of non-amputees suggest that pushing-off from the trailing limb can reduce collision forces on the leading limb. These collision forces may determine the peak knee external adduction moment (EAM), which has been linked to the development of knee OA in the general population. We therefore hypothesized that greater prosthetic push-off would lead to reduced loading and knee EAM of the intact limb in unilateral transtibial amputees. Seven unilateral transtibial amputees were studied during gait under three prosthetic foot conditions that were intended to vary push-off. Prosthetic foot-ankle push-off work, intact limb knee EAM and ground reaction impulses for both limbs during step-to-step transition were measured. Overall, trailing limb prosthetic push-off work was negatively correlated with leading intact limb 1st peak knee EAM (slope=-.72±.22; p=.011). Prosthetic push-off work and 1st peak intact knee EAM varied significantly with foot type. The prosthetic foot condition with the least push-off demonstrated the largest knee EAM, which was reduced by 26% with the prosthetic foot producing the most push-off. Trailing prosthetic limb push-off impulse was negatively correlated with leading intact limb loading impulse (slope=-.34±.14; p=.001), which may help explain how prosthetic limb push-off can affect intact limb loading. Prosthetic feet that perform more prosthetic push-off appear to be associated with a reduction in 1st peak intact knee EAM, and their use could potentially reduce the risk and burden of knee osteoarthritis in this population. Published by Elsevier B.V.

Prosthetic valves in adult patients with congenital heart disease : Rationale and design of the Dutch PROSTAVA study

NARCIS (Netherlands)

Freling, H. G.; van Slooten, Y. J.; van Melle, J. P.; Mulder, B. J. M.; van Dijk, A. P. J.; Hillege, H. L.; Post, M. C.; Sieswerda, G. Tj; Jongbloed, M. R. M.; Willems, T. P.; Pieper, P. G.

2012-01-01

Data on long-term complications in adult patients with congenital heart disease (ACHD) and a prosthetic valve are scarce. Moreover, the influence of prosthetic valves on quality of life (QoL) and functional outcome in ACHD patients with prosthetic valves has not been studied. The primary objective

Advances for prosthetic technology from historical perspective to current status to future application

CERN Document Server

LeMoyne, Robert

2016-01-01

This book focuses on the advances in transtibial prosthetic technology and targets research in the evolution of the powered prosthesis such as the BiOM, which was derived from considerable research and development at the Massachusetts Institute of Technology. The concept of the book spans the historical evolution of prosthetic applications from passive to new and futuristic robotic prosthetic technologies.  The author describes the reasons for amputation, surgical procedures, and an historical perspective of the prosthesis for the lower limb. He also addresses the phases and sub-phases of gait and compensatory mechanisms arising for a transtibial prosthesis and links the compensatory mechanisms to long-term morbidities.  The general technologies for gait analysis central to prosthetic design and the inherent biomechanics foundations for analysis are also explored.  The book reports on recent-past to current-term applications with passive elastic prostheses.  The core of the book deals with futuristic robo...

Multimodality Imaging Assessment of Prosthetic Heart Valves

NARCIS (Netherlands)

Suchá, D.; Symersky, Petr; Tanis, W; Mali, Willem P Th M; Leiner, Tim; van Herwerden, LA; Budde, Ricardo P J

Echocardiography and fluoroscopy are the main techniques for prosthetic heart valve (PHV) evaluation, but because of specific limitations they may not identify the morphological substrate or the extent of PHV pathology. Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) have

Prosthetic Joint Infection

Science.gov (United States)

Tande, Aaron J.

2014-01-01

SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided. PMID:24696437

Can We Achieve Intuitive Prosthetic Elbow Control Based on Healthy Upper Limb Motor Strategies?

Directory of Open Access Journals (Sweden)

Manelle Merad

2018-02-01

Full Text Available Most transhumeral amputees report that their prosthetic device lacks functionality, citing the control strategy as a major limitation. Indeed, they are required to control several degrees of freedom with muscle groups primarily used for elbow actuation. As a result, most of them choose to have a one-degree-of-freedom myoelectric hand for grasping objects, a myoelectric wrist for pronation/supination, and a body-powered elbow. Unlike healthy upper limb movements, the prosthetic elbow joint angle, adjusted prior to the motion, is not involved in the overall upper limb movements, causing the rest of the body to compensate for the lack of mobility of the prosthesis. A promising solution to improve upper limb prosthesis control exploits the residual limb mobility: like in healthy movements, shoulder and prosthetic elbow motions are coupled using inter-joint coordination models. The present study aims to test this approach. A transhumeral amputated individual used a prosthesis with a residual limb motion-driven elbow to point at targets. The prosthetic elbow motion was derived from IMU-based shoulder measurements and a generic model of inter-joint coordinations built from healthy individuals data. For comparison, the participant also performed the task while the prosthetic elbow was implemented with his own myoelectric control strategy. The results show that although the transhumeral amputated participant achieved the pointing task with a better precision when the elbow was myoelectrically-controlled, he had to develop large compensatory trunk movements. Automatic elbow control reduced trunk displacements, and enabled a more natural body behavior with synchronous shoulder and elbow motions. However, due to socket impairments, the residual limb amplitudes were not as large as those of healthy shoulder movements. Therefore, this work also investigates if a control strategy whereby prosthetic joints are automatized according to healthy individuals

Radiological visualization of prosthetic heart valves in situ

International Nuclear Information System (INIS)

Hoffmeister, H.M.; Pirschel, J.

1986-01-01

To determine the radiographic appearance of prosthetic heart valves 15 different models were investigated in situ. Fluoroscopy with detail radiographs and standard chest-radiographs were used for identification of the specific type of the prosthesis, for determination of details of the valve apparatus and for evaluation of the motion of the valve disc/ball. - Fluoroscopy and routine radiographs provided sufficient information to identify all prosthetic heart valves with exception of the Xenomedica bioprosthesis. If radiopaque material was used for the valve disc/ball, fluoroscopic assessment of the function of the valve was possible. Thus, in most types of disc or ball valves the opening/closing of the valve can be visualized, whereas in bioprosthesis a radiological determination of the mechanical function is not possible. (orig.) [de

Case study: survey of patient satisfaction with prosthesis quality and design among below-knee prosthetic leg socket users.

Science.gov (United States)

Mohd Hawari, Nurhanisah; Jawaid, Mohammad; Md Tahir, Paridah; Azmeer, Raja Ahmad

2017-11-01

The aim of this case study was to explore patient satisfaction with the quality of prosthetic leg sockets intended for persons with lower limb amputations. A qualitative study based on in-depth interviews, preceded by a questionnaire session, was carried out with patients from the Rehabilitation Center and Hospital in Malaysia. Twelve out-patient and in-patient amputees with lower limb amputations, specifically below-knee amputations, were chosen randomly. The analysis of patients' narratives aimed to identify the functional and esthetic characteristics of currently used prosthetic leg sockets and any problems related to them. The obtained results indicated that out of the 12 participants, 41.7% and 25% were satisfied and somewhat satisfied with their current prosthetic sockets. Durability and comfort were rated by the participants as the most important characteristics of prosthetic sockets, with 83.3%. As regards the esthetic appearance of the socket, 66.7% of the respondents considered that the most important feature was the material from which the socket was fabricated. Thus, we conclude that current satisfaction levels with the quality of prosthetic sockets among amputees in Malaysia are suitable, prosthesis being preferred by many amputees. The results can be used to direct future research on cosmesis and functionality of prosthetic socket design. Implications for Rehabilitation Case study will help participants to get cost effective prosthetic leg socket. Develop prosthetic leg socket comfortable as comparative to existing one. Help Malaysian government to make policy to develop local prosthetic leg socket at affordable price.

Factors influencing the cost of prosthetic joint infection treatment.

Science.gov (United States)

Peel, T N; Cheng, A C; Lorenzo, Y P; Kong, D C M; Buising, K L; Choong, P F M

2013-11-01

Prosthetic joint infection (PJI) is associated with significant costs to the healthcare system. Current literature examines the cost of specific treatment modalities without assessing other cost drivers for PJI. To examine the overall cost of the treatment of PJI and to identify factors associated with management costs. The costs of treatment of prosthetic joint infections were examined in 139 patients across 10 hospitals over a 3-year period (January 2006 to December 2008). Cost calculations included hospitalization costs, surgical costs, hospital-in-the-home costs and antibiotic therapy costs. Negative binomial regression analysis was performed to model factors associated with total cost. The median cost of treating prosthetic joint infection per patient was Australian $34,800 (interquartile range: 20,305, 56,929). The following factors were associated with increased treatment costs: septic revision arthroplasty (67% increase in treatment cost; P = 0.02), hypotension at presentation (70% increase; P = 0.03), polymicrobial infections (41% increase; P = 0.009), surgical treatment with one-stage exchange (100% increase; P = 0.002) or resection arthroplasty (48% increase; P = 0.001) were independently associated with increased treatment costs. Culture-negative prosthetic joint infections were associated with decreased costs (29% decrease in treatment cost; P = 0.047). Treatment failure was associated with 156% increase in treatment costs. This study identifies clinically important factors influencing treatment costs that may be of relevance to policy-makers, particularly in the setting of hospital reimbursement and guiding future research into cost-effective preventive strategies. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Increased risk of prosthetic joint infection associated with esophago-gastro-duodenoscopy with biopsy.

Science.gov (United States)

Coelho-Prabhu, Nayantara; Oxentenko, Amy S; Osmon, Douglas R; Baron, Todd H; Hanssen, Arlen D; Wilson, Walter R; Steckelberg, James M; Baddour, Larry M; Harmsen, William S; Mandrekar, Jay; Berbari, Elie F

2013-02-01

There are no prospective data regarding the risk of prosthetic joint infection following routine gastrointestinal endoscopic procedures. We wanted to determine the risk of prosthetic hip or knee infection following gastrointestinal endoscopic procedures in patients with joint arthroplasty. We conducted a prospective, single-center, case-control study at a single, tertiary-care referral center. Cases were defined as adult patients hospitalized for prosthetic joint infection of the hip or knee between December 1, 2001 and May 31, 2006. Controls were adult patients with hip or knee arthroplasties but without a diagnosis of joint infection, hospitalized during the same time period at the same orthopedic hospital. The main outcome measure was the odds ratio (OR) of prosthetic joint infection after gastrointestinal endoscopic procedures performed within 2 years before admission. 339 cases and 339 controls were included in the study. Of these, 70 cases (21%) cases and 82 controls (24%) had undergone a gastrointestinal endoscopic procedure in the preceding 2 years. Among gastrointestinal procedures that were assessed, esophago-gastro-duodenoscopy (EGD) with biopsy was associated with an increased risk of prosthetic joint infection (OR = 3, 95% CI: 1.1-7). In a multivariable analysis adjusting for sex, age, joint age, immunosuppression, BMI, presence of wound drain, prior arthroplasty, malignancy, ASA score, and prothrombin time, the OR for infection after EGD with biopsy was 4 (95% CI: 1.5-10). EGD with biopsy was associated with an increased risk of prosthetic joint infection in patients with hip or knee arthroplasties. This association will need to be confirmed in other epidemiological studies and adequately powered prospective clinical trials prior to recommending antibiotic prophylaxis in these patients.

A smartphone photogrammetry method for digitizing prosthetic socket interiors.

Science.gov (United States)

Hernandez, Amaia; Lemaire, Edward

2017-04-01

Prosthetic CAD/CAM systems require accurate 3D limb models; however, difficulties arise when working from the person's socket since current 3D scanners have difficulties scanning socket interiors. While dedicated scanners exist, they are expensive and the cost may be prohibitive for a limited number of scans per year. A low-cost and accessible photogrammetry method for socket interior digitization is proposed, using a smartphone camera and cloud-based photogrammetry services. 15 two-dimensional images of the socket's interior are captured using a smartphone camera. A 3D model is generated using cloud-based software. Linear measurements were comparing between sockets and the related 3D models. 3D reconstruction accuracy averaged 2.6 ± 2.0 mm and 0.086 ± 0.078 L, which was less accurate than models obtained by high quality 3D scanners. However, this method would provide a viable 3D digital socket reproduction that is accessible and low-cost, after processing in prosthetic CAD software. Clinical relevance The described method provides a low-cost and accessible means to digitize a socket interior for use in prosthetic CAD/CAM systems, employing a smartphone camera and cloud-based photogrammetry software.

Prosthetic Leg Control in the Nullspace of Human Interaction.

Science.gov (United States)

Gregg, Robert D; Martin, Anne E

2016-07-01

Recent work has extended the control method of virtual constraints, originally developed for autonomous walking robots, to powered prosthetic legs for lower-limb amputees. Virtual constraints define desired joint patterns as functions of a mechanical phasing variable, which are typically enforced by torque control laws that linearize the output dynamics associated with the virtual constraints. However, the output dynamics of a powered prosthetic leg generally depend on the human interaction forces, which must be measured and canceled by the feedback linearizing control law. This feedback requires expensive multi-axis load cells, and actively canceling the interaction forces may minimize the human's influence over the prosthesis. To address these limitations, this paper proposes a method for projecting virtual constraints into the nullspace of the human interaction terms in the output dynamics. The projected virtual constraints naturally render the output dynamics invariant with respect to the human interaction forces, which instead enter into the internal dynamics of the partially linearized prosthetic system. This method is illustrated with simulations of a transfemoral amputee model walking with a powered knee-ankle prosthesis that is controlled via virtual constraints with and without the proposed projection.

Ergonomic workplace assessment in orthotic and prosthetic workshops.

Science.gov (United States)

Salmani Nodooshan, H; Koohi Booshehri, S; Daneshmandi, H; Choobineh, A R

2016-10-17

In Iranian orthotic and prosthetic workshops, the majority of activities are carried out by manpower and the tasks are labor-intensive. In these workshops, ergonomic aspects of working conditions are seldom considered. This study was conducted in orthotic and prosthetic workshops with the objectives of determination of prevalence rate of MSDs among employees and assessment of ergonomics working conditions. In this cross-sectional study, all employees (n = 42; 29 males and 13 females) in 11 active orthotic and prosthetic production centers of Shiraz city participated. Data were collected using Nordic Musculoskeletal disorders Questionnaire (NMQ) and observational technique by an ergonomics checklist for assessment of working conditions. The means (SD) of age and job tenure (years) in the study individuals were 37.26 (10.21) and 12.8 (9.39), respectively. The most prevalent MSD symptoms in the past 12 months were reported in the lower back (42.9%), shoulders (40.5%) and knees (40.5%). Working conditions assessment showed that the main ergonomic problems in the workshops studied originated from awkward working posture, improper workstation design, poorly designed hand tools and incorrect manual material handling. Any interventional program for working conditions improvement should, therefore, focus on these areas.

The relevance of aortic endograft prosthetic infection

NARCIS (Netherlands)

Cernohorsky, Paul; Reijnen, Michel M. P. J.; Tielliu, Ignace F. J.; van Sterkenburg, Steven M. M.; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

Background: Vascular prosthetic graft infection is a severe complication after open aortic aneurysm repair. Reports of infected endografts are scarce. General treatment consensus with infected graft material is that it should be removed completely. The objective of this study was to describe the

Good quality of life outcomes after treatment of prosthetic joint infection with debridement and prosthesis retention.

Science.gov (United States)

Aboltins, Craig; Dowsey, Michelle; Peel, Trish; Lim, Wen K; Choong, Peter

2016-05-01

Patients treated for early prosthetic joint infection (PJI) with surgical debridement and prosthesis retention have a rate of successful infection eradication that is similar to patients treated with the traditional approach of prosthesis exchange. It is therefore important to consider other outcomes after prosthetic joint infection treatment that may influence management decisions, such as quality of life (QOL). Our aim was to describe infection cure rates and quality of life for patients with prosthetic joint infection treated with debridement and prosthesis retention and to determine if treatment with this approach was a risk factor for poor quality of life outcomes. Prospectively collected pre and post-arthroplasty data were available for 2,134 patients, of which PJI occurred in 41. For patients treated for prosthetic joint infection, the 2-year survival free of treatment failure was 87% (95%CI 84-89). Prosthetic joint infection cases treated with debridement and retention had a similar improvement from pre-arthroplasty to 12-months post-arthroplasty as patients without PJI in QOL according to the SF-12 survey. Prosthetic joint infection treated with debridement and retention was not a risk factor for poor quality of life on univariate or multivariate analysis. Prosthetic joint infection treated with debridement and prosthesis retention results in good cure rates and quality of life. Further studies are required that directly compare quality of life for different surgical approaches for prosthetic joint infection to better inform management decisions. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:898-902, 2016. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Overview: Mechanism and Control of a Prosthetic Arm.

Science.gov (United States)

Kulkarni, Tushar; Uddanwadiker, Rashmi

2015-09-01

Continuous growth in industrialization and lack of awareness in safety parameters the cases of amputations are growing. The search of safer, simpler and automated prosthetic arms for managing upper limbs is expected. Continuous efforts have been made to design and develop prosthetic arms ranging from simple harness actuated to automated mechanisms with various control options. However due the cost constraints, the automated prosthetic arms are still out of the reach of needy people. Recent data have shown that there is a wide scope to develop a low cost and light weight upper limb prosthesis. This review summarizes the various designs methodologies, mechanisms and control system developed by the researchers and the advances therein. Educating the patient to develop acceptability to prosthesis and using the same for the most basic desired functions of human hand, post amputation care and to improve patient's independent life is equally important. In conclusion it can be interpreted that there is a wide scope in design in an adaptive mechanism for opening and closing of the fingers using other methods of path and position synthesis. Simple mechanisms and less parts may optimize the cost factor. Reduction in the weight of the prosthesis may be achieved using polymers used for engineering applications. Control system will remain never ending challenge for the researchers, but it is essential to maintain the simplicity from the patients perspective.

Smartphones as image processing systems for prosthetic vision.

Science.gov (United States)

Zapf, Marc P; Matteucci, Paul B; Lovell, Nigel H; Suaning, Gregg J

2013-01-01

The feasibility of implants for prosthetic vision has been demonstrated by research and commercial organizations. In most devices, an essential forerunner to the internal stimulation circuit is an external electronics solution for capturing, processing and relaying image information as well as extracting useful features from the scene surrounding the patient. The capabilities and multitude of image processing algorithms that can be performed by the device in real-time plays a major part in the final quality of the prosthetic vision. It is therefore optimal to use powerful hardware yet to avoid bulky, straining solutions. Recent publications have reported of portable single-board computers fast enough for computationally intensive image processing. Following the rapid evolution of commercial, ultra-portable ARM (Advanced RISC machine) mobile devices, the authors investigated the feasibility of modern smartphones running complex face detection as external processing devices for vision implants. The role of dedicated graphics processors in speeding up computation was evaluated while performing a demanding noise reduction algorithm (image denoising). The time required for face detection was found to decrease by 95% from 2.5 year old to recent devices. In denoising, graphics acceleration played a major role, speeding up denoising by a factor of 18. These results demonstrate that the technology has matured sufficiently to be considered as a valid external electronics platform for visual prosthetic research.

ARM-based visual processing system for prosthetic vision.

Science.gov (United States)

Matteucci, Paul B; Byrnes-Preston, Philip; Chen, Spencer C; Lovell, Nigel H; Suaning, Gregg J

2011-01-01

A growing number of prosthetic devices have been shown to provide visual perception to the profoundly blind through electrical neural stimulation. These first-generation devices offer promising outcomes to those affected by degenerative disorders such as retinitis pigmentosa. Although prosthetic approaches vary in their placement of the stimulating array (visual cortex, optic-nerve, epi-retinal surface, sub-retinal surface, supra-choroidal space, etc.), most of the solutions incorporate an externally-worn device to acquire and process video to provide the implant with instructions on how to deliver electrical stimulation to the patient, in order to elicit phosphenized vision. With the significant increase in availability and performance of low power-consumption smart phone and personal device processors, the authors investigated the use of a commercially available ARM (Advanced RISC Machine) device as an externally-worn processing unit for a prosthetic neural stimulator for the retina. A 400 MHz Samsung S3C2440A ARM920T single-board computer was programmed to extract 98 values from a 1.3 Megapixel OV9650 CMOS camera using impulse, regional averaging and Gaussian sampling algorithms. Power consumption and speed of video processing were compared to results obtained to similar reported devices. The results show that by using code optimization, the system is capable of driving a 98 channel implantable device for the restoration of visual percepts to the blind.

Dynamic elasticity measurement for prosthetic socket design.

Science.gov (United States)

Kim, Yujin; Kim, Junghoon; Son, Hyeryon; Choi, Youngjin

2017-07-01

The paper proposes a novel apparatus to measure the dynamic elasticity of human limb in order to help the design and fabrication of the personalized prosthetic socket. To take measurements of the dynamic elasticity, the desired force generated as an exponential chirp signal in which the frequency increases and amplitude is maintained according to time progress is applied to human limb and then the skin deformation is recorded, ultimately, to obtain the frequency response of its elasticity. It is referred to as a Dynamic Elasticity Measurement Apparatus (DEMA) in the paper. It has three core components such as linear motor to provide the desired force, loadcell to implement the force feedback control, and potentiometer to record the skin deformation. After measuring the force/deformation and calculating the dynamic elasticity of the limb, it is visualized as 3D color map model of the limb so that the entire dynamic elasticity can be shown at a glance according to the locations and frequencies. For the visualization, the dynamic elasticities measured at specific locations and frequencies are embodied using the color map into 3D limb model acquired by using 3D scanner. To demonstrate the effectiveness, the visualized dynamic elasticities are suggested as outcome of the proposed system, although we do not have any opportunity to apply the proposed system to the amputees. Ultimately, it is expected that the proposed system can be utilized to design and fabricate the personalized prosthetic socket in order for releasing the wearing pain caused by the conventional prosthetic socket.

38 CFR 17.122 - Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices...

Science.gov (United States)

2010-07-01

... of the expenses of repairs to prosthetic appliances and similar devices furnished without prior... Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices furnished without prior authorization. The expenses of repairs to prosthetic appliances, or similar appliances...

Utilization of penile prosthesis and male incontinence prosthetics in Saudi Arabia.

Science.gov (United States)

Alwaal, Amjad; Al-Sayyad, Ahmad J

2017-01-01

Erectile dysfunction is a prevalent disease affecting over 50% of men between the ages of 40 and 70 years. Penile prosthesis represents the end of the line treatment when other less invasive therapies fail or are contraindicated. Male stress urinary incontinence can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male stress incontinence. No data exist on the utilization of penile prosthesis or male incontinence surgical treatment in Saudi Arabia. Generally, urological prosthetic surgery is performed either in private hospitals or in government hospitals. Our aim was to assess the trend of penile prosthesis and male incontinence device utilization in Saudi Arabia. We utilized sales' data of penile prosthetics, male slings, and AUS from the only two companies selling these devices in Saudi Arabia (AMS ® and Coloplast ® ), from January 2013 to December 2016. There were 2599 penile prosthesis implantation procedures done in the study period, with 67% of them performed in private institutions. There was a progressively increased use of penile prosthetics which nearly doubled from 2013 to 2016. The main type of prosthesis utilized was the semirigid type 70% versus 11% of the 2-piece inflatable and 17% of the 3-piece inflatable device. Only 10 slings and 31 AUS were inserted during the same study period. There is an increased utilization of penile prosthetics in Saudi Arabia. The private sector performs the majority of penile prosthesis procedures, and most of them are of the semirigid type. The governmental sector is more likely to perform inflatable penile prosthesis and male incontinence device procedures. Male incontinence prosthetics' use is very limited in Saudi Arabia.

Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline.

Science.gov (United States)

Vila, Andrea; Pagella, Hugo; Amadio, Claudio; Leiva, Alejandro

2016-12-01

Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joint infection due to multidrug resistant Acinetobacter baumannii, its appropriate use may preclude prosthesis exchange. Since the area under the curve divided by the minimum inhibitory concentration is the best pharmacodynamic predictor of its efficacy, we used tigecycline at high dose, in order to optimize its efficacy and achieve implant retention in 3 patients who refused prosthesis exchange. All patients with prosthetic joint infections treated at our Institution are prospectively registered in a database. Three patients with early prosthetic joint infection of total hip arthroplasty due to multidrug resistant A. baumannii were treated with debridement, antibiotics and implant retention, using a high maintenance dose of tigecycline (100 mg every 12 hours). The cases were retrospectively reviewed. All patients signed informed consent for receiving off-label use of tigecycline. Tigecycline was well tolerated, allowing its administration at high maintenance dose for a median of 40 days (range 30-60). Two patients were then switched to minocycline at standard doses for a median of 3.3 months in order to complete treatment. Currently, none of the patients showed relapse. Increasing the dose of tigecycline could be considered as a means to better attain pharmacodynamic targets in patients with severe or difficult-to-treat infections. Tigecycline at high maintenance dose might be useful when retention of the implant is attempted for treatment for prosthetic joint infections due to multidrug resistant Acinetobacter. Although this approach might be promising, off-label use of tigecycline should be interpreted cautiously until prospective data are available. Tigecycline is

Evaluation of prosthetic heart valves by transesophageal echocardiography: problems, pitfalls, and timing of echocardiography

NARCIS (Netherlands)

van den Brink, Renee B. A.

2006-01-01

Transesophageal echocardiography (TEE) is especially suitable for examination of prosthetic valves because of the proximity of the esophagus to the heart and absence of interference with lungs and ribs. This article reviews normal and abnormal morphologic characteristics of prosthetic valves such as

CRITERIA FOR THE EVALUATION AND ESTIMATION OF IATROGENIC PROSTHETIC FACTORS – SEMIOLOGY AND SYMPTOMATOLOGY

Directory of Open Access Journals (Sweden)

G. LUCA

2013-12-01

Full Text Available Introduction: The principles lying at the basis of a balanced dental occlusion cannot be analyzed separately, but only if considering the teeth (and, implicitly, dental occlusion as integrated into the masticatory system, which includes the masticatory muscles, the temporo-mandibu‑ lary joint and the maxillary bones. Scope: The scope of the present study was to correlate and establish the interde‑ pendence between the morpholgically-incorrect prosthetic works and the tissular and functional damages suffered by the neighbouring structures, as a result of some incor‑ rectly-made prosthetic works. Also, the study aims at iden‑ tifying the factors and limits responsible for a prolongued maintenance of such irreversible pathological modificati‑ ons within an asymptomatic zone for the patient. Materials and method: The working hypothesis of the present inves‑ tigation started from the analysis of the various objective signs, versus the morphology of the incorrectly performed prosthetic works. The study, initiated as early as 2009, in a private stomatological clinics (DentEstet, Bucuresti, includes a number of 500 patients (250 women and 250 men, selected among the patients having addressed the stomatological office from various reasons (not always related to the prosthetic pathology of the cases here under investigation. Included in the study have been only the patients with fixed prosthetic works associated with one or several of the previously described objective signs, potentially induced by the iatrogeneicity of the prosthetic works. Results: The pathological effects of the iatrogenic works here under analysis, upon both the antagonistic and prosthetic support teeth, may be clinically identified during a minute examination performed prior to produ‑ cing irreversible final effects (abrasions, fractures, dental mobility, etc.. Such noxious effects of the iatrogenic pros‑ thetic works appear as a false masticatory comfort and as a

Pre-operative Asymptomatic Bacteriuria: A Risk Factor For Prosthetic Joint Infection?

Science.gov (United States)

Weale, R; El-Bakri, F; Saeed, Kordo

2018-04-13

Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood. • Assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee. • Determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI. Patients who had total/unicondylar knee or total hip arthroplasty were retrospectively reviewed over a five-year period. Pre-operative urine samples within one year of surgery were analysed and those with ASB identified. Primary outcome was prosthetic joint infection (PJI) within the first postoperative year. 5542 patients were included. 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with a PJI, 33 had a pre-operative urine sample recorded. The infection rate in the ASB group was 5% (7 of 140), in the no-ASB group it was 0.61% (26 of 4228) and in the group without a urine sample it was 1.96% (23 of 1174) (p value prosthetic joint, suggestive the relationship is unlikely causal. Copyright © 2018. Published by Elsevier Ltd.

Prosthetics & Orthotics Manufacturing Initiative (POMI)

Science.gov (United States)

2012-12-21

suspension system, socket- ankle /knee interface, etc.) associated with a complete prosthetic system. More specific, the purpose of these deliverables was...strap. The waist belt consists of an adjustable belt utilizing polypropylene buckles and a 2‖ elastic suspension strap which descends to the anchor ...Superior View. Step 8: The suspension component consists of a 1’ anchor strap with a buckle and a 5’ – 6’ long shoulder strap with hook and

Single-stage revision for fungal peri-prosthetic joint infection: a single-centre experience.

Science.gov (United States)

Klatte, T O; Kendoff, D; Kamath, A F; Jonen, V; Rueger, J M; Frommelt, L; Gebauer, M; Gehrke, T

2014-04-01

Fungal peri-prosthetic infections of the knee and hip are rare but likely to result in devastating complications. In this study we evaluated the results of their management using a single-stage exchange technique. Between 2001 and 2011, 14 patients (ten hips, four knees) were treated for a peri-prosthetic fungal infection. One patient was excluded because revision surgery was not possible owing to a large acetabular defect. One patient developed a further infection two months post-operatively and was excluded from the analysis. Two patients died of unrelated causes. After a mean of seven years (3 to 11) a total of ten patients were available for follow-up. One patient, undergoing revision replacement of the hip, had a post-operative dislocation. Another patient, undergoing revision replacement of the knee, developed a wound infection and required revision 29 months post-operatively following a peri-prosthetic femoral fracture. The mean Harris hip score increased to 74 points (63 to 84; p prosthetic infection is feasible, with an acceptable rate of a satisfactory outcome.

Aerogel Use as a Skin Protective Liner In Space Suits and Prosthetic Limbs Project

Science.gov (United States)

Roberson, Luke Bennett

2014-01-01

Existing materials for prosthetic liners tend to be thick and airtight, causing perspiration to accumulate inside the liner and potentially causing infection and injury. The purpose of this project was to examine the suitability of aerogel for prosthetic liner applications for use in space suits and orthopedics. Three tests were performed on several types of aerogel to assess the properties of each material, and our initial findings demonstrated that these materrials would be excellent candidates for liner applications for prosthetics and space suits. The project is currently on hold until additional funding is obtained for application testing at the VH Hospitals in Tampa

EEG Mind Controlled Smart Prosthetic Arm – A Comprehensive Study

Directory of Open Access Journals (Sweden)

Taha Beyrouthy

2017-06-01

Full Text Available Recently, the field of prosthetics has seen many accomplishments especially with the integration of technological advancements. In this paper, different arm types (robotic, surgical, bionic, prosthetic and static are analyzed in terms of resistance, usage, flexibility, cost and potential. Most of these techniques have some problems; they are extremely expensive, hard to install and maintain and may require surgery. Therefore, our work introduces the initial design of an EEG mind controlled smart prosthetic arm. The arm is controlled by the brain commands, obtained from an electroencephalography (EEG headset, and equipped with a network of smart sensors and actuators that give the patient intelligent feedback about the surrounding environment and the object in contact. This network provides the arm with normal hand functionality, smart reflexes and smooth movements. Various types of sensors are used including temperature, pressure, ultrasonic proximity sensors, accelerometers, potentiometers, strain gauges and gyroscopes. The arm is completely 3D printed built from various lightweight and high strength materials that can handle high impacts and fragile elements as well. Our project requires the use of nine servomotors installed at different places in the arm. Therefore, the static and dynamic modes of servomotors are analyzed. The total cost of the project is estimated to be relatively cheap compared to other previously built arms. Many scenarios are analyzed corresponding to the actions that the prosthetic arm can perform, and an algorithm is created to match these scenarios. Experimental results show that the proposed EEG Mind-controlled Arm is a promising alternative for current solutions that require invasive and expensive surgical procedures.

Successful Thrombolysis of Aortic Prosthetic Valve Thrombosis ...

African Journals Online (AJOL)

Arun Kumar Agnihotri

patients with valvular heart disease). Endorsed by the Society of Cardiovascular. Anesthesiologists, Society for Cardiovascular. Angiography and Interventions, and Society of. Thoracic Surgeons. J Am Coll Cardiol. 2008;52(13):e1-142. 5. Elkayam U, Bitar F. Valvular heart disease and pregnancy. Part II: prosthetic valves.

Consumer satisfaction in prosthetics and orthotics facilities

NARCIS (Netherlands)

Geertzen, J.H.B.; Gankema, H.G.J.; Groothoff, J.W.; Dijkstra, P.U.

The aim of this study was to assess consumer/patient satisfaction with the services of the prosthetics and orthotics (P&O) facilities in the north of the Netherlands, using a modified SERVQUAL questionnaire. In this questionnaire, consumer interests and experiences are assessed on a 5-point Likert

Prosthetic valve obstruction: Redo surgery or fibrinolysis?

Directory of Open Access Journals (Sweden)

Avinash Inamdar

2017-01-01

Full Text Available Objective: The aim of this study was to compare the efficacy and safety of surgery versus fibrinolytic therapy in patients with prosthetic valve obstruction. Materials and Methods: We compared 15 patients of prosthetic valve thrombosis treated by surgical line of management and another 15 patients treated by thrombolysis. All patients were initially assessed by clinical evaluation and diagnosis confirmed by transthoracic and transesophageal two-dimensional echocardiography. Depending on hemodynamic stability, pannus, or thrombus on transesophageal echocardiography, the patients were assigned surgical or medical line of management. Results: Patients mortality rate was 40% in fibrinolytic group and 13.33% in surgical group. Recurrence was 40% in fibrinolytic group while there was no recurrence till date in surgery group. Complications were more in fibrinolytic group as opposed to surgery group patient. Conclusion: From our experience, we conclude that redo surgery is effective and definitive treatment, especially in patients with stable hemodynamic conditions.

Self-cleaning skin-like prosthetic polymer surfaces

Science.gov (United States)

Simpson, John T [Clinton, TN; Ivanov, Ilia N [Knoxville, TN; Shibata, Jason [Manhattan Beach, CA

2012-03-27

An external covering and method of making an external covering for hiding the internal endoskeleton of a mechanical (e.g., prosthetic) device that exhibits skin-like qualities is provided. The external covering generally comprises an internal bulk layer in contact with the endoskeleton of the prosthetic device and an external skin layer disposed about the internal bulk layer. The external skin layer is comprised of a polymer composite with carbon nanotubes embedded therein. The outer surface of the skin layer has multiple cone-shaped projections that provide the external skin layer with superhydrophobicity. The carbon nanotubes are preferably vertically aligned between the inner surface and outer surface of the external skin layer in order to provide the skin layer with the ability to transmit heat. Superhydrophobic powders may optionally be used as part of the polymer composite or applied as a coating to the surface of the skin layer to enhance superhydrophobicity.

Is the Prosthetic Homologue Necessary for Embodiment?

Science.gov (United States)

Dornfeld, Chelsea; Swanston, Michelle; Cassella, Joseph; Beasley, Casey; Green, Jacob; Moshayev, Yonatan; Wininger, Michael

2016-01-01

Embodiment is the process by which patients with limb loss come to accept their peripheral device as a natural extension of self. However, there is little guidance as to how exacting the prosthesis must be in order for embodiment to take place: is it necessary for the prosthetic hand to look just like the absent hand? Here, we describe a protocol for testing whether an individual would select a hand that looks like their own from among a selection of five hands, and whether the hand selection (regardless of homology) is consistent across multiple exposures to the same (but reordered) set of candidate hands. Pilot results using healthy volunteers reveals that hand selection is only modestly consistent, and that selection of the prosthetic homologue is atypical (61 of 192 total exposures). Our protocol can be executed in minutes, and makes use of readily available equipment and softwares. We present both a face-to-face and a virtual protocol, for maximum flexibility of implementation.

An evaluation of prosthetic status and treatment needs among institutionalized elderly individuals of Delhi, India

OpenAIRE

Nisha Yadav; Roma Yadav; Meetika Pahuja; Sanchit Pardhan; Sahiba Miglani; Tamanna Malik

2017-01-01

Context: Oral health is essential for elderly person's general health and well-being. The most common oral problem in elderly is tooth loss which results due to periodontal diseases and caries. Prosthetic status is very important as it is related to dietary intake and maintaining nutritional status. Hence, to promote the oral health of the elderly, we need to know their prosthetic status and need. Aims: The aim of this study is to find the prosthetic status and need of 65–74 years old elderly...

Smart Prosthetic Hand Technology - Phase 2

Science.gov (United States)

2011-05-01

functional magnetic resonance imaging (f- MRI ) was used to analyze the reciprocal adaptation between the human brain and the prosthetic hand by the...Schmidt PC. Influence of compacted hydrophobic and hydrophilic colloidal silicon dioxide on tableting properties of pharmaceutical excipients. Drug Dev...nanoparticles, and manganese nanoparticles) in magnetic resonance imaging ( MRI ) in the detection and staging of cancer [2]. 2.1 Iron Oxide

Immediate effects of a new microprocessor-controlled prosthetic knee joint: a comparative biomechanical evaluation.

Science.gov (United States)

Bellmann, Malte; Schmalz, Thomas; Ludwigs, Eva; Blumentritt, Siegmar

2012-03-01

To investigate the immediate biomechanical effects after transition to a new microprocessor-controlled prosthetic knee joint. Intervention cross-over study with repeated measures. Only prosthetic knee joints were changed. Motion analysis laboratory. Men (N=11; mean age ± SD, 36.7±10.2y; Medicare functional classification level, 3-4) with unilateral transfemoral amputation. Two microprocessor-controlled prosthetic knee joints: C-Leg and a new prosthetic knee joint, Genium. Static prosthetic alignment, time-distance parameters, kinematic and kinetic parameters, and center of pressure. After a half-day training and an additional half-day accommodation, improved biomechanical outcomes were demonstrated by the Genium: lower ground reaction forces at weight acceptance during level walking at various velocities, increased swing phase flexion angles during walking on a ramp, and level walking with small steps. Maximum knee flexion angle during swing phase at various velocities was nearly equal for Genium. Step-over-step stair ascent with the Genium knee was more physiologic as demonstrated by a more equal load distribution between the prosthetic and contralateral sides and a more natural gait pattern. When descending stairs and ramps, knee flexion moments with the Genium tended to increase. During quiet stance on a decline, subjects using Genium accepted higher loading of the prosthetic side knee joint, thus reducing same side hip joint loading as well as postural sway. In comparision to the C-Leg, the Genium demonstrated immediate biomechanical advantages during various daily ambulatory activities, which may lead to an increase in range and diversity of activity of people with above-knee amputations. Results showed that use of the Genium facilitated more natural gait biomechanics and load distribution throughout the affected and sound musculoskeletal structure. This was observed during quiet stance on a decline, walking on level ground, and walking up and down ramps and

Prosthetic joint infection caused by Pasteurella multocida: a case series and review of literature.

Science.gov (United States)

Honnorat, Estelle; Seng, Piseth; Savini, Hélène; Pinelli, Pierre-Olivier; Simon, Fabrice; Stein, Andreas

2016-08-20

Pasteurella multocida is a well-recognized zoonotic agent following dog or cat bites or scratches. Nevertheless, prosthetic joint infection caused by P. multocida are rarely reported. We report here a series of six cases of prosthetic joint infection caused by P. multocida managed at a referral centre for the treatment of bone and joint infection in southern France. We also reviewed the 26 cases reported in literature. The mean age of our cases was 74 years [±8.2, range 63-85]. In majority of our cases (5 cases) were associated with knee prostheses and one case with a hip prosthesis. Most of cases occurred after cat or dog scratches or licks or contact. Diagnoses of prosthetic joint infection caused by P. multocida were made by positive cultures of surgical biopsies or needle aspiration. Mean time delay between prosthetic joint implantation and infection onset was 7.6 years (±5.12 years, range 2-17). Local inflammation, which occurred in all six cases, was the most frequent clinical symptom, followed by pain in five cases, fever and swollen joints in four cases, and a fistula with purulent discharge inside the wound in two cases. The mean time of antibiotic therapy was 8 months. Surgical treatment with prosthesis removal was performed in three cases. Six of our cases were in remission without apparent relapse at 3 years after end of treatment. Prosthetic joint infections caused by P. multocida usually occur after animal scratches or bites, but can occasionally occur after a short animal lick. These infections are usually resulting from a contiguous infection and localized in the knee. An early antibiotic therapy after surgical debridement could avoid prosthetic withdrawal, notably in elderly patients. Patients with prosthetic joints should be warned that animals are potential sources of serious infection and urgent medical advice should be sought if they are bitten or scratched.

Systematic variation of prosthetic foot spring affects center-of-mass mechanics and metabolic cost during walking.

Science.gov (United States)

Zelik, Karl E; Collins, Steven H; Adamczyk, Peter G; Segal, Ava D; Klute, Glenn K; Morgenroth, David C; Hahn, Michael E; Orendurff, Michael S; Czerniecki, Joseph M; Kuo, Arthur D

2011-08-01

Lower-limb amputees expend more energy to walk than non-amputees and have an elevated risk of secondary disabilities. Insufficient push-off by the prosthetic foot may be a contributing factor. We aimed to systematically study the effect of prosthetic foot mechanics on gait, to gain insight into fundamental prosthetic design principles. We varied a single parameter in isolation, the energy-storing spring in a prototype prosthetic foot, the controlled energy storage and return (CESR) foot, and observed the effect on gait. Subjects walked on the CESR foot with three different springs. We performed parallel studies on amputees and on non-amputees wearing prosthetic simulators. In both groups, spring characteristics similarly affected ankle and body center-of-mass (COM) mechanics and metabolic cost. Softer springs led to greater energy storage, energy return, and prosthetic limb COM push-off work. But metabolic energy expenditure was lowest with a spring of intermediate stiffness, suggesting biomechanical disadvantages to the softest spring despite its greater push-off. Disadvantages of the softest spring may include excessive heel displacements and COM collision losses. We also observed some differences in joint kinetics between amputees and non-amputees walking on the prototype foot. During prosthetic push-off, amputees exhibited reduced energy transfer from the prosthesis to the COM along with increased hip work, perhaps due to greater energy dissipation at the knee. Nevertheless, the results indicate that spring compliance can contribute to push-off, but with biomechanical trade-offs that limit the degree to which greater push-off might improve walking economy. © 2011 IEEE

The Prosthetic Experience Between Body and Technology

DEFF Research Database (Denmark)

Søndergaard, Morten

2018-01-01

In this paper, I argue that a prosthetic aesthetic instigated by experimental art practices operate with and within a ‘second nature’ – in-between science and art. Drawing on theories from Dewey and Edelman and examples from Da Vinci, Brancusi, Man Ray, Dali and Stelarc, I am calling...

Aortic allografts in treatment of aortic valve and ascending aorta prosthetic endocarditis

Directory of Open Access Journals (Sweden)

S.V. Spiridonov

2017-03-01

Full Text Available The aim – to assess short- and long-term results of aortic root replacement using aortic allografts in patients with prosthetic endocarditis. Materials and methods. Since February 2009 until June 2016 aortic valve and ascending aorta replacement using aortic allografts was performed in 26 patients with prosthetic endocarditis. In 50 % of cases at initial operation aortic valve replacement was performed, in another 50 % of cases – aortic valve and ascending aorta replacement. Echocardiography was performed 10 days, 3, 6 and 12 months, 2, 3 and 5 years after surgery. Analysis of long-term results included all cases of deaths, prosthesis-related complications and recurrence of endocarditis. Results. 30-day mortality was 23.1 %. Extracorporeal membranous oxygenation (ECMO was used only in 5 patients (19.2 %. Four patients were weaned from ECMO. We did not observe any allograft-related complications. During follow-up period there were no cases of reoperation due to structural allograft failure. Relapse of infection occurred in 1 patient (3.8 % four years after the operation and led to lethal outcome. Conclusion. Reoperations using allografts are an effective surgical treatment of prosthetic endocarditis. In majority of cases prosthetic endocarditis was caused by gram-positive cocci (Staphylococcus. In 84.6 % of cases it was associated with destruction of paravalvular structures and abscesses formation. Heart failure was a causative factor of different complications in these patients, which required ECMO in 19.2 % of patients. In 80 % of cases patients were weaned from ECMO. Allografts using for the treatment of prosthetic endocarditis is associated with high resistance to infection and with a significant rate of freedom from recurrence of endocarditis within 3 years after surgery.

Selected applications for current polymers in prosthetic dentistry - state of the art.

Science.gov (United States)

Kawala, Maciej; Smardz, Joanna; Adamczyk, Lukasz; Grychowska, Natalia; Wieckiewicz, Mieszko

2018-05-10

Polymers are widely applied in medicine, including dentistry, i.e. in prosthodontics. The following paper is aimed at demonstrating the applications of selected modern polymers in prosthetic dentistry based on the reported literature. The study was conducted using the PubMed, SCOPUS and CINAHL databases in relation to documents published during 1999-2017. The following keywords were used: polymers with: prosthetic dentistry, impression materials, denture base materials, bite registration materials, denture soft liners, occlusal splint materials and 3D printing. Original papers and reviews which were significant from the modern clinical viewpoint and practical validity in relation to the possibility of using polymeric materials in prosthetic dentistry, were presented. Denture base materials were most commonly modified polymers. Modifications mainly concerned antimicrobial properties and reinforcement of the material structure by introducing additional fibers. Antimicrobial modifications were also common in case of relining materials. Polymeric materials have widely been used in prosthetic dentistry. Modifications of their composition allow achieving new, beneficial properties that affect quality of patients' life. Progress in science allows for a more methodologically-advanced research on the synthesis of new polymeric materials and incorporation of new substances into already known polymeric materials, that will require systematization and appropriate classification. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Characterization of microbes in prosthetic joint specimens by culture-independent molecular methods

DEFF Research Database (Denmark)

Xu, Yijuan; Rudkjøbing, Vibeke Børsholt; Simonsen, Ole

Prosthetic joint infection (PJI) is one of the most challenging complications of joint alloplasty. Formation of biofilm is a prominent feature of PJIs and constitutes a challenge to current sampling procedures and culture practices to obtain a reliable diagnosis. The aim of the study was to inves......Prosthetic joint infection (PJI) is one of the most challenging complications of joint alloplasty. Formation of biofilm is a prominent feature of PJIs and constitutes a challenge to current sampling procedures and culture practices to obtain a reliable diagnosis. The aim of the study...... was to investigate the microbial diversity in surgical samples (eg. synovial fluid, periprosthetic tissue, removed prosthesis) from 22 prosthetic patients using a range of culture-independent molecular methods including broad range 16S rRNA gene PCR, cloning, phylogeny, quantitative PCR (qPCR), and fluorescence...

Novel implant for peri-prosthetic proximal tibia fractures.

Science.gov (United States)

Tran, Ton; Chen, Bernard K; Wu, Xinhua; Pun, Chung Lun

2018-03-01

Repair of peri-prosthetic proximal tibia fractures is very challenging in patients with a total knee replacement or arthroplasty. The tibial component of the knee implant severely restricts the fixation points of the tibial implant to repair peri-prosthetic fractures. A novel implant has been designed with an extended flange over the anterior of tibial condyle to provide additional points of fixation, overcoming limitations of existing generic locking plates used for proximal tibia fractures. Furthermore, the screws fixed through the extended flange provide additional support to prevent the problem of subsidence of tibial component of knee implant. The design methodology involved extraction of bone data from CT scans into a flexible CAD format, implant design and structural evaluation and optimisation using FEM as well as prototype development and manufacture by selective laser melting 3D printing technology with Ti6Al4 V powder. A prototype tibia implant was developed based on a patient-specific bone structure, which was regenerated from the CT images of patient's tibia. The design is described in detail and being applied to fit up to 80% of patients, for both left and right sides based on the average dimensions and shape of the bone structure from a wide range of CT images. A novel tibial implant has been developed to repair peri-prosthetic proximal tibia fractures which overcomes significant constraints from the tibial component of existing knee implant. Copyright © 2018 Elsevier Ltd. All rights reserved.

The influence of environmental and personal factors on participation of lower-limb prosthetic users in low-income countries: prosthetists' perspectives.

Science.gov (United States)

Kam, Season; Kent, Mallory; Khodaverdian, Alin; Daiter, Liane; Njelesani, Janet; Cameron, Debra; Andrysek, Jan

2015-05-01

To examine the environmental and personal factors in low-income countries (LICs) that influence prosthetic rehabilitation of adults with lower-limb (LL) amputations and their ability to participate in daily activities. In this qualitative descriptive study, 11 prosthetists participated in semi-structured interviews by telephone or Skype. Qualitative thematic analysis was guided by the International Classification of Function. Facilitating continuity of care, consideration of physical environments and usage, prosthetic quality including durability and socket fit, and minimizing the visibility of disability, were found to be important factors affecting the provision of prosthetic services in LICs. Environmental and personal factors must be considered when providing prosthetic rehabilitation for adults with LL amputations in LICs in order to optimize participation in activities. Results from this study provide new insights about some of the factors that influence the ability of individuals with LL amputations to rehabilitate to a level where they are able to participate in meaningful activities within their communities. There are unique environmental and personal components that can influence activity and participation of lower-limb (LL) prosthetic users in low-income countries (LICs). These components are often overlooked in the design of prosthetic devices and provision of prosthetic services. Continuity of care, condition of the post-surgical residuum, outdoor environments of common occupations, aesthetics and durability of prostheses, and user comfort should all be considered when providing prosthetic rehabilitation to adults with LL amputations in LICs to promote activity and participation. Results of our study can inform the practice of prosthetists in LICs by highlighting their contributions in enabling participation for LL prosthetic users. Our results can also inform the design of durable and comfortable prostheses and the provision of more appropriate

Nitinol for Prosthetic and Orthotic Applications

Science.gov (United States)

Henderson, Emma; Buis, Arjan

2011-07-01

As global populations age, conditions such as stroke and diabetes require individuals to use rehabilitation technology for many years to come due to chronic musculoskeletal, sensory, and other physical impairments. One in four males currently aged 45 will experience a stroke within 40 years and will often require access to prolonged rehabilitation. In addition, worldwide, one individual loses a limb every 30 s due to the complications of diabetes. As a result, innovative ideas are required to devise more effective prosthetic and orthotic devices to enhance quality of life. While Nitinol has already found much favor within the biomedical industry, one area, which has not yet exploited its unique properties, is in the field of physical rehabilitation, ranging from prosthetic and orthotic devices to assistive technology such as wheelchairs. Improved intervention capabilities based on materials such as Nitinol have the potential to vastly improve patients' quality of life and in the case of orthoses, may even reduce the severity of the condition over time. It is hoped that this study will spark discussion and interest for the materials community in a field which has yet to be fully exploited.

A survey of prosthetic eye wearers to investigate mucoid discharge

Directory of Open Access Journals (Sweden)

Pine K

2012-05-01

Full Text Available Keith Pine1, Brian Sloan2, Joanna Stewart3, Robert J Jacobs11Department of Optometry and Vision Science, 2Department of Ophthalmology, New Zealand National Eye Centre, 3Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New ZealandBackground: This study aimed to better understand the causes and treatments of mucoid discharge associated with prosthetic eye wear by reviewing the literature and surveying anophthalmic patients.Methods: An anonymous questionnaire was completed by 429 prosthetic eye wearers who used visual analog scales to self-measure their discharge experience for four discharge characteristics: frequency, color, volume, and viscosity. These characteristics were analyzed with age, ethnicity, years wearing a prosthesis, eye loss cause, removal and cleaning regimes, hand-washing behavior, age of current prosthesis, and professional repolishing regimes as explanatory variables. Eighteen ocularists’ Web sites containing comments on the cause and treatment of discharge were surveyed.Results: Associations were found between discharge frequency and cleaning regimes with more frequent cleaning accompanying more frequent discharge. Color was associated with years of wearing and age, with more years of wearing and older people having less colored discharge. Volume was associated with cleaning regimes with more frequent cleaners having more volume. Viscosity was associated with cleaning regimes and years of wearing with more frequent cleaning and shorter wearing time accompanying more viscous discharge. No associations were found between discharge characteristics and ethnicity, eye loss cause, hand washing, age of current prosthesis, or repolishing regimes. Forty-seven percent of ocularists’ Web sites advised that discharge was caused by surface deposits on the prosthesis, 29% by excessive handling of the prosthesis, and 24% by other causes.Conclusions: A standardized treatment

Prosthetic management of an ocular defect

Directory of Open Access Journals (Sweden)

Siddesh Kumar Chintal

2010-01-01

Full Text Available The disfigurement associated with the loss of an eye can cause significant physical and emotional problems. Various treatment modalities are available, one of which is implants. Although implant has a superior outcome, it may not be advisable in all patients due to economic factors. The present article describes the prosthetic management of an ocular defect with a custom-made ocular prosthesis.

LEUKOCYTE AND BACTERIA IMAGING IN PROSTHETIC JOINT INFECTION

NARCIS (Netherlands)

Glaudemans, Andor W. J. M.; Galli, Filippo; Pacilio, Marta; Signore, Alberto

2013-01-01

There has been a significant increase in the number of joint prosthesis replacements worldwide. Although relatively uncommon, complications can occur with the most serious being an infection. Various radiological and nuclear imaging techniques are available to diagnose prosthetic joint infections

Esthetic, functional, and prosthetic outcomes with implant-retained finger prostheses.

Science.gov (United States)

Aydin, Cemal; Nemli, Secil Karakoca; Yilmaz, Handan

2013-04-01

Traumatic amputation of fingers results in a serious impairment of hand function and affects the psychological status of the patients. The implant-retained finger prostheses are an alternative treatment. The aim of this case report is to represent the use of osseointegrated implants for retention of finger prostheses in a patient with amputated thumb and index finger. Dental implants were placed in the residual bone of the fingers using two-stage surgery. Custom-made attachments were used to provide retention between implants and silicone prostheses. Prosthetic fingernails were made of composite resin material. After 6 months, implants were clinically successful, and the patient was satisfied with the appearance and the function of the prostheses. The complications of broken prosthetic nail and mild discoloration were observed. Reconstruction of amputated fingers with implant-retained prosthesis is a worthwhile treatment providing esthetic, functional, and psychological benefits, although some complications might be experienced. Clinical relevance Implant-retained finger prostheses are an acceptable treatment modality for patients with amputated fingers. Evaluating implant prognosis, functional results and prosthetic results of the patients are necessary to address the benefits and complications of the treatment.

Nuclear Medicine in Diagnosis of Prosthetic Valve Endocarditis: An Update

Science.gov (United States)

Musso, Maria; Petrosillo, Nicola

2015-01-01

Over the past decades cardiovascular disease management has been substantially improved by the increasing introduction of medical devices as prosthetic valves. The yearly rate of infective endocarditis (IE) in patient with a prosthetic valve is approximately 3 cases per 1,000 patients. The fatality rate of prosthetic valve endocarditis (PVE) remains stable over the years, in part due to the aging of the population. The diagnostic value of echocardiography in diagnosis is operator-dependent and its sensitivity can decrease in presence of intracardiac devices and valvular prosthesis. The modified Duke criteria are considered the gold standard for diagnosing IE; their sensibility is 80%, but in clinical practice their diagnostic accuracy in PVE is lower, resulting inconclusively in nearly 30% of cases. In the last years, these new imaging modalities have gained an increasing attention because they make it possible to diagnose an IE earlier than the structural alterations occurring. Several studies have been conducted in order to assess the diagnostic accuracy of various nuclear medicine techniques in diagnosis of PVE. We performed a review of the literature to assess the available evidence on the role of nuclear medicine techniques in the diagnosis of PVE. PMID:25695043

The effects of a controlled energy storage and return prototype prosthetic foot on transtibial amputee ambulation.

Science.gov (United States)

Segal, Ava D; Zelik, Karl E; Klute, Glenn K; Morgenroth, David C; Hahn, Michael E; Orendurff, Michael S; Adamczyk, Peter G; Collins, Steven H; Kuo, Arthur D; Czerniecki, Joseph M

2012-08-01

The lack of functional ankle musculature in lower limb amputees contributes to the reduced prosthetic ankle push-off, compensations at other joints and more energetically costly gait commonly observed in comparison to non-amputees. A variety of energy storing and return prosthetic feet have been developed to address these issues but have not been shown to sufficiently improve amputee biomechanics and energetic cost, perhaps because the timing and magnitude of energy return is not controlled. The goal of this study was to examine how a prototype microprocessor-controlled prosthetic foot designed to store some of the energy during loading and return it during push-off affects amputee gait. Unilateral transtibial amputees wore the Controlled Energy Storage and Return prosthetic foot (CESR), a conventional foot (CONV), and their previously prescribed foot (PRES) in random order. Three-dimensional gait analysis and net oxygen consumption were collected as participants walked at constant speed. The CESR foot demonstrated increased energy storage during early stance, increased prosthetic foot peak push-off power and work, increased prosthetic limb center of mass (COM) push-off work and decreased intact limb COM collision work compared to CONV and PRES. The biological contribution of the positive COM work for CESR was reduced compared to CONV and PRES. However, the net metabolic cost for CESR did not change compared to CONV and increased compared to PRES, which may partially reflect the greater weight, lack of individualized size and stiffness and relatively less familiarity for CESR and CONV. Controlled energy storage and return enhanced prosthetic push-off, but requires further design modifications to improve amputee walking economy. Published by Elsevier B.V.

The influence of staff training and education on prosthetic and orthotic service quality: A scoping review.

Science.gov (United States)

Forghany, Saeed; Sadeghi-Demneh, Ebrahim; Trinler, Ursula; Onmanee, Pornsuree; Dillon, Michael P; Baker, Richard

2018-06-01

Education and training in prosthetics and orthotics typically comply with International Society for Prosthetics and Orthotics standards based on three categories of prosthetic and orthotic professionals. This scoping study sought to describe the evidence base available to answer the question, How are prosthetic and orthotic services influenced by the training of staff providing them? Scoping review. A structured search of the peer-reviewed literature catalogued in major electronic databases yielded 3039 papers. Following review of title and abstract, 93 articles were considered relevant. Full-text review reduced this number to 25. Only two articles were identified as providing direct evidence of the effects of training and education on service provision. While both suggested that there was an impact, it is difficult to see how the more specific conclusions of either could be generalised. The other 23 articles provide a useful background to a range of issues including the specification of competencies that training programmes should deliver (3 articles), descriptions of a range of training programmes and the effects of training and education on student knowledge and skills. Although it is considered axiomatic, the service quality is dependent on practitioner education and training. There is insufficient evidence to establish whether levels of training and education in prosthetics and orthotics have an effect on the quality of prosthetic and orthotic services. Clinical relevance There is very little evidence about the effects of training and education of prosthetists and orthotists on service quality. While this is a somewhat negative finding, we feel that it is important to bring this to the attention of the prosthetics and orthotics community.

First-in-man demonstration of a fully implanted myoelectric sensors system to control an advanced electromechanical prosthetic hand.

Science.gov (United States)

Pasquina, Paul F; Evangelista, Melissa; Carvalho, A J; Lockhart, Joseph; Griffin, Sarah; Nanos, George; McKay, Patricia; Hansen, Morten; Ipsen, Derek; Vandersea, James; Butkus, Josef; Miller, Matthew; Murphy, Ian; Hankin, David

2015-04-15

Advanced motorized prosthetic devices are currently controlled by EMG signals generated by residual muscles and recorded by surface electrodes on the skin. These surface recordings are often inconsistent and unreliable, leading to high prosthetic abandonment rates for individuals with upper limb amputation. Surface electrodes are limited because of poor skin contact, socket rotation, residual limb sweating, and their ability to only record signals from superficial muscles, whose function frequently does not relate to the intended prosthetic function. More sophisticated prosthetic devices require a stable and reliable interface between the user and robotic hand to improve upper limb prosthetic function. Implantable Myoelectric Sensors (IMES(®)) are small electrodes intended to detect and wirelessly transmit EMG signals to an electromechanical prosthetic hand via an electro-magnetic coil built into the prosthetic socket. This system is designed to simultaneously capture EMG signals from multiple residual limb muscles, allowing the natural control of multiple degrees of freedom simultaneously. We report the status of the first FDA-approved clinical trial of the IMES(®) System. This study is currently in progress, limiting reporting to only preliminary results. Our first subject has reported the ability to accomplish a greater variety and complexity of tasks in his everyday life compared to what could be achieved with his previous myoelectric prosthesis. The interim results of this study indicate the feasibility of utilizing IMES(®) technology to reliably sense and wirelessly transmit EMG signals from residual muscles to intuitively control a three degree-of-freedom prosthetic arm. Copyright © 2014 Elsevier B.V. All rights reserved.

Impact of pannus formation on hemodynamic dysfunction of prosthetic aortic valve: pannus extent and its relationship to prosthetic valve motion and degree of stenosis.

Science.gov (United States)

Koo, Hyun Jung; Ha, Hojin; Kang, Joon-Won; Kim, Jeong A; Song, Jae-Kwan; Kim, Hwa Jung; Lim, Tae-Hwan; Yang, Dong Hyun

2018-02-19

Although pannus is an important cause of prosthetic valve dysfunction, the minimum pannus size that can induce hemodynamic dysfunction has not yet been determined. This study investigated the correlation between the limitation of motion (LOM) of the prosthetic valve and pannus extent and determined the pannus extent that could induce severe aortic stenosis. This study included 49 patients who underwent mechanical aortic valve replacement (AVR) and showed pannus on cardiac computed tomography (CT). Pannus width, ratio of pannus width to valve diameter, pannus area, effective orifice area, encroachment ratio by pannus, pannus involvement angle and percent LOM of mechanical valves were evaluated on CT. Transvalvular peak velocity (TPV) and transvalvular pressure gradient (TPG) were measured by transesophageal echocardiography to determine the degree of aortic stenosis. The relationship between percent LOM of the prosthetic valve and pannus extent and the cut-off of pannus extent required to induce severe aortic stenosis were evaluated. The mean interval between AVR and pannus formation was 11 years and was longer in patients with than without severe aortic stenosis (14.0 vs. 7.3 years). On CT, the percent LOM of the prosthetic valve was significantly associated with the extent of pannus only in patients with pannus involvement angle > 180° (r = 0.55-0.68, P Pannus width, effective orifice area, and encroachment ratio were significantly associated with increased TPV and TPG (r = 0.51-0.62, P Pannus width > 3.5 mm, pannus width/valve inner diameter > 0.15, and encroachment ratio > 0.14 were significantly associated with severe aortic stenosis (TPV > 4 m/s; mean TPG ≥ 35 mmHg), with c-indices of 0.74-079 (P pannus extent parameters are good indicators of significant hemodynamic changes with increased TPV and mean TPG.

The clinical significance of perivalvular pannus in prosthetic mitral valves: Can cardiac CT be helpful?

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Chang, Suyon; Suh, Young Joo; Han, Kyunghwa; Kim, Jin Young; Kim, Young Jin; Chang, Byung-Chul; Choi, Byoung Wook

2017-12-15

The clinical significance of pannus in the prosthetic mitral valve (MV) is not well documented. To investigate the clinical significance of pannus on cardiac computed tomography (CT) in patients with a prosthetic MV. A total of 130 patients with previous MV replacement who underwent cardiac CT were retrospectively included in this study. The presence of pannus, paravalvular leak (PVL) around the prosthetic MV and limitation of motion (LOM) of the MV were analyzed using CT. Between patients with MV pannus and those without pannus, CT, echocardiographic, and redo-surgery findings were compared. The diagnostic performance of CT and transesophageal echocardiography (TEE) for the detection of MV pannus was also compared, using surgical findings as a standard reference. MV pannus was observed on cardiac CT in 32.3% of the study population. Patients with MV pannus detected on CT more commonly had LOM (28.2% vs. 15.2%) and less frequently had PVL of the prosthetic MV (16.7% vs. 25%) than patients without MV pannus (P>0.05). Prosthetic valve obstruction (PVO) due prosthetic MV pannus requiring redo-surgery was present in only five patients (11.9%). Cardiac CT detected MV pannus with sensitivity of 65.2% and specificity of 80.9% and showed better diagnostic performance than TEE (Ppannus can frequently be seen on cardiac CT. However, its clinical significance should be assessed with careful consideration, because PVO due to MV pannus is relatively uncommon, and pannus can be seen in patients without any clinical problems. Copyright © 2017 Elsevier B.V. All rights reserved.

An evaluation of prosthetic status and treatment needs among institutionalized elderly individuals of Delhi, India

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Nisha Yadav

2017-01-01

Full Text Available Context: Oral health is essential for elderly person's general health and well-being. The most common oral problem in elderly is tooth loss which results due to periodontal diseases and caries. Prosthetic status is very important as it is related to dietary intake and maintaining nutritional status. Hence, to promote the oral health of the elderly, we need to know their prosthetic status and need. Aims: The aim of this study is to find the prosthetic status and need of 65–74 years old elderly residing in old age homes of Delhi, India. Settings and Design: A cross-sectional study was conducted among a total of 464 residents of 20 old age homes of Delhi, India. Material and Methods: Residents with age group of 64–75 were included in the study. The prosthetic status with treatment need was recorded using the World Health Organization Oral Health Assessment Form (1997. Statistical Analysis Used: Chi-square test and t-test were used to find significance of variables. P < 0.05 was considered significant. Results: Full removable dentures were worn by 7.30% of participants with predominance in upper arch, and one bridge was seen in 9.10% of participants with predominance in lower arch. Full removable denture was required in 25.20% of participants. Most of participants required multiunit prosthesis in both upper as well as lower arch (42.20% and 36.20%, respectively. Conclusion: The present study underlines a considerable need for dental treatment in elderly as the prosthetic status of participants was poor, and prosthetic needs were high.

Prosthetic Smart Socket Technology to Improve Patient Interaction, Usability, Comfort, Fit and Function

Science.gov (United States)

2017-10-01

impact on society beyond science and technology ? Nothing to report at this time. 5. CHANGES/PROBLEMS: Changes in approach and reasons for...AWARD NUMBER: W81XWH-16-1-0785 TITLE: Prosthetic Smart Socket Technology to Improve Patient Interaction, Usability, Comfort, Fit and Function...2016 - 29 Sep 2017 4. TITLE AND SUBTITLE Prosthetic Smart Socket Technology to Improve Patient Interaction, Usability, Comfort, Fit and Function 5a

From satisfaction to expectation: the patient's perspective in lower limb prosthetic care.

Science.gov (United States)

Van der Linde, Harmen; Hofstad, Cheriel J; Geertzen, Jan H B; Postema, Klaas; Van Limbeek, Jacques

2007-07-15

To obtain information about the wishes and experiences of patients with a lower limb amputation with regard to prosthetic prescription and their exchange of information with the healthcare providers. Cross-sectional questionnaire. Outpatient clinic of a Rehabilitation Centre. A random sample of patients with a lower limb amputation (n = 81). In analogy with the QUOTE questionnaire a focus group technique was used. Prosthetic users formulated 24 specific items, which were of importance according to them. The items were divided into 4 categories: (i) service demand, (ii) prosthetic prescription, (iii) information, (iv) insurance aspects. The questionnaire consisted of two sets (A and B) of 24 items rating importance of items and experience in everyday practice. To identify different dimensions within the 24 items, a factor analysis in SPSS was performed for lists A and B followed by a varimax rotation. Impact factors were calculated by multiplying the mean score of importance on an item with the percentage of patients that experienced this item as negative. A total of 113 questionnaires were sent by e-mail with a response of 73%. The outcomes of the questionnaires resulted in 2 sets of information: One concerning the importance of several items in the process of prosthetic prescription, the other the experience of the prosthetic user about those items. By multiplying the scores on importance by the percentage of negative experience per item (impact score) points of improvement for clinical practice were formulated. A discrepancy between the needs of patients and what they experience in their contacts with clinical professionals as the most important dimension was noticed. A questionnaire with specific items for a homogeneous target group is a good method to formulate points of improvement for clinical practice in healthcare.

Multi-Disciplinary Antimicrobial Strategies for Improving Orthopaedic Implants to Prevent Prosthetic Joint Infections in Hip and Knee

Science.gov (United States)

Getzlaf, Matthew A.; Lewallen, Eric A.; Kremers, Hilal M.; Jones, Dakota L.; Bonin, Carolina A.; Dudakovic, Amel; Thaler, Roman; Cohen, Robert C.; Lewallen, David G.; van Wijnen, Andre J.

2016-01-01

Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria. PMID:26449208

Obstructed bi-leaflet prosthetic mitral valve imaging with real-time three-dimensional transesophageal echocardiography.

Science.gov (United States)

Shimbo, Mai; Watanabe, Hiroyuki; Kimura, Shunsuke; Terada, Mai; Iino, Takako; Iino, Kenji; Ito, Hiroshi

2015-01-01

Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85-year-old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D-TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D-TEE were compatible with those measured by fluoroscopy. Moreover, RT3D-TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D-TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis. © 2014 Wiley Periodicals, Inc.

Can we close large prosthetic space with orthodontics?

Science.gov (United States)

Mesko, Mauro Elias; Skupien, Jovito Adiel; Valentini, Fernanda; Pereira-Cenci, Tatiana

2013-01-01

For years, the treatment for the replacement of a missing tooth was a fixed dental prosthesis. Currently, implants are indicated to replace missing teeth due to high clinical success and with the advantage of not performing preparations in the adjacent tooth. Another option for space closure is the use of orthodontics associated to miniscrews for anchorage allowing better control of the orthodontic biomechanics and especially making possible closure of larger prosthetic spaces. Thus, this article describes two cases with indications and discussion of the advantages and disadvantages of using orthodontics for prosthetic spaces closure. The cases herein presented show that it is possible to close an space when there are available teeth in the adjacent area. It can be concluded that when a malocclusion is present there will be a strong trend to indicate space closure by orthodontic movement as it preserves natural teeth and seems a more physiological approach.

The History of Nontraditional or Ectopic Placement of Reservoirs in Prosthetic Urology.

Science.gov (United States)

Perito, Paul; Wilson, Steven

2016-04-01

Reservoir placement during implantation of prosthetic urology devices has been problematic throughout the history of the surgical treatment of erectile dysfunction and urinary incontinence. We thought it would be interesting to review the history of reservoir placement leading up to current surgical techniques. To provide an overview of the past and present techniques for reservoir placement and discuss the evolutionary process leading to safe and effective placement of prosthetic reservoirs. We reviewed data pertaining to inflatable penile prosthesis (IPP) reservoirs and pressure-regulating balloons (PRB) in a chronological fashion, spanning 25 years. Main outcomes included a historical review of techniques for IPP reservoir and PRB placement leading to the subsequent incremental improvements in safety and efficacy when performing penile implants and artificial urinary sphincters. Prosthetic urologic reservoirs have traditionally been placed in the retropubic space. Over the years, urologists have attempted use of alternative spaces including peritoneal, epigastric, "ectopic," posterior to transversalis, and high submuscular. Current advances in prosthetic urologic reservoir placement allow safe and effective abdominal wall placement of reservoirs. These novel approaches appear to be so effective that urologists may now be able to cease using the traditional retropubic space for reservoir placement, even in the case of virgin pelves. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

A Control Strategy with Tactile Perception Feedback for EMG Prosthetic Hand

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Changcheng Wu

2015-01-01

Full Text Available To improve the control effectiveness and make the prosthetic hand not only controllable but also perceivable, an EMG prosthetic hand control strategy was proposed in this paper. The control strategy consists of EMG self-learning motion recognition, backstepping controller with stiffness fuzzy observation, and force tactile representation. EMG self-learning motion recognition is used to reduce the influence on EMG signals caused by the uncertainty of the contacting position of the EMG sensors. Backstepping controller with stiffness fuzzy observation is used to realize the position control and grasp force control. Velocity proportional control in free space and grasp force tracking control in restricted space can be realized by the same controller. The force tactile representation helps the user perceive the states of the prosthetic hand. Several experiments were implemented to verify the effect of the proposed control strategy. The results indicate that the proposed strategy has effectiveness. During the experiments, the comments of the participants show that the proposed strategy is a better choice for amputees because of the improved controllability and perceptibility.

[Microbiological characteristics and patterns of resistance in prosthetic joint infections in a referral hospital].

Science.gov (United States)

Ortega-Peña, Silvestre; Colín-Castro, Claudia; Hernández-Duran, Melissa; López-Jácome, Esaú; Franco-Cendejas, Rafael

2015-01-01

The prosthetic joint infection is the most feared and catastrophic complication for cause severe physical damage to patients and, generates high economic costs. To describe the microbiological characteristics and to determine the resistance pattern in prosthetic joint infections in a reference hospital in Mexico. Patients whose prosthetic devices were withdrawn due to suspicion of septic and aseptic loosening were included. Cultures were performed to identify microorganisms and susceptibility analysis. Of the 111 patients included, 55% were diagnosed with prosthetic joint infection, with the most frequent prosthesis being of the hip (43%). Positive cultures were obtained in 97% of the infected cases, of which 75% were monomicrobial infections. The most frequent bacterial species isolated were: Staphylococcus epidermidis (31%), Enterococcus faecalis (16%), Staphylococcus aureus (13%), and Escherichia coli (8%). The resistance patterns for the Staphylococcus genus were: oxacillin (79%), erythromycin (45%) and ciprofloxacin (37%). Enterococcus faecalis showed a high percentage of resistance to erythromycin and clindamycin (86%), and fluoroquinolones (43%). The large majority (86%) of Escherichia coli were extended spectrum beta-lactamases positive, in addition to having high resistance to fluoroquinolones (86%), trimethoprim/sulfamethoxazole (86%) and gentamicin (72%). The microbiological characteristics found in prosthetic joint infections vary according to the hospitals. In this series, a high proportion of coagulase-negative Staphylococci and Enterococcus spp. were found, as well as a high bacterial resistance. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Prosthetic joint infection caused by Granulicatella adiacens: a case series and review of literature.

Science.gov (United States)

Quénard, Fanny; Seng, Piseth; Lagier, Jean-Christophe; Fenollar, Florence; Stein, Andreas

2017-06-23

Bone and joint infection involving Granulicatella adiacens is rare, and mainly involved in cases of bacteremia and infectious endocarditis. Here we report three cases of prosthetic joint infection involving G. adiacens that were successfully treated with surgery and prolonged antimicrobial treatment. We also review the two cases of prosthetic joint infection involving G. adiacens that are reported in the literature. Not all five cases of prosthetic joint infection caused by G. adiacens were associated with bacteremia or infectious endocarditis. Dental care before the onset of infection was observed in two cases. The median time delay between arthroplasty implantation and the onset of infection was of 4 years (ranging between 2 and 10 years). One of our cases was identified with 16srRNA gene sequencing, one case with MALDI-TOF mass spectrometry, and one case with both techniques. Two literature cases were diagnosed by 16srRNA gene sequencing. All five cases were cured after surgery including a two-stage prosthesis exchange in three cases, a one-stage prosthesis exchange in one case, and debridement, antibiotics, irrigation, and retention of the prosthesis in one case, and prolonged antimicrobial treatment. Prosthetic joint infection involving G. adiacens is probably often dismissed due to difficult culture or misdiagnosis, in particular in the cases of polymicrobial infection. Debridement, antibiotics, irrigation, and retention of the prosthesis associated with prolonged antimicrobial treatment (≥ 8 weeks) should be considered as a treatment strategy for prosthetic joint infection involving G. adiacens.

[Intra-prosthetic dislocation of the Bousquet dual mobility socket].

Science.gov (United States)

Lecuire, F; Benareau, I; Rubini, J; Basso, M

2004-05-01

The Bousquet system is a dual mobility head-polyethylene polyethylene-metal cup socket. The polyethylene insert retaining the femoral head moves in the noncemented metal cup, increasing both mobility and stability. Between 1989 and 1997, seven cases of intra-prosthetic dislocation (six patients) were observed. The femoral head escaped from the polyethylene insert due to wear. On the average, this complication occurred ten Years after implantation. Risk of dislocation was high in six of the seven hips. All patients had a large sized stem screwed into the femoral neck. There was a characteristic radiological aspect with loss of the concentric head metal cup configuration. The head was applied against the upper wall of the metal cup. Surgical replacement was undertaken early in six patients by simply changing the insert without modifying the other stable components. Outcome remained good at three to eight Years. One patient underwent late surgery. The insert and the cup were replaced with a classical implant. Functional outcome was good but recurrent dislocation occurred. At mid-term, intra-prosthetic dislocation of dual mobility sockets appears to be exceptional. Dislocation results from polyethylene wear leading to failure of the insert to retain the prosthetic head. Wear is favored by direct phenomena (direct contact between neck and insert which can occur early if there is a small difference in the head and neck diameters) or indirect phenomena (factors limiting polyethylene metal-cup mobility). Surgical treatment is necessary. If undertaken early, replacement with a modular head and insert can be sufficient if the prosthesis has not loosened but the metal cup may have to be replaced in the event of metal-metal contact between the head and the cup. Prosthesis loosening, wear of the metal cup, or an identified cause of dislocation imply replacing the failing implants. Implantation of the dual mobility system is particularly interesting for patients with a high risk

Extrinsic mechanism obstructing the opening of a prosthetic mitral valve: an unusual case of suture entrapment.

Science.gov (United States)

Ozkan, Mehmet; Astarcioglu, Mehmet Ali; Karakoyun, Suleyman; Balkanay, Mehmet

2012-02-01

Obstruction to a prosthetic cardiac valve is a well-recognized complication of cardiac valve replacement. Malfunction of the mobile component of a prosthetic valve to open or close correctly may occur in consequence of intrinsic or extrinsic causes (thrombus, vegetation, entrapment of left ventricular myocardium, suture entanglement, and pannus formation) that may result prosthetic valve stenosis and/or insufficiency. In the case we report a 48-year-old female with valve dysfunction occurred early after surgery, as one valve leaflet was only able to partially open due to suture entrapment. © 2011, Wiley Periodicals, Inc.

Prosthetic Management of Patients Presenting with Juvenile ...

African Journals Online (AJOL)

Eighteen were referred for prosthetic replacement. Their age ranged between 18 and 36 years. A total of 24 removable partial dentures were fabricated, 17[70.8%] were kennedy class III type, of which 11[64.7%] had the bounded saddle located in the anterior segment. Majority 8[44.4%] of the patients had 2-4 teeth replaced ...

Pseudotumor of the Hip due to Fungal Prosthetic Joint Infection

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Stefano Artiaco

2013-01-01

Full Text Available Pseudotumors associated with total hip arthroplasty have been associated with metal-on-metal and metal-on-polyethylene total hip arthroplasties due to a granulomatous foreign-body reaction to methyl methacrylate, polyethylene, or metal ion release, but they have not been related to prosthetic joint infections. In this paper, we report an unusual case of Candida albicans total hip arthroplasty infection, causing a large inflammatory pseudotumor of the hip joint. Fungal periprosthetic joint infections are a rare clinical entity and difficult to diagnose, and a pseudotumor may be part of their clinical presentation. They should be suspected in immunodeficient host patients when clinical symptoms of prosthetic joint infections are observed.

Retrieval of a leaflet escaped in a Tri-technologies bileaflet mechanical prosthetic valve.

Science.gov (United States)

Cianciulli, Tomás F; Lax, Jorge A; Saccheri, María C; Guidoin, Robert; Salvado, César M; Fernández, Adrián J; Prezioso, Horacio A

2008-01-01

The escape of the prosthetic heart valve disc is one of the causes of prosthetic dysfunction that requires emergency surgery. The removal of the embolized disc should be carried out because of the risk of a progressive extrusion on the aortic wall. Several imaging techniques can be used for the detection of the missing disc localization. In this report we describe a 32-year-old man who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted in cardiogenic shock. Transesophageal echocardiography showed acute-onset massive mitral regurgitation. The patient underwent emergency replacement of the prosthetic valve. Only one of the two leaflets remained in the removed prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet. The abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the terminal portion of the aortic bifurcation. To retrieve the embolized disc laparotomy and aortotomy were performed three months later. The escaped leaflet shows a fracture of one of the pivot systems caused by structural failure. This kind of failure mode is usually the result of high stress concentration.

A geometrical optimization of a magneto-rheological rotary brake in a prosthetic knee

International Nuclear Information System (INIS)

Gudmundsson, K H; Jonsdottir, F; Thorsteinsson, F

2010-01-01

Magneto-rheological (MR) fluids have been successfully introduced to prosthetic devices. One such device is a biomechanical prosthetic knee that uses MR fluids to actively control its rotary stiffness. The brake is rotational, utilizing the MR fluid in shear mode. In this study, the geometrical design of the MR brake is addressed. This includes the design of the magnetic circuit and the geometry of the fluid chamber. Mathematical models are presented that describe the rotary torque of the brake. A novel perfluorinated polyether (PFPE)-based MR fluid is introduced, whose properties are tailored for the prosthetic knee. On-state and off-state rheological measurements of the MR fluid are presented. The finite element method is used to evaluate the magnetic flux density in the MR fluid. The design is formulated as an optimization problem, aiming to maximize the braking torque. A parametric study is carried out for several design parameters. Subsequently, a multi-objective optimization problem is defined that considers three design objectives: the field-induced braking torque, the off-state rotary stiffness and the weight of the brake. Trade-offs between the three design objectives are investigated which provides a basis for informed design decisions on furthering the success of the MR prosthetic knee

Prosthetic joint infection due to Lysobacter thermophilus diagnosed by 16S rRNA gene sequencing

OpenAIRE

B Dhawan; S Sebastian; R Malhotra; A Kapil; D Gautam

2016-01-01

We report the first case of prosthetic joint infection caused by Lysobacter thermophilus which was identified by 16S rRNA gene sequencing. Removal of prosthesis followed by antibiotic treatment resulted in good clinical outcome. This case illustrates the use of molecular diagnostics to detect uncommon organisms in suspected prosthetic infections.

Scintigraphic detection of prosthetic joint and soft tissue sepsis secondary to tuberculosis

International Nuclear Information System (INIS)

Zeiger, L.S.; Watters, W.; Sherk, H.

1984-01-01

In a 40-year-old Hispanic woman with pain and swelling in the left knee with a prosthesis, the combination of Ga-67 citrate and Tc-99m methylene diphosphonate (MDP) scans was used to indicate that there was a septic prosthetic joint. At surgery, the joint was infected and a foreign body was found. Cultures positive for tuberculosis were found also. The presence of an incongruent Ga-67 and Tc-99m (MDP) scan pattern suggests infection of the prosthetic joint, as in the following case

Prosthetic prescription in the Netherlands : an observational study

NARCIS (Netherlands)

van der Linde, H; Geertzen, JHB; Hofstad, CJ; Postema, K; Van Limbeek, Jacques

2003-01-01

Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to

Resource-efficient proces chains to manufacture patient-specific prosthetic fingers

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Hagedorn-Hansen, D.

2016-05-01

Full Text Available The high cost of quality prostheses, together with the lack of trained prosthetists, makes it challenging to obtain prosthetic devices in developing communities. Modern 3D digitising techniques and additive manufacturing (AM technologies are gaining popularity in the bio-medical industry and, in the case of prosthesis production, reduce the need for a trained prosthetist. The objective of this research was to develop a new resource-efficient process chain for the manufacturing of prosthetic fingers using additive manufacturing technologies, and to compare it with the traditional (Sculptor process chain. Fused deposition modelling (FDM, open-source FDM, 3-dimensional printing (3DP, and stereolithography (SLA were evaluated in terms of their costs, time, material usage, and aesthetic quality. The surface qualities produced with the different additive manufacturing technologies were also compared. The results showed that 3DP was the preferred technology and was the best candidate for the production of prosthesis in terms of cost, quality, and time for developing communities. SLA produced the highest aesthetic quality prosthesis, but was the most expensive. It was concluded that using the additive manufacturing technology process chain to produce prosthetic fingers is faster and more cost effective than the traditional method.

Simulation Techniques and Prosthetic Approach Towards Biologically Efficient Artificial Sense Organs- An Overview

OpenAIRE

Neogi, Biswarup; Ghosal, Soumya; Mukherjee, Soumyajit; Das, Achintya; Tibarewala, D. N.

2011-01-01

An overview of the applications of control theory to prosthetic sense organs including the senses of vision, taste and odor is being presented in this paper. Simulation aspect nowadays has been the centre of research in the field of prosthesis. There have been various successful applications of prosthetic organs, in case of natural biological organs dis-functioning patients. Simulation aspects and control modeling are indispensible for knowing system performance, and to generate an original a...

The use of ceramic in prosthetic hip surgery. The state of the art.

Science.gov (United States)

Toni, A; Terzi, S; Sudanese, A; Tabarroni, M; Zappoli, F A; Stea, S; Giunti, A

1995-01-01

The authors review current knowledge regarding the use of ceramic materials in prosthetic hip surgery, both as constituents of prosthetic components, and as materials used to coat metallic surfaces. A review of the literature defines the advantages and disadvantages to using ceramic-polyethylene or ceramic-ceramic combinations, based on the possibility that alumina coating may favor localized bone demineralization, and on the first promising clinical results of the use of hydroxyapatite coating.

Cyborg beast: a low-cost 3d-printed prosthetic hand for children with upper-limb differences.

Science.gov (United States)

Zuniga, Jorge; Katsavelis, Dimitrios; Peck, Jean; Stollberg, John; Petrykowski, Marc; Carson, Adam; Fernandez, Cristina

2015-01-20

There is an increasing number of children with traumatic and congenital hand amputations or reductions. Children's prosthetic needs are complex due to their small size, constant growth, and psychosocial development. Families' financial resources play a crucial role in the prescription of prostheses for their children, especially when private insurance and public funding are insufficient. Electric-powered (i.e., myoelectric) and body-powered (i.e., mechanical) devices have been developed to accommodate children's needs, but the cost of maintenance and replacement represents an obstacle for many families. Due to the complexity and high cost of these prosthetic hands, they are not accessible to children from low-income, uninsured families or to children from developing countries. Advancements in computer-aided design (CAD) programs, additive manufacturing, and image editing software offer the possibility of designing, printing, and fitting prosthetic hands devices at a distance and at very low cost. The purpose of this preliminary investigation was to describe a low-cost three-dimensional (3D)-printed prosthetic hand for children with upper-limb reductions and to propose a prosthesis fitting methodology that can be performed at a distance. No significant mean differences were found between the anthropometric and range of motion measurements taken directly from the upper limbs of subjects versus those extracted from photographs. The Bland and Altman plots show no major bias and narrow limits of agreements for lengths and widths and small bias and wider limits of agreements for the range of motion measurements. The main finding of the survey was that our prosthetic device may have a significant potential to positively impact quality of life and daily usage, and can be incorporated in several activities at home and in school. This investigation describes a low-cost 3D-printed prosthetic hand for children and proposes a distance fitting procedure. The Cyborg Beast

Indium-granulocyte scanning in the painful prosthetic joint

International Nuclear Information System (INIS)

Pring, D.J.; Henderson, R.G.; Keshavarzian, A.; Rivett, A.G.; Krausz, T.; Coombs, R.R.; Lavender, J.P.

1986-01-01

The value of indium-111-labeled granulocyte scanning to determine the presence of infection was assessed in 50 prosthetic joints (41 of which were painful) in 40 patients. Granulocytes were obtained from the patients' blood and labeled in plasma with indium 111 tropolonate. Abnormal accumulation of indium 111 in the region of the prosthesis was noted. Proven infection occurred in 11 prostheses, and all of the infections were detected by indium-111-labeled granulocyte scanning. Nineteen were not infected (including nine asymptomatic controls) and only two produced false-positive scans. This represents a specificity of 89.5%, sensitivity of 100%, and overall accuracy of 93.2%. These results compare favorably with plain radiography. There was no radiologic evidence of infection in three of the infected prostheses, and 10 of the noninfected prostheses had some radiologic features that suggested sepsis. We conclude that indium-granulocyte scanning can reliably detect or exclude infection in painful prosthetic joints and should prove useful in clinical management

CT Assessment of the axial deviation of the femoral and tibial prosthetic components in total knee arthroplasty

International Nuclear Information System (INIS)

Rimondi, E.; Molinari, M.; Moio, A.; Busacca, M.; Trentani, F.; Trentani, P.; Tigani, D.; Nigrosoli, M.

2000-01-01

CT assessment of the axial deviation of the femoral and tibial prosthetic components in total knee arthroplasty. From January to July 1999, 17 patients, 10 males and 7 females, mean age 66 years (standard deviation plus or minus 4) were examined after total knee arthroplasty. Exclusion criteriawere prosthesis loosening and severe (equal or superior to 7'' varus o valgus deviation. All patients were examined with knee radiography in the standing position completed by axial projection of patella and by CT scanning. It was used a modification of Berger technique and carried out comparative CT scans extended lower limbs and acquisitions perpendicular to the mechanical axis of the knee, from the femoral supracondylar region down to the plane crossing the distal end of the tibial prosthetic component. Reference lines were then drawn electronically on given scanning planes to reckon the axial deviation of the femoral and tibial prosthetic components. Six patients, one female and 5 males with normal rotational values of femoral and tibial prosthetic components presented no clinical symptoms. Eight patients, 4 females and 4 males, with abnormal values presented the following clinical symptoms: medial impingement, (incomplete) dislocation patella, and lateral instability. One female patient with a normal rotational value of femoral prosthetic component and an altered value of tibial prosthetic component presented medial impingement. Finally two patients, one female and one male, were absolutely asymptomatic although the rotational values of the two prosthetic components were beyond the normal range. Total knee arthroplasty is presently a standard treatment for many conditions involving this joint. There are several possible postoperative complications, namely fractures, dislocations (a)septic losening and femoropatellar instability. The latter condition is the most frequent complication among implant failures and is caused by bad orientation of the femoral and tibial

Orthodontic space closure versus prosthetic replacement of missing upper lateral incisors in patients with bilateral cleft lip and palate.

Science.gov (United States)

Oosterkamp, Barbara C M; Dijkstra, Pieter U; Remmelink, Hendrik J; van Oort, Robert P; Sandham, Andrew

2010-11-01

To compare dental aesthetics and function of orthodontic space closure versus prosthetic replacement of upper lateral incisors in patients with bilateral cleft lip and palate. The predominant mode of prosthetic replacement was resin-bonded bridges. The retrospective study group consisted of 17 patients treated with orthodontic space closure (13 men, four women; median age, 27.1 years; interquartile range, 20.6 to 33.3 years) and 10 patients treated with prosthetic replacement (five men, five women; median age, 27.7 years; interquartile range, 20.9 to 39.7 years). Dental aesthetics were evaluated by the patients and by a professional panel. Mandibular function was evaluated by means of the mandibular function impairment questionnaire. The level of mandibular impairment was calculated using the Function Impairment Rating Scale. With respect to dental aesthetics, no significant differences between patients treated with orthodontic space closure and prosthetic replacement were found. With respect to function, the level of mandibular impairment was significantly higher in patients treated with prosthetic replacement compared with patients treated with orthodontic space closure, as indicated by high scores on specific masticatory functions. Orthodontic space closure and prosthetic replacement in bilateral cleft lip and palate patients produce similar results in terms of aesthetics. In terms of function, prosthetic replacement results in significantly more impairment of specific masticatory functions.

Comparative study of radiography and scintigraphy for loosening and infection of prosthetic hip replacement

International Nuclear Information System (INIS)

Park, Mi Sook; Lee, Sun Wha; Choi, Woo Suk; Lim, Joo Won; Song, Han Joon; Ahn, Chi Yul

1987-01-01

Prosthetic hip replacement is associated with certain complications which result in a painful hip. Many of these, e. g. prosthetic dislocation, fracture, trochanteric avulsion, and heterotopic calcification are easily diagnosed by conventional radiography. However, radiographic evaluation for infection and/pr loosening of prosthesis as major complications requiring reoperation often contributes little to the resolution of the diagnostic problem. The authors made a comparative study of plain radiography and scintigraphy of 39 cases performed revision at Kyung Hee University Hospital from Sep. '81-to Aug. '86. The results were as follows: 1. In 39 revised prosthetic hip replacement, 26 cases (67%) of loosening without infection and 11 cases (28%) of infection were proven. 2. In loosening of prosthesis, plain radiography showed true positive rate of 76% and true negative rate of 60%, and scintigraphy showed true positive rate of 75% and true negative rate of 95%. 3. In infection of prosthesis, plain radiography revealed true positive rate of 55% and true negative rate of 96%, and scintigraphy revealed true positive rate of 100% and true negative rate of 83%. 4. Scintigraphy and plain radiography were useful as complementary procedure in evaluating and differentiating loosening and/or infection of prosthetic component

The effects of common footwear on stance-phase mechanical properties of the prosthetic foot-shoe system.

Science.gov (United States)

Major, Matthew J; Scham, Joel; Orendurff, Michael

2018-04-01

Prosthetic feet are prescribed based on their mechanical function and user functional level. Subtle changes to the stiffness and hysteresis of heel, midfoot, and forefoot regions can influence the dynamics and economy of gait in prosthesis users. However, the user's choice of shoes may alter the prosthetic foot-shoe system mechanical characteristics, compromising carefully prescribed and rigorously engineered performance of feet. Observe the effects of footwear on the mechanical properties of the prosthetic foot-shoe system including commonly prescribed prosthetic feet. Repeated-measures, Mechanical characterization. The stiffness and energy return was measured using a hydraulic-driven materials test machine across combinations of five prosthetic feet and four common shoes as well as a barefoot condition. Heel energy return decreased by an average 4%-9% across feet in all shoes compared to barefoot, with a cushioned trainer displaying the greatest effect. Foot designs that may improve perceived stability by providing low heel stiffness and rapid foot-flat were compromised by the addition of shoes. Shoes altered prosthesis mechanical characteristics in the sagittal and frontal planes, suggesting that shoe type should be controlled or reported in research comparing prostheses. Understanding of how different shoes could alter certain gait-related characteristics of prostheses may aid decisions on footwear made by clinicians and prosthesis users. Clinical relevance Shoes can alter function of the prosthetic foot-shoe system in unexpected and sometimes undesirable ways, often causing similar behavior across setups despite differences in foot design, and prescribing clinicians should carefully consider these effects on prosthesis performance.

Tactile Sensing Reflexes for Advanced Prosthetic Hands

Science.gov (United States)

2016-10-01

Jeremy A. Fishel, Member, IEEE Figure 1. A) Custom NumaTac prosthetic fingertip sensor core and foam; B) Ottobock VariPlus Speed hand installed with two...oal – H ardw are P rototype D evelopm ent R   Identify alternatives for outcom e m easures R   E xplore sensor design param eters C Y16 G oals – C

Prosthetic finger phalanges with lifelike skin compliance for low-force social touching interactions

Directory of Open Access Journals (Sweden)

Ge Shuzhi

2011-03-01

Full Text Available Abstract Background Prosthetic arms and hands that can be controlled by the user's electromyography (EMG signals are emerging. Eventually, these advanced prosthetic devices will be expected to touch and be touched by other people. As realistic as they may look, the currently available prosthetic hands have physical properties that are still far from the characteristics of human skins because they are much stiffer. In this paper, different configurations of synthetic finger phalanges have been investigated for their skin compliance behaviour and have been compared with the phalanges of the human fingers and a phalanx from a commercially available prosthetic hand. Methods Handshake tests were performed to identify which areas on the human hand experience high contact forces. After these areas were determined, experiments were done on selected areas using an indenting probe to obtain the force-displacement curves. Finite element simulations were used to compare the force-displacement results of the synthetic finger phalanx designs with that of the experimental results from the human and prosthetic finger phalanges. The simulation models were used to investigate the effects of (a varying the internal topology of the finger phalanx and (b varying different materials for the internal and external layers. Results and Conclusions During handshake, the high magnitudes of contact forces were observed at the areas where the full grasping enclosure of the other person's hand can be achieved. From these areas, the middle phalanges of the (a little, (b ring, and (c middle fingers were selected. The indentation experiments on these areas showed that a 2 N force corresponds to skin tissue displacements of more than 2 mm. The results from the simulation model show that introducing an open pocket with 2 mm height on the internal structure of synthetic finger phalanges increased the skin compliance of the silicone material to 235% and the polyurethane material to

METHODOLOGY OF PROSTHETIC TREATMENT IN PATIENTS WITH MAXILLECTOMY

Directory of Open Access Journals (Sweden)

Ivan Gerdzhikov

2018-06-01

Full Text Available Aim: The aim of the described method is to present the main stages in the prosthetic treatment with hollow bulb obturator, which provides optimum defect hermetization and restoration of the damaged functions. Materials and methods: The clinical case, described is on a 70-years-old patient with edentulous jaws and maxillary defect in the right half of the upper jaw. The preliminary impressions were taken with irreversible hydrocolloid impression material, and the final impressions were taken with additive silicone material. The occlusion height and the centric relations were registered as the classical technique. After the successful trial denture appointment, the surface of the plaster master model was covered by isolation polish. After this procedure, the master model was covered by even wax layer with 5mm thickness. It was designed to be thinner in the area of the resection line. The designed cavity was filled in with silicone impression material and covered with the folio. The base plate with the arranged teeth was fixed to the model, packed in the cuvette and finished from heat-cured acrylic resin with low quantity of residual monomer. After the polymerization process, the silicone material was removed, and the obturators cap was fixed to the denture’s base plate with cold cured acrylic resin. The obturator and the complete denture of the mandible were adjusted and articulated in patient’s mouth in the final clinical stage. Results: The applied prosthetic method allowed successful defect hermetization and helped for the restoration of the speech, feeding and patient’s self-esteem. Conclusion: Prosthetic rehabilitation of patients with maxillary resection is possible only with the application of specific treatment methods.

Prosthetic joint infection due to Lysobacter thermophilus diagnosed by 16S rRNA gene sequencing

Directory of Open Access Journals (Sweden)

B Dhawan

2016-01-01

Full Text Available We report the first case of prosthetic joint infection caused by Lysobacter thermophilus which was identified by 16S rRNA gene sequencing. Removal of prosthesis followed by antibiotic treatment resulted in good clinical outcome. This case illustrates the use of molecular diagnostics to detect uncommon organisms in suspected prosthetic infections.

Prosthesis use in adult acquired major upper-limb amputees: patterns of wear, prosthetic skills and the actual use of prostheses in activities of daily life.

Science.gov (United States)

Østlie, Kristin; Lesjø, Ingrid Marie; Franklin, Rosemary Joy; Garfelt, Beate; Skjeldal, Ola Hunsbeth; Magnus, Per

2012-11-01

To describe patterns of prosthesis wear and perceived prosthetic usefulness in adult acquired upper-limb amputees (ULAs). To describe prosthetic skills in activities of daily life (ADL) and the actual use of prostheses in the performance of ADL tasks. To estimate the influence of prosthetic skills on actual prosthesis use and the influence of background factors on prosthetic skills and actual prosthesis use. Cross-sectional study analysing population-based questionnaire data (n = 224) and data from interviews and clinical testing in a referred/convenience sample of prosthesis-wearing ULAs (n = 50). Effects were analysed using linear regression. 80.8% wore prostheses. 90.3% reported their most worn prosthesis as useful. Prosthetic usefulness profiles varied with prosthetic type. Despite demonstrating good prosthetic skills, the amputees reported actual prosthesis use in only about half of the ADL tasks performed in everyday life. In unilateral amputees, increased actual use was associated with sufficient prosthetic training and with the use of myoelectric vs cosmetic prostheses, regardless of amputation level. Prosthetic skills did not affect actual prosthesis use. No background factors showed significant effect on prosthetic skills. Most major ULAs wear prostheses. Individualised prosthetic training and fitting of myoelectric rather than passive prostheses may increase actual prosthesis use in ADL.

Significance of angular mismatch between vertebral endplate and prosthetic endplate in lumbar total disc replacement.

Science.gov (United States)

Lee, Chong Suh; Chung, Sung Soo; Oh, Sung Kyun; You, Je Wook

2011-05-01

A retrospective study. To determine whether angular mismatch between the vertebral endplate and prosthetic endplate during lumbar total disc replacement (L-TDR) affects the radiological and clinical outcomes. A prosthesis anchored to the vertebral body by using a large central keel carries an inherent risk of angular mismatch between the vertebral endplate and prosthetic endplate at a segment with a greater degree of lordosis, such as L5-S1. Theoretically, this angular mismatch can cause several problems, such as segmental hyperlordosis, anterior positioning of the upper prosthesis, posterior prosthetic edge subsidence, decreased range of motion (ROM), and a poor clinical outcome. This study evaluated 64 prosthetic levels of 56 patients who were implanted with L-TDR between June 2002 and February 2006. There were 38 and 26 prosthetic levels at the L4-5 and L5-S1, respectively. The mean follow-up period was 25.6 (12 to 49) months. The angle of mismatch between the lower endplate of the upper vertebral body and the upper prosthetic plate, segmental flexion/extension ROM, segmental lordosis angle at extension, distance from the posterior wall of the vertebral body to the posterior prosthetic edge were measured by obtaining radiographs. Clinically, the Visual Analogue Scale and Oswestry Disability Index were also evaluated. The angular mismatches between the upper vertebra and prosthesis at L4-5 and L5-S1 were 1.6 degree and 5.6 degree, respectively (P body to the posterior edge of the prosthesis in L5-S1 were 6.8 degree (4 to 13), 12.8 degree (8 to 17), and 3.8 mm (1 to 6 mm) in patients with an angular mismatch of 0.05). Angular mismatch was more common in L5-S1 than in L4-5. L-TDR at the most lordotic level, L5-S1, and implantation of an upper prosthesis with a mismatched angle seem to be the causes of a reduced segmental ROM, increased segmental lordosis, and anterior malpositioning of the prosthesis. However, these changes do not affect the clinical outcomes of

Differential contributions of specimen types, culturing, and 16S rRNA sequencing in diagnosis of prosthetic joint infections

DEFF Research Database (Denmark)

Larsen, Lone Heimann; Khalid, Vesal; Xu, Yijuan

2018-01-01

Prosthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems. Infection detection has been improved with modified culture methods and molecular diagnostics. However, comparisons between modified and conventional microbiology methods are difficult due...... to variations in specimen sampling. In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). Project specimens included joint...... fluid (JF), bone biopsy specimens (BB), soft-tissue biopsy specimens (STB), and swabs (SW) from the prosthesis, collected in situ, and sonication fluid collected from prosthetic components (PC). Specimens were cultured for 6 (conventional) or 14 days, and 16S rRNA sequencing was performed at study...

Diagnostic evaluation of left-sided prosthetic heart valve dysfunction

NARCIS (Netherlands)

Habets, Jesse; Budde, Ricardo P.; Symersky, Petr; van den Brink, Renee B.; de Mol, Bas A.; Mali, Willem P.; van Herwerden, Lex A.; Chamuleau, Steven A.

Prosthetic heart valve (PHV) dysfunction is a rare, but potentially life-threatening, complication. In clinical practice, PHV dysfunction poses a diagnostic dilemma. Echocardiography and fluoroscopy are the imaging techniques of choice and are routinely used in daily practice. However, these

Diagnostic evaluation of left-sided prosthetic heart valve dysfunction

NARCIS (Netherlands)

Habets, Jesse; Budde, Ricardo P.; Symersky, Petr; van den Brink, Renee B.; de Mol, Bas A.; Mali, Willem P.; van Herwerden, Lex A.; Chamuleau, Steven A.

2011-01-01

Prosthetic heart valve (PHV) dysfunction is a rare, but potentially life-threatening, complication. In clinical practice, PHV dysfunction poses a diagnostic dilemma. Echocardiography and fluoroscopy are the imaging techniques of choice and are routinely used in daily practice. However, these

Prosthetic model, but not stiffness or height, affects the metabolic cost of running for athletes with unilateral transtibial amputations.

Science.gov (United States)

Beck, Owen N; Taboga, Paolo; Grabowski, Alena M

2017-07-01

Running-specific prostheses enable athletes with lower limb amputations to run by emulating the spring-like function of biological legs. Current prosthetic stiffness and height recommendations aim to mitigate kinematic asymmetries for athletes with unilateral transtibial amputations. However, it is unclear how different prosthetic configurations influence the biomechanics and metabolic cost of running. Consequently, we investigated how prosthetic model, stiffness, and height affect the biomechanics and metabolic cost of running. Ten athletes with unilateral transtibial amputations each performed 15 running trials at 2.5 or 3.0 m/s while we measured ground reaction forces and metabolic rates. Athletes ran using three different prosthetic models with five different stiffness category and height combinations per model. Use of an Ottobock 1E90 Sprinter prosthesis reduced metabolic cost by 4.3 and 3.4% compared with use of Freedom Innovations Catapult [fixed effect (β) = -0.177; P Run (β = -0.139; P = 0.002) prostheses, respectively. Neither prosthetic stiffness ( P ≥ 0.180) nor height ( P = 0.062) affected the metabolic cost of running. The metabolic cost of running was related to lower peak (β = 0.649; P = 0.001) and stance average (β = 0.772; P = 0.018) vertical ground reaction forces, prolonged ground contact times (β = -4.349; P = 0.012), and decreased leg stiffness (β = 0.071; P running. Instead, an optimal prosthetic model, which improves overall biomechanics, minimizes the metabolic cost of running for athletes with unilateral transtibial amputations. NEW & NOTEWORTHY The metabolic cost of running for athletes with unilateral transtibial amputations depends on prosthetic model and is associated with lower peak and stance average vertical ground reaction forces, longer contact times, and reduced leg stiffness. Metabolic cost is unrelated to prosthetic stiffness, height, and stride kinematic symmetry. Unlike nonamputees who decrease leg stiffness with

Distal anastomotic vein adjunct usage in infrainguinal prosthetic bypasses.

Science.gov (United States)

McPhee, James T; Goodney, Philip P; Schanzer, Andres; Shaykevich, Shimon; Belkin, Michael; Menard, Matthew T

2013-04-01

Single-segment saphenous vein remains the optimal conduit for infrainguinal revascularization. In its absence, prosthetic conduit may be used. Existing data regarding the significance of anastomotic distal vein adjunct (DVA) usage with prosthetic grafts are based on small series. This is a retrospective cohort analysis derived from the regional Vascular Study Group of New England as well as the Brigham and Women's hospital database. A total of 1018 infrainguinal prosthetic bypass grafts were captured in the dataset from 73 surgeons at 15 participating institutions. Propensity scoring and 3:1 matching was performed to create similar exposure groups for analysis. Outcome measures of interest included: primary patency, freedom from major adverse limb events (MALEs), and amputation free survival at 1 year as a function of vein patch utilization. Time to event data were compared with the log-rank test; multivariable Cox proportional hazard models were used to evaluate the adjusted association between vein cuff usage and the primary end points. DVA was defined as a vein patch, cuff, or boot in any configuration. Of the 1018 bypass operations, 94 (9.2%) had a DVA whereas 924 (90.8%) did not (no DVA). After propensity score matching, 88 DVAs (25%) and 264 no DVAs (75%) were analyzed. On univariate analysis of the matched cohort, the DVA and no DVA groups were similar in terms of mean age (70.0 vs 69.0; P = .55), male sex (58.0% vs 58.3%; P > .99), and preoperative characteristics such as living at home (93.2% vs 94.3%; P = .79) and independent ambulatory status (72.7% vs 75.7%; P = .64). The DVA and no DVA groups had similar rates of major comorbidities such as hypertension chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and dialysis dependence (P > .05 for all). Likewise, they had similar rates of distal origin grafts (13.6% vs 12.5%; P = .85), critical limb ischemia indications (P = .53), and prior arterial bypass (58% vs 47%; P = .08

Production of radioiodinated prosthetic group for indirect protein labeling

International Nuclear Information System (INIS)

Santos, Josefina da Silva

2001-01-01

Monoclonal antibodies and their fragments and, more recently, radiolabeled peptides have been extensively studied in order to develop radiopharmaceuticals for diagnostic and therapy in Nuclear Medicine. The radioiodination of proteins can be done by a direct method, with radioiodine being incorporated in to a tyrosine residue of the protein by electrophilic substitution. The main problem in the use of radioiodinated proteins, is that they are often dehalogenated in vivo by the action of specific enzymes, probably because of the structural similarity between iodophenyl groups and thyroid hormones. Several protein radioiodination methods have been developed in order to minimize this in vivo dehalogenation using prosthetic groups for indirect labeling. In this case, the radioiodine is first incorporated in to the prosthetic group that is subsequently attached to a terminal amino group or to a ε-amino group of lysine residue. The aim of this work is to obtain a radioiodinated prosthetic group for indirect labeling of proteins. The prosthetic group selected was the N-succinimidyl-4-radioiodine benzoate (SIB), obtained by the iodination of the p-bromobenzoic acid followed by the reaction with TSTU (0-(N-succinimidyl)-N,N,N',N'-tetramethyl uronium tetrafluoroborate) The results of these studies showed that the p-radio iodobenzoic acid was obtained with a radiochemical purity greater than 92% and a labeling yield of about 65%. Some reaction parameters were studied like temperature, time and Cu Cl mass (cataliser). The SIB was quantitatively obtained from p-radio iodobenzoic acid, using basic medium and after removing the water from the reaction using an nitrogen stream. The kinetic of this reaction is very fast with complete consumption of the p-radioiodebenzoic acid after 5 minutes. The coupling of the SIB prosthetic group to the protein was studied using Human Immunoglobulin (IgG) as a protein model. In a comparative way, the same protein was used on direct labeling

Development and testing of new upper-limb prosthetic devices: research designs for usability testing.

Science.gov (United States)

Resnik, Linda

2011-01-01

The purposes of this article are to describe usability testing and introduce designs and methods of usability testing research as it relates to upper-limb prosthetics. This article defines usability, describes usability research, discusses research approaches to and designs for usability testing, and highlights a variety of methodological considerations, including sampling, sample size requirements, and usability metrics. Usability testing is compared with other types of study designs used in prosthetic research.

Design, Sensing and Control of a Robotic Prosthetic Eye for Natural Eye Movement

OpenAIRE

J. J. Gu; M. Meng; A. Cook; P. X. Liu

2006-01-01

Loss of an eye is a tragedy for a person, who may suffer psychologically and physically. This paper is concerned with the design, sensing and control of a robotic prosthetic eye that moves horizontally in synchronization with the movement of the natural eye. Two generations of robotic prosthetic eye models have been developed. The first generation model uses an external infrared sensor array mounted on the frame of a pair of eyeglasses to detect the natural eye movement and to feed the contro...

Tensile strength and impact resistance properties of materials used in prosthetic check sockets, copolymer sockets, and definitive laminated sockets

OpenAIRE

Maria J. Gerschutz, PhD; Michael L. Haynes, MS; Derek M. Nixon, BS; James M. Colvin, MS

2011-01-01

Prosthetic sockets serve as the interface between people with amputations and their prostheses. Although most materials used to make prosthetic sockets have been used for many years, knowledge of these materials' properties is limited, especially after they are subjected to fabrication processes. This study evaluated tensile and impact properties of the current state-of-the-art materials used to fabricate prosthetic check sockets, copolymer sockets, and definitive laminated sockets. Thermolyn...

Biomechanical characteristics, patient preference and activity level with different prosthetic feet: a randomized double blind trial with laboratory and community testing.

Science.gov (United States)

Raschke, Silvia U; Orendurff, Michael S; Mattie, Johanne L; Kenyon, David E A; Jones, O Yvette; Moe, David; Winder, Lorne; Wong, Angie S; Moreno-Hernández, Ana; Highsmith, M Jason; J Sanderson, David; Kobayashi, Toshiki

2015-01-02

Providing appropriate prosthetic feet to those with limb loss is a complex and subjective process influenced by professional judgment and payer guidelines. This study used a small load cell (Europa™) at the base of the socket to measure the sagittal moments during walking with three objective categories of prosthetic feet in eleven individuals with transtibial limb loss with MFCL K2, K3 and K4 functional levels. Forefoot stiffness and hysteresis characteristics defined the three foot categories: Stiff, Intermediate, and Compliant. Prosthetic feet were randomly assigned and blinded from participants and investigators. After laboratory testing, participants completed one week community wear tests followed by a modified prosthetics evaluation questionnaire to determine if a specific category of prosthetic feet was preferred. The Compliant category of prosthetic feet was preferred by the participants (P=0.025) over the Stiff and Intermediate prosthetic feet, and the Compliant and Intermediate feet had 15% lower maximum sagittal moments during walking in the laboratory (P=0.0011) compared to the Stiff feet. The activity level of the participants did not change significantly with any of the wear tests in the community, suggesting that each foot was evaluated over a similar number of steps, but did not inherently increase activity. This is the first randomized double blind study in which prosthetic users have expressed a preference for a specific biomechanical characteristic of prosthetic feet: those with lower peak sagittal moments were preferred, and specifically preferred on slopes, stairs, uneven terrain, and during turns and maneuvering during real world use. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Telemedicine consulting in the patient preparation and planning of prosthetic tooth replacement.

Science.gov (United States)

Mladenović, Dragan; Tosić, Goran; Zivković, Dusan; Djindjić, Natasa; Mladenović, Lidija; Mladenović, Sanja; Marković, Ivana

2013-09-01

In the management of edentulous spaces, there is a permanent need of a dentist-prosthetician in charge to consult other specialists. Modern telemedicine, based on powerful computer and telecomunication systems, offers an adequate answer to these challenges, being able to transfer and obtain clinical data and consultation information over large distances. Using smartphone or a computer, the teleconsultant acces the system, downloads and review the data and photographs and gave suggestions. The system then enables direct, real time contact with the consultant, chat, or directs them to contact each other by phone. We presented telemedicine consulting in the patient preparation and planning of prosthetic tooth replacement in 3 cases with different teleconsultation requirements: the first case for prosthetic rehabilitation of his upper teeth, the second one for prosthetic management of his partial edentulousness and "a growth on his gums" in the vestibular region of the frontal teeth and the third one for prosthetic management of total edentulousness of her upper jaw. We used the system of telemedicine in dentistry, established at the Faculty of Medicine in Kosovska Mitrovica. The operation was based on the computer application system XPA3 Online, computer networking and mobile smartphone network. All consultations were succefull with no need for further procedures in regional center. The use of a mobile smartphone has brought about the mobility and availability of teleconsultant specialists in an extent never seen before. Prostheticians are thus able to offer better service to their patients and improve the quality of management of partially or totally edentulous patients, especially in rural areas.

Surface EMG and intra-socket force measurement to control a prosthetic device

Science.gov (United States)

Sanford, Joe; Patterson, Rita; Popa, Dan

2015-06-01

Surface electromyography (SEMG) has been shown to be a robust and reliable interaction method allowing for basic control of powered prosthetic devices. Research has shown a marked decrease in EMG-classification efficiency throughout activities of daily life due to socket shift and movement and fatigue as well as changes in degree of fit of the socket throughout the subject's lifetime. Users with the most severe levels of amputation require the most complex devices with the greatest number of degrees of freedom. Controlling complex dexterous devices with limited available inputs requires the addition of sensing and interaction modalities. However, the larger the amputation severity, the fewer viable SEMG sites are available as control inputs. Previous work reported the use of intra-socket pressure, as measured during wrist flexion and extension, and has shown that it is possible to control a powered prosthetic device with pressure sensors. In this paper, we present data correlations of SEMG data with intra-socket pressure data. Surface EMG sensors and force sensors were housed within a simulated prosthetic cuff fit to a healthy-limbed subject. EMG and intra-socket force data was collected from inside the cuff as a subject performed pre-defined grip motions with their dominant hand. Data fusion algorithms were explored and allowed a subject to use both intra-socket pressure and SEMG data as control inputs for a powered prosthetic device. This additional input modality allows for an improvement in input classification as well as information regarding socket fit through out activities of daily life.

Peri-prosthetic fractures around tumor endoprostheses: a retrospective analysis of eighteen cases.

Science.gov (United States)

Barut, Nicolas; Anract, Philippe; Babinet, Antoine; Biau, David

2015-09-01

Tumour hip and knee endoprostheses have become the mainstay for reconstruction of patients with bone tumours. Fixation into host bone has improved over time. However, some patients present with a peri-prosthetic fracture over follow-up. The objective of this study was to analyse the mode of presentation and survival of implant after a peri-prosthetic fracture around a tumour endoprosthesis. Eighteen peri-prosthetic fractures (17 patients) were included. All patients were treated at a tertiary care center. There were 11 (65%) women; the median age at the time of fracture was 38 years old. All implants were cemented and all knee endoprostheses were fixed-hinge. Twelve (67%) fractures occurred after femoral resection and six (33%) fractures after proximal tibial resection. There were three femoral neck fractures (UCS C), three femoral shaft type C fractures, two femoral shaft type B1, one tibial shaft type B2, three tibial shaft type C, three ankle fractures (UCS C) and three patella fractures (UCS F). Two fractures were treated conservatively and 16 were operated on. Only one patient had the implant revised. There were eight (44%) failures over follow-up; none of the conservative treatment failed. The cumulative probability of failure for any reason was 27% (8-52) and 55% (22-79) at five and ten years, respectively. Peri-prosthetic fractures around massive endoprostheses are different from that of standard implants. There are more type C fractures; internal fixation is an attractive option at the time of presentation but the risk of revision over follow-up is high and patients should be informed accordingly.

Rapid prototyping prosthetic hand acting by a low-cost shape-memory-alloy actuator.

Science.gov (United States)

Soriano-Heras, Enrique; Blaya-Haro, Fernando; Molino, Carlos; de Agustín Del Burgo, José María

2018-06-01

The purpose of this article is to develop a new concept of modular and operative prosthetic hand based on rapid prototyping and a novel shape-memory-alloy (SMA) actuator, thus minimizing the manufacturing costs. An underactuated mechanism was needed for the design of the prosthesis to use only one input source. Taking into account the state of the art, an underactuated mechanism prosthetic hand was chosen so as to implement the modifications required for including the external SMA actuator. A modular design of a new prosthesis was developed which incorporated a novel SMA actuator for the index finger movement. The primary objective of the prosthesis is achieved, obtaining a modular and functional low-cost prosthesis based on additive manufacturing executed by a novel SMA actuator. The external SMA actuator provides a modular system which allows implementing it in different systems. This paper combines rapid prototyping and a novel SMA actuator to develop a new concept of modular and operative low-cost prosthetic hand.

Comparative study of radiography and scintigraphy for loosening and infection of prosthetic hip replacement

Energy Technology Data Exchange (ETDEWEB)

Park, Mi Sook; Lee, Sun Wha; Choi, Woo Suk; Lim, Joo Won; Song, Han Joon; Ahn, Chi Yul [College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

1987-10-15

Prosthetic hip replacement is associated with certain complications which result in a painful hip. Many of these, e. g. prosthetic dislocation, fracture, trochanteric avulsion, and heterotopic calcification are easily diagnosed by conventional radiography. However, radiographic evaluation for infection and/pr loosening of prosthesis as major complications requiring reoperation often contributes little to the resolution of the diagnostic problem. The authors made a comparative study of plain radiography and scintigraphy of 39 cases performed revision at Kyung Hee University Hospital from Sep. '81-to Aug. '86. The results were as follows: 1. In 39 revised prosthetic hip replacement, 26 cases (67%) of loosening without infection and 11 cases (28%) of infection were proven. 2. In loosening of prosthesis, plain radiography showed true positive rate of 76% and true negative rate of 60%, and scintigraphy showed true positive rate of 75% and true negative rate of 95%. 3. In infection of prosthesis, plain radiography revealed true positive rate of 55% and true negative rate of 96%, and scintigraphy revealed true positive rate of 100% and true negative rate of 83%. 4. Scintigraphy and plain radiography were useful as complementary procedure in evaluating and differentiating loosening and/or infection of prosthetic component.

Illusory movement perception improves motor control for prosthetic hands

Science.gov (United States)

Marasco, Paul D.; Hebert, Jacqueline S.; Sensinger, Jon W.; Shell, Courtney E.; Schofield, Jonathon S.; Thumser, Zachary C.; Nataraj, Raviraj; Beckler, Dylan T.; Dawson, Michael R.; Blustein, Dan H.; Gill, Satinder; Mensh, Brett D.; Granja-Vazquez, Rafael; Newcomb, Madeline D.; Carey, Jason P.; Orzell, Beth M.

2018-01-01

To effortlessly complete an intentional movement, the brain needs feedback from the body regarding the movement’s progress. This largely non-conscious kinesthetic sense helps the brain to learn relationships between motor commands and outcomes to correct movement errors. Prosthetic systems for restoring function have predominantly focused on controlling motorized joint movement. Without the kinesthetic sense, however, these devices do not become intuitively controllable. Here we report a method for endowing human amputees with a kinesthetic perception of dexterous robotic hands. Vibrating the muscles used for prosthetic control via a neural-machine interface produced the illusory perception of complex grip movements. Within minutes, three amputees integrated this kinesthetic feedback and improved movement control. Combining intent, kinesthesia, and vision instilled participants with a sense of agency over the robotic movements. This feedback approach for closed-loop control opens a pathway to seamless integration of minds and machines. PMID:29540617

Customized mold radiotherapy with prosthetic apparatus for oral cancers

International Nuclear Information System (INIS)

Noguchi, Tadahide; Tsuchiya, Yoshiyuki; Hayasaka, Junichi; Itoh, Hiroto; Jinbu, Yoshinori; Kusama, Mikio; Takahashi, Satoru; Nakazawa, Masanori

2014-01-01

Eight patients (6 males, 2 females; median age, 78 years; age range, 31-94 years) were treated by mold radiotherapy with a prosthetic apparatus for oral cancers between October 2006 and March 2013. The primary sites were the tongue in 3 cases, hard palate and buccal mucosa in 2 cases each, and oral floor in 1 case. The type of treatment consisted of radical radiotherapy and palliative radiotherapy in 2 cases each, and preoperative radiotherapy, postoperative radiotherapy, additional radiotherapy after external beam radiotherapy and systemic chemotherapy in 1 case each. Patients received 40-50 Gy in 8-10 fractions with mold radiotherapy. Two patients who received radical radiotherapy showed no signs of recurrence or metastasis. The present therapy contributed to patients' palliative, postoperative, and preoperative therapy. Mold radiotherapy with a prosthetic appliance was performed safely and was a useful treatment for several types of oral cancer. (author)

Red flag in the emergency department: fracture and primary failure of a prosthetic valve.

Science.gov (United States)

Ozsarac, Murat; Karcioglu, Ozgur; Ayrik, Cuneyt; Bozkurt, Seyran; Turkcuer, Ibrahim; Gumrukcu, Serhat

2005-07-01

This case report concerns a patient with fracture and primary dysfunction of a prosthetic valve. A 40-year-old man presented to the Emergency Department with a chief complaint of breakthrough pleuritic back pain and shortness of breath. Past surgical history was significant only for an aortic valve replacement and mitral valve replacement performed 16 years prior. The transthoracic echocardiography raised suspicion of prosthesis malposition. The patient was taken to the operating room by cardiothoracic surgeons for valve replacement. Operative findings revealed that a prosthetic valve leaflet in the mitral position had broken off. Primary prosthetic valve failure should not be overlooked in the differential diagnosis of patients with valve replacement and a rapidly deteriorating clinical course. Emergency echocardiography is a guide to convenient diagnosis and management. Early surgical consultation and early reparative surgery might prevent unnecessary morbidity and mortality.

Developing and modeling of voice control system for prosthetic robot arm in medical systems

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Koksal Gundogdu

2018-04-01

Full Text Available In parallel with the development of technology, various control methods are also developed. Voice control system is one of these control methods. In this study, an effective modelling upon mathematical models used in the literature is performed, and a voice control system is developed in order to control prosthetic robot arms. The developed control system has been applied on four-jointed RRRR robot arm. Implementation tests were performed on the designed system. As a result of the tests; it has been observed that the technique utilized in our system achieves about 11% more efficient voice recognition than currently used techniques in the literature. With the improved mathematical modelling, it has been shown that voice commands could be effectively used for controlling the prosthetic robot arm. Keywords: Voice recognition model, Voice control, Prosthetic robot arm, Robotic control, Forward kinematic

Dynamic Facial Prosthetics for Sufferers of Facial Paralysis

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Fergal Coulter

2011-10-01

Full Text Available BackgroundThis paper discusses the various methods and the materialsfor the fabrication of active artificial facial muscles. Theprimary use for these will be the reanimation of paralysedor atrophied muscles in sufferers of non-recoverableunilateral facial paralysis.MethodThe prosthetic solution described in this paper is based onsensing muscle motion of the contralateral healthy musclesand replicating that motion across a patient’s paralysed sideof the face, via solid state and thin film actuators. Thedevelopment of this facial prosthetic device focused onrecreating a varying intensity smile, with emphasis ontiming, displacement and the appearance of the wrinklesand folds that commonly appear around the nose and eyesduring the expression.An animatronic face was constructed with actuations beingmade to a silicone representation musculature, usingmultiple shape-memory alloy cascades. Alongside theartificial muscle physical prototype, a facial expressionrecognition software system was constructed. This formsthe basis of an automated calibration and reconfigurationsystem for the artificial muscles following implantation, soas to suit the implantee’s unique physiognomy.ResultsAn animatronic model face with silicone musculature wasdesigned and built to evaluate the performance of ShapeMemory Alloy artificial muscles, their power controlcircuitry and software control systems. A dual facial motionsensing system was designed to allow real time control overmodel – a piezoresistive flex sensor to measure physicalmotion, and a computer vision system to evaluate real toartificial muscle performance.Analysis of various facial expressions in real subjects wasmade, which give useful data upon which to base thesystems parameter limits.ConclusionThe system performed well, and the various strengths andshortcomings of the materials and methods are reviewedand considered for the next research phase, when newpolymer based artificial muscles are constructed

Ureaplasma parvum prosthetic joint infection detected by PCR.

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Farrell, John J; Larson, Joshua A; Akeson, Jeffrey W; Lowery, Kristin S; Rounds, Megan A; Sampath, Rangarajan; Bonomo, Robert A; Patel, Robin

2014-06-01

We describe the first reported case of Ureaplasma parvum prosthetic joint infection (PJI) detected by PCR. Ureaplasma species do not possess a cell wall and are usually associated with colonization and infection of mucosal surfaces (not prosthetic material). U. parvum is a relatively new species name for certain serovars of Ureaplasma urealyticum, and PCR is useful for species determination. Our patient presented with late infection of his right total knee arthroplasty. Intraoperative fluid and tissue cultures and pre- and postoperative synovial fluid cultures were all negative. To discern the pathogen, we employed PCR coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Our patient's failure to respond to empirical antimicrobial treatment and our previous experience with PCR/ESI-MS in culture-negative cases of infection prompted us to use this approach over other diagnostic modalities. PCR/ESI-MS detected U. parvum in all samples. U. parvum-specific PCR testing was performed on all synovial fluid samples to confirm the U. parvum detection. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

A Prosthetic Foot Emulator to Optimize Prescription of Prosthetic Feet in Veterans and Service Members with Leg Amputations

Science.gov (United States)

2017-09-01

mobility, prosthetic foot preference and walking ability after two weeks of use in the home and community setting. No exclusions based on sex , race...2012 Page 17 of 33 Data collection Photos and video recording With the participant’s explicit consent, we may take video and photos during portions of...this study, for documentation and use in research publications. All videos and photos will exclue the participant’s face and identifying marks will

Three-dimensional flow structures past a bio-prosthetic valve in an in-vitro model of the aortic root

OpenAIRE

Hasler, David; Obrist, Dominik

2018-01-01

The flow field past a prosthetic aortic valve comprises many details that indicate whether the prosthesis is functioning well or not. It is, however, not yet fully understood how an optimal flow scenario would look, i.e. which subtleties of the fluid dynamics in place are essential regarding the durability and compatibility of a prosthetic valve. In this study, we measured and analyzed the 3D flow field in the vicinity of a bio-prosthetic heart valve in function of the aortic root size. The m...

Current standard rules of combined anteversion prevent prosthetic impingement but ignore osseous contact in total hip arthroplasty.

Science.gov (United States)

Weber, Markus; Woerner, Michael; Craiovan, Benjamin; Voellner, Florian; Worlicek, Michael; Springorum, Hans-Robert; Grifka, Joachim; Renkawitz, Tobias

2016-12-01

In this prospective study of 135 patients undergoing cementless total hip arthroplasty (THA) we asked whether six current definitions of combined anteversion prevent impingement and increase postoperative patient individual impingement-free range-of-motion (ROM). Implant position was measured by an independent, external institute on 3D-CT performed six weeks post-operatively. Post-operative ROM was calculated using a CT-based algorithm detecting osseous and/or prosthetic impingement by virtual hip movement. Additionally, clinical ROM was evaluated pre-operatively and one-year post-operatively by a blinded observer. Combined component position of cup and stem according to the definitions of Ranawat, Widmer, Dorr, Hisatome and Yoshimine inhibited prosthetic impingement in over 90 %, while combined osseous and prosthetic impingement still occurred in over 40 % of the cases. The recommendations by Jolles, Widmer, Dorr, Yoshimine and Hisatome enabled higher flexion (p ≤ 0.001) and internal rotation (p ≤ 0.006). Clinically, anteversion rules of Widmer and Yoshimine provided one-year post-operatively statistically but not clinically relevant higher internal rotation (p ≤0.034). Standard rules of combined anteversion detect prosthetic but fail to prevent combined osseous and prosthetic impingement in THA. Future models will have to account for the patient-individual anatomic situation to ensure impingement-free ROM.

Oral health-related quality of life and prosthetic status of nursing home residents with or without dementia.

Science.gov (United States)

Klotz, Anna-Luisa; Hassel, Alexander Jochen; Schröder, Johannes; Rammelsberg, Peter; Zenthöfer, Andreas

2017-01-01

The objective of this cross-sectional study was to evaluate the effect of prosthetic status on the oral health-related quality of life (OHRQoL) of nursing home residents with or without dementia. The study was performed in 14 nursing homes across the federal state of Baden-Württemberg, Germany. All eligible participants were included, and general and medical information and information about their dental and prosthetic statuses were collected. The Geriatric Oral Health Assessment Index (GOHAI) was administered to evaluate OHRQoL. The Mini-Mental State Examination (MMSE) served to classify participants into living or not living with dementia according to the established cutoff value for dementia (MMSE health was also similar in both groups ( P >0.05). The number of teeth (odds ratio [OR]: 2.0), the type of prosthetic status (OR: 6.5), and denture-related treatment needs (OR: 2.4) were the major factors significantly affecting OHRQoL ( P nursing home residents is substantially compromised. Several prosthetic treatment needs for residents living with or without dementia were identified. Edentulism without tooth replacement and having <5 teeth resulted in an increased risk of substantially compromised OHRQoL. Further studies should be conducted to determine whether improvements in prosthetic status can increase OHRQoL.

Swing Phase Control of Semi-Active Prosthetic Knee Using Neural Network Predictive Control With Particle Swarm Optimization.

Science.gov (United States)

Ekkachai, Kittipong; Nilkhamhang, Itthisek

2016-11-01

In recent years, intelligent prosthetic knees have been developed that enable amputees to walk as normally as possible when compared to healthy subjects. Although semi-active prosthetic knees utilizing magnetorheological (MR) dampers offer several advantages, they lack the ability to generate active force that is required during some states of a normal gait cycle. This prevents semi-active knees from achieving the same level of performance as active devices. In this work, a new control algorithm for a semi-active prosthetic knee during the swing phase is proposed to reduce this gap. The controller uses neural network predictive control and particle swarm optimization to calculate suitable command signals. Simulation results using a double pendulum model show that the generated knee trajectory of the proposed controller is more similar to the normal gait than previous open-loop controllers at various ambulation speeds. Moreover, the investigation shows that the algorithm can be calculated in real time by an embedded system, allowing for easy implementation on real prosthetic knees.

Corynebacterium minutissimum vascular graft infection: case report and review of 281 cases of prosthetic device-related Corynebacterium infection.

Science.gov (United States)

Reece, Rebecca M; Cunha, Cheston B; Rich, Josiah D

2014-09-01

Corynebacterium spp. have proven their pathogenic potential in causing infections, particularly in the setting of immunosuppression and prosthetic devices. We conducted a PubMed literature review of all cases of Corynebacterium prosthetic device infections published in the English language through December 2013. The majority of cases involved peritoneal dialysis and central venous catheters, but prosthetic joints and central nervous system shunts/drains were also involved. The management of these cases in terms of retention or removal of the device was not uniform; however, the overall mortality remained the same among both groups. All of these prosthetic device infections pose potential problems in management when the device cannot be removed safely for the patient, especially with the lack of data on the pathogenicity of Corynebacterium species. However with better identification of species and sensitivities, successful treatment is possible even with retention of the device.

Role of CT in patients with prosthetic heart valves

NARCIS (Netherlands)

Suchá, D.

2016-01-01

Valvular heart disease accounts for a substantial part of the cardiovascular disease worldwide with an estimated prevalence of 2.5% in the Western population aged <65 years and over 13% in the population aged >75 years. Surgical prosthetic heart valve (PHV) replacement is the indicated therapy for

Diagnostic flowcharts in osteomyelitis, spondylodiscitis and prosthetic joint infection

NARCIS (Netherlands)

Jutte, P.; Lazzeri, E.; Sconfienza, L. M.; Cassar-Pullicino, V.; Trampuz, A.; Petrosillo, N.; Signore, A.

Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnose and to treat. Structured diagnostic workup may very well improve the accuracy and speed of diagnosis, thereby improving the outcome since treatment may very well be more successful and less harmful if

A rare case of prosthetic endocarditis and dehiscence in a mechanical valved conduit.

Science.gov (United States)

Kannan, Arun; Smith, Cristy; Subramanian, Sreekumar; Janardhanan, Rajesh

2014-02-07

A middle-aged adult patient with a history of aortic root replacement with a mechanical valved conduit and remote chest trauma was referred to our institution with prosthetic endocarditis. Transoesophageal echocardiogram at our institution confirmed a near-complete dehiscence of the prosthetic aortic valve from the conduit, with significant perivalvular flow forming a pseudoaneurysm. The patient underwent a high-risk re-operation, involving redo aortic root replacement with a homograft after extensive debridement of the infected tissue. The patient was discharged to an outside facility after an uncomplicated hospital course, and remains stable.

Locomotor Performance During Rehabilitation of People With Lower Limb Amputation and Prosthetic Nonuse 12 Months After Discharge.

Science.gov (United States)

Roffman, Caroline E; Buchanan, John; Allison, Garry T

2016-07-01

It is recognized that multifactorial assessments are needed to evaluate balance and locomotor function in people with lower limb amputation. There is no consensus on whether a single screening tool could be used to identify future issues with locomotion or prosthetic use. The purpose of this study was to determine whether different tests of locomotor performance during rehabilitation were associated with significantly greater risk of prosthetic abandonment at 12 months postdischarge. This was a retrospective cohort study. Data for descriptive variables and locomotor tests (ie, 10-Meter Walk Test [10MWT], Timed "Up & Go" Test [TUGT], Six-Minute Walk Test [6MWT], and Four Square Step Test [FSST]) were abstracted from the medical records of 201 consecutive participants with lower limb amputation. Participants were interviewed and classified as prosthetic users or nonusers at 12 months postdischarge. The Mann-Whitney U test was used to analyze whether there were differences in locomotor performance. Receiver operating characteristic curves were generated to determine performance thresholds, and relative risk (RR) was calculated for nonuse. At 12 months postdischarge, 18% (n=36) of the participants had become prosthetic nonusers. Performance thresholds, area under the curve (AUC), and RR of nonuse (95% confidence intervals [CI]) were: for the 10MWT, if walking speed was ≤0.44 ms(-1) (AUC=0.743), RR of nonuse=2.76 (95% CI=1.83, 3.79; PLocomotor performance during rehabilitation may predict future risk of prosthetic nonuse. It may be implied that the 10MWT has the greatest clinical utility as a single screening tool for prosthetic nonuse, given the highest proportion of participants were able to perform this test early in rehabilitation. However, as locomotor skills improve, other tests (in particular, the 6MWT) have specific clinical utility. To fully enable implementation of these locomotor criteria for prosthetic nonuse into clinical practice, validation is warranted

Using computed tomography and 3D printing to construct custom prosthetics attachments and devices.

Science.gov (United States)

Liacouras, Peter C; Sahajwalla, Divya; Beachler, Mark D; Sleeman, Todd; Ho, Vincent B; Lichtenberger, John P

2017-01-01

The prosthetic devices the military uses to restore function and mobility to our wounded warriors are highly advanced, and in many instances not publically available. There is considerable research aimed at this population of young patients who are extremely active and desire to take part in numerous complex activities. While prosthetists design and manufacture numerous devices with standard materials and limb assemblies, patients often require individualized prosthetic design and/or modifications to enable them to participate fully in complex activities. Prosthetists and engineers perform research and implement digitally designs in collaboration to generate equipment for their patient's rehabilitation needs. 3D printing allows for these devices to be manufactured from an array of materials ranging from plastic to titanium alloy. Many designs require form fitting to a prosthetic socket or a complex surface geometry. Specialty items can be scanned using computed tomography and digitally reconstructed to produce a virtual 3D model the engineer can use to design the necessary features of the desired prosthetic, device, or attachment. Completed devices are tested for fit and function. Numerous custom prostheses and attachments have been successfully translated from the research domain to clinical reality, in particular, those that feature the use of computed tomography (CT) reconstructions. The purpose of this project is to describe the research pathways to implementation for the following clinical designs: sets of bilateral hockey skates; custom weightlifting prosthetic hands; and a wine glass holder. This article will demonstrate how to incorporate CT imaging and 3D printing in the design and manufacturing process of custom attachments and assistive technology devices. Even though some of these prosthesis attachments may be relatively simple in design to an engineer, they have an enormous impact on the lives of our wounded warriors.

Telemedicine consulting in the patient preparation and planning of prosthetic tooth replacement

Directory of Open Access Journals (Sweden)

Mladenović Dragan

2013-01-01

Full Text Available Introduction. In the management of edentulous spaces, there is a permanent need of a dentist-prosthetician in charge to consult other specialists. Modern telemedicine, based on powerful computer and telecomunication systems, offers an adequate answer to these challenges, being able to transfer and obtain clinical data and consultation information over large distances. Using smartphone or a computer, the teleconsultant acces the system, downloads and review the data and photographs and gave suggestions. The system then enables direct, real time contact with the consultant, chat, or directs them to contact each other by phone. Case report. We presented telemedicine consulting in the patient preparation and planning of prosthetic tooth replacement in 3 cases with different teleconsultation requirements: the first case for prosthetic rehabilitation of his upper teeth, the second one for prosthetic management of his partial edentulousness and “a growth on his gums” in the vestibular region of the frontal teeth and the third one for prosthetic management of total edentulousness of her upper jaw. We used the system of telemedicine in dentistry, established at the Faculty of Medicine in Kosovska Mitrovica. The operation was based on the computer application system XPA3 Online, computer networking and mobile smartphone network. All consultations were succefull with no need for further procedures in regional center. Conclusion. The use of a mobile smartphone has brought about the mobility and availability of teleconsultant specialists in an extent never seen before. Prostheticians are thus able to offer better service to their patients and improve the quality of management of partially or totally edentulous patients, especially in rural areas.

Automated hexahedral mesh generation from biomedical image data: applications in limb prosthetics.

Science.gov (United States)

Zachariah, S G; Sanders, J E; Turkiyyah, G M

1996-06-01

A general method to generate hexahedral meshes for finite element analysis of residual limbs and similar biomedical geometries is presented. The method utilizes skeleton-based subdivision of cross-sectional domains to produce simple subdomains in which structured meshes are easily generated. Application to a below-knee residual limb and external prosthetic socket is described. The residual limb was modeled as consisting of bones, soft tissue, and skin. The prosthetic socket model comprised a socket wall with an inner liner. The geometries of these structures were defined using axial cross-sectional contour data from X-ray computed tomography, optical scanning, and mechanical surface digitization. A tubular surface representation, using B-splines to define the directrix and generator, is shown to be convenient for definition of the structure geometries. Conversion of cross-sectional data to the compact tubular surface representation is direct, and the analytical representation simplifies geometric querying and numerical optimization within the mesh generation algorithms. The element meshes remain geometrically accurate since boundary nodes are constrained to lie on the tubular surfaces. Several element meshes of increasing mesh density were generated for two residual limbs and prosthetic sockets. Convergence testing demonstrated that approximately 19 elements are required along a circumference of the residual limb surface for a simple linear elastic model. A model with the fibula absent compared with the same geometry with the fibula present showed differences suggesting higher distal stresses in the absence of the fibula. Automated hexahedral mesh generation algorithms for sliced data represent an advancement in prosthetic stress analysis since they allow rapid modeling of any given residual limb and optimization of mesh parameters.

Histopathological and Immunohistochemical Evaluation of Pannus Tissue in Patients with Prosthetic Valve Dysfunction.

Science.gov (United States)

Karakoyun, Süleyman; Ozan Gürsoy, Mustafa; Yesin, Mahmut; Kalçık, Macit; Astarcıoğlu, Mehmet Ali; Gündüz, Sabahattin; Emrah Oğuz, Ali; Çoban Kökten, Şermin; Nimet Karadayı, Ayşe; Tuncer, Altuğ; Köksal, Cengiz; Gökdeniz, Tayyar; Özkan, Mehmet

2016-01-01

Prosthetic valve dysfunction due to pannus formation is a rare but serious complication. Currently, limited data are available concerning the pathogenesis and immunohistochemical properties of pannus. The study aim was to investigate the morphological, histopathological and immunohistochemical characteristics of pannus formation in patients with prosthetic valve dysfunction. A total of 35 patients (10 males, 25 females; mean age 44 ± 16 years) who had undergone re-do valve surgery due to prosthetic valve obstruction was enrolled in the study. Immunohistochemical studies were aimed at evaluating the expression of alphasmooth muscle actin (α-SMA) and desmin in myofibroblasts and smooth muscle cells; epithelial membrane antigen (EMA) in epithelial cells; and CD34, Factor VIII and vascular endothelial growth factor (VEGF) in endothelial cells. Matrix metalloproteinases (MMPs) -2 and -9, and transforming growth factor-beta (TGF-β) were used to demonstrate cytokine release from macrophages, leukocytes, fibroblasts and myofibroblasts. Pannus appeared as a tough and thick tissue hyperplasia which began from outside the suture ring in the periannular region and extended to the inflow and outflow surfaces of the prosthetic valves. Histopathological analysis showed the pannus tissue to consist of chronic inflammatory cells (lymphocytes, plasma cells, macrophages and foreign body giant cells), spindle cells such as myofibroblasts, capillary blood vessels and endothelial cells laying down the lumens. Calcification was present in the pannus tissue of 19 explanted prostheses. Immunohistochemical studies revealed positive α-SMA expression in all patients, whereas 60.5% of patients were positive for desmin, 50% for EMA, 42.1% for VEGF, 39.5% for TBF-β, 42.1% for MMP-2, 86.8% for CD34, and 97.4% for Factor VIII. MMP-9 was negative in all patients. Pannus tissue appears to be formed as the result of a neointimal response in periannular regions of prosthetic valves that consist

EFFICIENCY OF PROSTHETIC TREATMENT WITH POST RESECTION PROSTHESES WITH SOLID SUBSTITUTE PART

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Ivan Gerdzhikov

2016-08-01

Full Text Available Aim: The aim of this study is to track the effectiveness of prosthetic treatment with post resection dentures with solid substitute part and their role in the restoration of damaged functions. Materials and methods: The study included 14 patients (9 men and 5 women with different size and location of defects in the upper jaw treated in the period 2010-2016 with post resection prostheses with a solid substitute part. The impressions were taken with irreversible hydrocolloid impression material. The prostheses were completed by heat-curing acrylic with low quantity residual monomer. The effectiveness of prosthetics was evaluated by the method of Mihaylov for both oral-nasal examination of the pressure with the device "Oronasopneumotest." For objectifying and assess the occlusal-articulation ratios was held computerized occlusal analysis with the system T-SCAN 8. Results: The results showed successful obturation and sealing of defects in all patients. It was found satisfactory recovery of the speaking function and normalization of occlusal-articulation ratios. Conclusion: The prosthetic treatment with post resection prostheses with a solid substitute part allows successful recovery of the lost speech and chewing functions, helping to restore self esteem and social rehabilitation of patients.

Computed Tomography of the complications of prosthetic surgery of the abdominal aorta

International Nuclear Information System (INIS)

Giovagnorio, Francesco; Andreoli, Chiara; De Cicco, Maria Luisa

1997-01-01

Computerized Tomography has gained an important role in the diagnosis of the complications of prosthetic surgery of the abdominal aorta: the importance of such complications come from their frequency, which is proportional to the increasing number of interventions, and their severity. The authors investigated the CT patterns of the most frequent complications. 24 patients referred for strongly suspected postoperative complications were examined in 2 years: fever and leukocytosis (20 cases) and progressive anemia (4 cases) were the most frequent findings. The operation had been performed 7± 12 weeks before (2 patients were excluded because surgery dated less than 3 weeks. 14 patients had infective complications: thickening (57%) and inhomogeneity (43%) of the periprosthetic wrap and ectopic gas bubble (78%) were the most frequent Computerized Tomography findings. The authors also observed 2 periprosthetic hematomas, 1 aneurysm relapse and 1 prosthetic graft rupture. In conclusion, CT confirmed its important role in the study of the complications of prosthetic aortic surgery, despite its know poor specificity in the demonstration of the aorta in the first 2-3 months postoperatively, in the initial stages of infection and in the diagnosis of aorta-enteric fistulas

Prosthetic graft infection: limitations of indium white blood cell scanning

International Nuclear Information System (INIS)

Brunner, M.C.; Mitchell, R.S.; Baldwin, J.C.; James, D.R.; Olcott, C. IV; Mehigan, J.T.; McDougall, I.R.; Miller, D.C.

1986-01-01

The lack of a rapid, noninvasive, and accurate method to confirm or rule out prosthetic graft infection continues to constitute a compelling and vexing clinical problem. A host of adjunctive diagnostic techniques has been used in the past, but early promising results subsequently have usually not yielded acceptable sensitivity (reflecting false negatives) and specificity (reflecting false positive) data. White blood cell (WBC) indium 111 scanning has recently been added to this list. The utility and accuracy of 111 In WBC scans were assessed by retrospective review of WBC scan results in 70 patients undergoing evaluation for possible prosthetic graft infection over a 7-year period. Operative and autopsy data (mean follow-up, 18 months for survivors with negative scans) were used to confirm the 22 positive, 45 negative, and three equivocal WBC scans. The false positive rate (+/- 70% confidence limits) was 36% +/- 6% (n = 8) among the 22 patients with positive scans (44% +/- 6% [11 of 25] if the three equivocal scans are included as false positive), yielding a specificity of 85% +/- 5% and an overall accuracy rate of 88% +/- 4% (80% +/- 5% and 84% +/- 5%, respectively, if the three equivocal cases are considered as false positive). All three patients with equivocal scans ultimately were judged not to have prosthetic graft infection. As implied by the high accuracy rate, the sensitivity of the test was absolute (100% [14 of 14]); there were no false negative results

Comparison of using different bridge prosthetic designs for partial defect restoration through mathematical modeling.

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Styranivska, Oksana; Kliuchkovska, Nataliia; Mykyyevych, Nataliya

2017-01-01

To analyze the stress-strain states of bone and abutment teeth during the use of different prosthetic designs of fixed partial dentures with the use of relevant mathematical modeling principles. The use of Comsol Multiphysics 3.5 (Comsol AB, Sweden) software during the mathematical modeling of stress-strain states provided numerical data for analytical interpretation in three different clinical scenarios with fixed dentures and different abutment teeth and demountable prosthetic denture with the saddle-shaped intermediate part. Microsoft Excel Software (Microsoft Office 2017) helped to evaluate absolute mistakes of stress and strain parameters of each abutment tooth during three modeled scenarios and normal condition and to summarize data into the forms of tables. In comparison with the fixed prosthetic denture supported by the canine, first premolar, and third molar, stresses at the same abutment teeth with the use of demountable denture with the saddle-shaped intermediate part decreased: at the mesial abutment tooth by 2.8 times, at distal crown by 6.1 times, and at the intermediate part by 11.1 times, respectively, the deformation level decreased by 3.1, 1.9, and 1.4 times at each area. The methods of mathematical modeling proved that complications during the use of fixed partial dentures based on the overload effect of the abutment teeth and caused by the deformation process inside the intermediate section of prosthetic construction.

Determining asymmetry of roll-over shapes in prosthetic walking

NARCIS (Netherlands)

Curtze, C.; Otten, Bert; Hof, A.L.; Postema, K.

2011-01-01

How does the inherent asymmetry of the locomotor system in people with lower-limb amputation affect the ankle-foot roll-over shape of prosthetic walking? In a single-case design, we evaluated the walking patterns of six people with lower-limb amputation (3 transtibial and 3 transfemoral) and three

Fiber-array based optogenetic prosthetic system for stimulation therapy

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Gu, Ling; Cote, Chris; Tejeda, Hector; Mohanty, Samarendra

2012-02-01

Recent advent of optogenetics has enabled activation of genetically-targeted neuronal cells using low intensity blue light with high temporal precision. Since blue light is attenuated rapidly due to scattering and absorption in neural tissue, optogenetic treatment of neurological disorders may require stimulation of specific cell types in multiple regions of the brain. Further, restoration of certain neural functions (vision, and auditory etc) requires accurate spatio-temporal stimulation patterns rather than just precise temporal stimulation. In order to activate multiple regions of the central nervous system in 3D, here, we report development of an optogenetic prosthetic comprising of array of fibers coupled to independently-controllable LEDs. This design avoids direct contact of LEDs with the brain tissue and thus does not require electrical and heat isolation, which can non-specifically stimulate and damage the local brain regions. The intensity, frequency, and duty cycle of light pulses from each fiber in the array was controlled independently using an inhouse developed LabView based program interfaced with a microcontroller driving the individual LEDs. While the temporal profile of the light pulses was controlled by varying the current driving the LED, the beam profile emanating from each fiber tip could be sculpted by microfabrication of the fiber tip. The fiber array was used to stimulate neurons, expressing channelrhodopsin-2, in different locations within the brain or retina. Control of neural activity in the mice cortex, using the fiber-array based prosthetic, is evaluated from recordings made with multi-electrode array (MEA). We also report construction of a μLED array based prosthetic for spatio-temporal stimulation of cortex.

Prosthetic component segmentation with blur compensation: a fast method for 3D fluoroscopy.

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Tarroni, Giacomo; Tersi, Luca; Corsi, Cristiana; Stagni, Rita

2012-06-01

A new method for prosthetic component segmentation from fluoroscopic images is presented. The hybrid approach we propose combines diffusion filtering, region growing and level-set techniques without exploiting any a priori knowledge of the analyzed geometry. The method was evaluated on a synthetic dataset including 270 images of knee and hip prosthesis merged to real fluoroscopic data simulating different conditions of blurring and illumination gradient. The performance of the method was assessed by comparing estimated contours to references using different metrics. Results showed that the segmentation procedure is fast, accurate, independent on the operator as well as on the specific geometrical characteristics of the prosthetic component, and able to compensate for amount of blurring and illumination gradient. Importantly, the method allows a strong reduction of required user interaction time when compared to traditional segmentation techniques. Its effectiveness and robustness in different image conditions, together with simplicity and fast implementation, make this prosthetic component segmentation procedure promising and suitable for multiple clinical applications including assessment of in vivo joint kinematics in a variety of cases.

Prosthetic Aortic Valve Fixation Study: 48 Replacement Valves Analyzed Using Digital Pressure Mapping.

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Lee, Candice Y; Wong, Joshua K; Ross, Ronald E; Liu, David C; Khabbaz, Kamal R; Martellaro, Angelo J; Gorea, Heather R; Sauer, Jude S; Knight, Peter A

Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures. Simulating open and minimally invasive access, 4 surgeons, blinded to data acquisition, each secured 12 valves using manual knot-tying (hand-tied [HT] or knot-pusher [KP]) or automated titanium fasteners (TFs). Real-time pressure measurements and times were recorded. Two-dimensional (2D) and 3D pressure maps were generated for all valves. Pressures less than 80 mm Hg were considered at risk for PVL. Pressures under each knot (intrasuture) fell less than 80 mm Hg for 12 of 144 manual knots (5/144 HT, 7/144 KP) versus 0 of 288 TF (P prosthetic valve security.

May one-stage exchange for Candida albicans peri-prosthetic infection be successful?

Science.gov (United States)

Jenny, J-Y; Goukodadja, O; Boeri, C; Gaudias, J

2016-02-01

Fungal infection of a total joint arthroplasty has a low incidence but is generally considered as more difficult to cure than bacterial infection. As for bacterial infection, two-stage exchange is considered as the gold standard of treatment. We report two cases of one-stage total joint exchange for fungal peri-prosthetic infection with Candida albicans, where the responsible pathogens was only identified on intraoperative samples. This situation can be considered as a one-stage exchange for fungal peri-prosthetic infection without preoperative identification of the responsible organism, which is considered as having a poor prognosis. Both cases were free of infection after two years. One-stage revision has several potential advantages over two-stage revision, including shorter hospital stay and rehabilitation, no interim period with significant functional impairment, shorter antibiotic treatment, better functional outcome and probably lower costs. We suggest that one-stage revision for C. albicans peri-prosthetic infection may be successful even without preoperative fungal identification. Level IV-Historical cases. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Early prosthetic valve endocarditis caused by Corynebacterium kroppenstedtii.

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Hagemann, Jürgen Benjamin; Essig, Andreas; Herrmann, Manuel; Liebold, Andreas; Quader, Mohamed Abo

2015-12-01

Corynebacterium (C.) kroppenstedtii is a rarely detected agent of bacterial infections in humans. Here, we describe the first case of prosthetic valve endocarditis caused by C. kroppenstedtii. Application of molecular methods using surgically excised valve tissue was a cornerstone for the establishment of the microbiological diagnosis, which is crucial for targeted antimicrobial treatment. Copyright © 2015 Elsevier GmbH. All rights reserved.

Autologous alternative veins may not provide better outcomes than prosthetic conduits for below-knee bypass when great saphenous vein is unavailable.

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Avgerinos, Efthymios D; Sachdev, Ulka; Naddaf, Abdallah; Doucet, Dannielle R; Mohapatra, Abhisekh; Leers, Steven A; Chaer, Rabih A; Makaroun, Michel S

2015-08-01

There is a need to better define the role of alternative autologous vein (AAV) segments over contemporary prosthetic conduits in patients with critical limb ischemia when great saphenous vein (GSV) is not available for use as the bypass conduit. Consecutive patients who underwent bypass to infrageniculate targets between 2007 and 2011 were categorized in three groups: GSV, AAV, and prosthetic. The primary outcome was graft patency. The secondary outcome was limb salvage. Cox proportional hazards regression was used to adjust for baseline confounding variables. A total of 407 infrainguinal bypasses to below-knee targets were analyzed; 255 patients (63%) received a single-segment GSV, 106 patients (26%) received an AAV, and 46 patients (11%) received a prosthetic conduit. Baseline characteristics were similar among groups, with the exception of popliteal targets and anticoagulation use being more frequent in the prosthetic group. Primary patency at 2 and 5 years was estimated at 47% and 32%, respectively, for the GSV group; 24% and 23% for the AAV group; and 43% and 38% for the prosthetic group. Primary assisted patency at 2 and 5 years was estimated at 71% and 55%, respectively, for the GSV group; 53% and 51% for the AAV group; and 45% and 40% for the prosthetic group. Secondary patency at 2 and 5 years was estimated at 75% and 60%, respectively, for the GSV group; 57% and 55% for the AAV group; and 46% and 41% for the prosthetic group. In Cox analysis, primary patency (hazard ratio [HR], 0.55; P < .001; 95% confidence interval [CI], 0.404-0.758), primary assisted patency (HR, 0.57; P = .004; 95% CI, 0.388-0.831), and secondary patency (HR, 0.56; P = .005; 95% CI, 0.372-0.840) were predicted by GSV compared with AAV, but there was no difference between AAV and prosthetic grafts except for the primary patency, for which prosthetic was protective (HR, 0.38; P < .001; 95% CI, 0.224-0.629). Limb salvage was similar among groups. AAV conduits may not offer a significant

Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization.

Science.gov (United States)

Calik, Eyup Serhat; Limandal, Husnu Kamil; Arslan, Umit; Tort, Mehmet; Yildiz, Ziya; Bayram, Ednan; Dag, Ozgur; Kaygin, Mehmet Ali; Erkut, Bilgehan

2015-12-14

Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models. A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn't specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy. After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery. The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.

Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections.

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Matter-Parrat, V; Ronde-Oustau, C; Boéri, C; Gaudias, J; Jenny, J-Y

2017-04-01

Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Pre prosthetic reconstruction of alveolar ridge

Directory of Open Access Journals (Sweden)

Prabhuji Munivenkatappa Lakshmaiahenkatesh

2011-01-01

Full Text Available Dento-alveolar bony defects are common and occur due to a variety of causes, such as, pulpal pathology, traumatic tooth extraction, advanced periodontal disease, implant failure, tumor or congenital anomalies. These defects often cause a significant problem in dental treatment and rehabilitation. Many techniques exist for effective soft and hard tissue augmentation. The approach is largely based on the extent of the defect and specific procedures to be performed for the implant or prosthetic rehabilitation. This article presents case reports of soft and hard tissue ridge augmentation.

Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard

Energy Technology Data Exchange (ETDEWEB)

Tsai, I.Chen [Taichung Veterans General Hospital, Department of Radiology, Taichung (China); Institute of Clinical Medicine and Faculty of Medicine, National Yang-Ming University, Taipei (China); Lin, Yung-Kai; Chang, Yen; Wang, Chung-Chi; Hsieh, Shih-Rong; Wei, Hao-Ji; Tsai, Hung-Wen [Taichung Veterans General Hospital, Section of Cardiovascular Surgery, Cardiovascular Center, Taichung (China); Fu, Yun-Ching; Jan, Sheng-Ling [Institute of Clinical Medicine and Faculty of Medicine, National Yang-Ming University, Taipei (China); Taichung Veterans General Hospital, Section of Pediatric Cardiology, Department of Pediatrics, Taichung (China); Wang, Kuo-Yang [Taichung Veterans General Hospital, Section of General Cardiology, Cardiovascular Center, Taichung (China); Chung-Shan Medical University, Department of Medicine, Taichung (China); Chen, Min-Chi; Chen, Clayton Chi-Chang [Taichung Veterans General Hospital, Department of Radiology, Taichung (China); Central Taiwan University of Science and Technology, Department of Radiological Technology, Taichung (China)

2009-04-15

The purpose was to compare the findings of multi-detector computed tomography (MDCT) in prosthetic valve disorders using the operative findings as a gold standard. In a 3-year period, we prospectively enrolled 25 patients with 31 prosthetic heart valves. MDCT and transthoracic echocardiography (TTE) were done to evaluate pannus formation, prosthetic valve dysfunction, suture loosening (paravalvular leak) and pseudoaneurysm formation. Patients indicated for surgery received an operation within 1 week. The MDCT findings were compared with the operative findings. One patient with a Bjoerk-Shiley valve could not be evaluated by MDCT due to a severe beam-hardening artifact; thus, the exclusion rate for MDCT was 3.2% (1/31). Prosthetic valve disorders were suspected in 12 patients by either MDCT or TTE. Six patients received an operation that included three redo aortic valve replacements, two redo mitral replacements and one Amplatzer ductal occluder occlusion of a mitral paravalvular leak. The concordance of MDCT for diagnosing and localizing prosthetic valve disorders and the surgical findings was 100%. Except for images impaired by severe beam-hardening artifacts, MDCT provides excellent delineation of prosthetic valve disorders. (orig.)

Recurrent pannus formation causing prosthetic aortic valve dysfunction: is excision without valve re-replacement applicable?

Science.gov (United States)

Darwazah, Ahmad K

2012-06-29

Prosthetic valve dysfunction at aortic position is commonly caused by pannus formation. The exact etiology is not known. It arises from ventricular aspect of the prosthesis encroaching its leaflets causing stenosis or it may remain localized causing left ventricular outflow tract obstruction without affecting valve function.The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement.A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve.Management of our case presents several questions, whether recurrence of pannus is caused by sparing the prosthetic valve, is it simply an exaggeration of an inflammatory healing process in certain individuals or is it ideal to re-replace the valve despite a well preserved function.

A pulsatile flow model for in vitro quantitative evaluation of prosthetic valve regurgitation

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S. Giuliatti

2000-03-01

Full Text Available A pulsatile pressure-flow model was developed for in vitro quantitative color Doppler flow mapping studies of valvular regurgitation. The flow through the system was generated by a piston which was driven by stepper motors controlled by a computer. The piston was connected to acrylic chambers designed to simulate "ventricular" and "atrial" heart chambers. Inside the "ventricular" chamber, a prosthetic heart valve was placed at the inflow connection with the "atrial" chamber while another prosthetic valve was positioned at the outflow connection with flexible tubes, elastic balloons and a reservoir arranged to mimic the peripheral circulation. The flow model was filled with a 0.25% corn starch/water suspension to improve Doppler imaging. A continuous flow pump transferred the liquid from the peripheral reservoir to another one connected to the "atrial" chamber. The dimensions of the flow model were designed to permit adequate imaging by Doppler echocardiography. Acoustic windows allowed placement of transducers distal and perpendicular to the valves, so that the ultrasound beam could be positioned parallel to the valvular flow. Strain-gauge and electromagnetic transducers were used for measurements of pressure and flow in different segments of the system. The flow model was also designed to fit different sizes and types of prosthetic valves. This pulsatile flow model was able to generate pressure and flow in the physiological human range, with independent adjustment of pulse duration and rate as well as of stroke volume. This model mimics flow profiles observed in patients with regurgitant prosthetic valves.

Development and preliminary evaluation of a new anatomically based prosthetic alignment method for below-knee prosthesis.

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Tafti, Nahid; Karimlou, Masoud; Mardani, Mohammad Ali; Jafarpisheh, Amir Salar; Aminian, Gholam Reza; Safari, Reza

2018-04-20

The objectives of current study were to a) assess similarities and relationships between anatomical landmark-based angles and distances of lower limbs in unilateral transtibial amputees and b) develop and evaluate a new anatomically based static prosthetic alignment method. First sub-study assessed the anthropometrical differences and relationships between the lower limbs in the photographs taken from amputees. Data were analysed via paired t-test and regression analysis. Results show no significant differences in frontal and transverse planes. In the sagittal plane, the anthropometric parameters of the amputated limb were significantly correlated to the corresponding variables of the sound limb. The results served as bases for the development of a new prosthetic alignment method. The method was evaluated on a single subject study. Prosthetic alignment carried out by an experienced prosthetist was compared with such alignment adjusted by an inexperienced prosthetist but with the use of the developed method. In sagittal and frontal planes, the socket angle was tuned with respect to the shin angle, and the position of the prosthetic foot was tuned in relation to the pelvic landmarks. Further study is needed to assess the proposed method on a larger sample of amputees and prosthetists.

Prosthetic vision: devices, patient outcomes and retinal research.

Science.gov (United States)

Hadjinicolaou, Alex E; Meffin, Hamish; Maturana, Matias I; Cloherty, Shaun L; Ibbotson, Michael R

2015-09-01

Retinal disease and its associated retinal degeneration can lead to the loss of photoreceptors and therefore, profound blindness. While retinal degeneration destroys the photoreceptors, the neural circuits that convey information from the eye to the brain are sufficiently preserved to make it possible to restore sight using prosthetic devices. Typically, these devices consist of a digital camera and an implantable neurostimulator. The image sensor in a digital camera has the same spatiotopic arrangement as the photoreceptors of the retina. Therefore, it is possible to extract meaningful spatial information from an image and deliver it via an array of stimulating electrodes directly to the surviving retinal circuits. Here, we review the structure and function of normal and degenerate retina. The different approaches to prosthetic implant design are described in the context of human and preclinical trials. In the last section, we review studies of electrical properties of the retina and its response to electrical stimulation. These types of investigation are currently assessing a number of key challenges identified in human trials, including stimulation efficacy, spatial localisation, desensitisation to repetitive stimulation and selective activation of retinal cell populations. © 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.

Uptake of radiolabeled leukocytes in prosthetic graft infection

International Nuclear Information System (INIS)

Serota, A.I.; Williams, R.A.; Rose, J.G.; Wilson, S.E.

1981-01-01

The utility of radionuclide labeled leukocytes in the demonstration of infection within vascular prostheses was examined. The infrarenal aorta was replaced with a 3 cm Dacron graft in 12 dogs. On the third postoperative day, six of the animals received an intravenous injection of 10(8) Staphylococcus aureus. Labeled leukocyte scans were performed at postoperative days one and three, and then weekly for 8 weeks with indium-111 and technetium-99 labeled autologous leukocytes. When scans showed focal uptake of isotope in the area of prosthetic material, the grafts were aseptically excised and cultured on mannitol-salt agar. Both control and infected animals had retroperitoneal isotope activity in the immediate postoperative period that disappeared by the end of the first week. By the eighth postoperative week, all of the animals that received the bacteremic challenge had both radionuclide concentration in the region of the vascular prosthesis and S. aureus cultured subsequently from the perigraft tissues. None of the control animals had either radionuclide or bacteriologic evidence of infection at the eighth postoperative week. The radiolabeled leukocyte scan is a highly sensitive and specific technique, clinically applicable for the diagnosis of vascular prosthetic infections

Rapid Molecular Microbiologic Diagnosis of Prosthetic Joint Infection

Science.gov (United States)

Cazanave, Charles; Greenwood-Quaintance, Kerryl E.; Hanssen, Arlen D.; Karau, Melissa J.; Schmidt, Suzannah M.; Gomez Urena, Eric O.; Mandrekar, Jayawant N.; Osmon, Douglas R.; Lough, Lindsay E.; Pritt, Bobbi S.; Steckelberg, James M.

2013-01-01

We previously showed that culture of samples obtained by prosthesis vortexing and sonication was more sensitive than tissue culture for prosthetic joint infection (PJI) diagnosis. Despite improved sensitivity, culture-negative cases remained; furthermore, culture has a long turnaround time. We designed a genus-/group-specific rapid PCR assay panel targeting PJI bacteria and applied it to samples obtained by vortexing and sonicating explanted hip and knee prostheses, and we compared the results to those with sonicate fluid and periprosthetic tissue culture obtained at revision or resection arthroplasty. We studied 434 subjects with knee (n = 272) or hip (n = 162) prostheses; using a standardized definition, 144 had PJI. Sensitivities of tissue culture, of sonicate fluid culture, and of PCR were 70.1, 72.9, and 77.1%, respectively. Specificities were 97.9, 98.3, and 97.9%, respectively. Sonicate fluid PCR was more sensitive than tissue culture (P = 0.04). PCR of prosthesis sonication samples is more sensitive than tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection and provides same-day PJI diagnosis with definition of microbiology. The high assay specificity suggests that typical PJI bacteria may not cause aseptic implant failure. PMID:23658273

Evaluation of p53 Polymorphism in Patients with Pannus-Derived Prosthetic Dysfunction.

Science.gov (United States)

Gursoy, Mustafa Ozan; Karakoyun, Suleyman; Kalcik, Macit; Yesin, Mahmut; Gunduz, Sabahattin; Astarcioğlu, Mehmet Ali; Oğuz, Ali Emrah; Ozkan, Mehmet

2015-09-01

Prosthetic valve dysfunction (PVD) due to pannus formation is considered to occur due to a bioreaction to prosthetic material. The p53 gene plays a critical role in apoptosis and cell proliferation. p53 Arg72Pro polymorphism has been found to be associated with coronary stent restenosis, but has not yet been studied in prosthetic heart valve dysfunction. The study aim was to evaluate the association between pannus-derived PVD and p53 G72C(Arg72Pro) polymorphism. This single-center, prospective study included 25 patients (20 females, five males; mean age 45.6 +/- 12.5 years; group 1) who underwent redo valve surgery due to PVD, and 49 age- and gender-matched control patients (44 females, five males; mean age 47.3 +/- 12.2 years; group 2) with normofunctional prostheses. The prostheses were examined using transthoracic and transesophageal echocardiography. Analyses of p53 G72C(Arg72Pro) polymorphism were performed using Roche LightCyler 2.0 Real-time polymerase chain reaction. The most common location of replaced valves was the mitral position in both groups (88% and 89.8%, respectively). In group 1, normal alleles (GG) were observed in 12 patients (48%), while one patient (4%) showed a homozygous mutation (GC) and 12 patients (48%) showed a heterozygous mutation (CC). In group 2, 21 patients (42.9%) had normal alleles (GG), while four (8.2%) had a homozygous mutation (CC) and 24 (48.9%) had a heterozygous mutation (GC). No significant difference was observed between the groups with regards to p53 Arg72Pro polymorphism (p = 0.769). In patients with prosthetic valves, the underlying mechanism behind pannus formation is unrelated to p53 Arg72Pro polymorphism.

A personalized 3D-printed prosthetic joint replacement for the human temporomandibular joint: From implant design to implantation.

Science.gov (United States)

Ackland, David C; Robinson, Dale; Redhead, Michael; Lee, Peter Vee Sin; Moskaljuk, Adrian; Dimitroulis, George

2017-05-01

Personalized prosthetic joint replacements have important applications in cases of complex bone and joint conditions where the shape and size of off-the-shelf components may not be adequate. The objective of this study was to design, test and fabricate a personalized 3D-printed prosthesis for a patient requiring total joint replacement surgery of the temporomandibular joint (TMJ). The new 'Melbourne' prosthetic TMJ design featured a condylar component sized specifically to the patient and fixation screw positions that avoid potential intra-operative damage to the mandibular nerve. The Melbourne prosthetic TMJ was developed for a 58-year-old female recipient with end-stage osteoarthritis of the TMJ. The load response of the prosthesis during chewing and a maximum-force bite was quantified using a personalized musculoskeletal model of the patient's masticatory system developed using medical images. The simulations were then repeated after implantation of the Biomet Microfixation prosthetic TMJ, an established stock device. The maximum condylar stresses, screw stress and mandibular stress at the screw-bone interface were lower in the Melbourne prosthetic TMJ (259.6MPa, 312.9MPa and 198.4MPa, respectively) than those in the Biomet Microfixation device (284.0MPa, 416.0MPa and 262.2MPa, respectively) during the maximum-force bite, with similar trends also observed during the chewing bite. After trialing surgical placement and evaluating prosthetic TMJ stability using cadaveric specimens, the prosthesis was fabricated using 3D printing, sterilized, and implanted into the female recipient. Six months post-operatively, the prosthesis recipient had a normal jaw opening distance (40.0 mm), with no complications identified. The new design features and immediate load response of the Melbourne prosthetic TMJ suggests that it may provide improved clinical and biomechanical joint function compared to a commonly used stock device, and reduce risk of intra-operative nerve damage

Secure Microprocessor-Controlled Prosthetic Leg for Elderly Amputees: Preliminary Results

Directory of Open Access Journals (Sweden)

S. Krut

2011-01-01

Full Text Available We introduce a new prosthetic leg design, adapted to elderly trans-femoral amputees. Technical progress in prosthesis design mainly concerns active individuals. An important number of elderly amputees are not very mobile, tire easily, present reduced muscle strength, and have difficulties managing their balance. Therefore, the needs and characteristics of this specific population are very different from those of younger ones and the prosthetic solutions are not adapted. Our artificial knee has been designed to fulfill the specific requirements of this population in terms of capabilities, transfer assistance, security, intuitiveness, simplicity of use, and types of physical activity to be performed. We particularly focused our efforts on ensuring safe and secure stand-to-sit transfers. We developed an approach to control the different states of the prosthetic joint (blocked, free, resistant, associated with different physical activities. Amputee posture and motion are observed through a single multi-axis force sensor embedded in the prosthesis. The patient behaves naturally, while the controller analyses his movements in order to detect his intention to sit down. The detection algorithm is based on a reference pattern, calibrated individually, to which the sensor data are compared, and submitted to a set of tests allowing the discrimination of the intention to sit down from other activities. Preliminary validation of the system has been performed in order to verify the applicability of the prosthesis to different tasks: walking, standing, sitting down, standing up, picking up an object from a chair, slope and stair climbing.

Iodine-125 orbital brachytherapy with a prosthetic implant in situ

Energy Technology Data Exchange (ETDEWEB)

Stannard, Clare [Groote Schuur Hospital and Cape Town Univ. (South Africa). Dept. of Radiation Oncology; Maree, Gert; Munro, Roger [Groote Schuur Hospital and Cape Town Univ. (South Africa). Dept. of Medical Physics; Lecuona, Karin [Groote Schuur Hospital and Cape Town Univ. (South Africa). Dept. of Ophthalmology; Sauerwein, Wolfgang [Universitaetsklinikum Essen (Germany). Strahlenklinik, NCTeam

2011-05-15

Purpose: Brachytherapy is one method of irradiating the orbit after enucleation of an eye with a malignant tumor that has a potential to recur. It consists of 6 trains of I-125 seeds placed around the periphery of the orbit, a shorter central train, and a metal disc, loaded with seeds, placed beneath the eyelids. The presence of a prosthetic orbital implant requires omission of the central train and adjustment of the activity of the seeds in the anterior orbit around the prosthesis. Patients and Methods: This is a retrospective review of the technical modifications and outcome of 12 patients treated in this manner: 6 with retinoblastoma, 5 with malignant melanoma, and 1 with an intraocular rhabdomyosarcoma. The median dose was 35.5 Gy in 73 hours for retinoblastoma and 56 Gy in 141 hours for malignant melanoma. Patients with retinoblastoma and rhabdomyosarcoma also received chemotherapy. Results: The tubes can be placed satisfactorily around the prosthesis. The increased activity in the anterior half of the tubes produced comparable dose distributions. There have been no orbital recurrences, no extrusion of the prosthesis, and cosmesis is good. Conclusion: Insertion of a prosthetic implant at the time of enucleation greatly enhances the subsequent cosmetic appearance. This should be encouraged unless there is frank tumor in the orbit. Orbital brachytherapy without the central train continues to give excellent local control. The short treatment time and good cosmesis are added advantages. The patient is spared the expense and inconvenience of removing and replacing the prosthetic implant. (orig.)

Orthodontic Space Closure Versus Prosthetic Replacement of Missing Upper Lateral Incisors in Patients With Bilateral Cleft Lip and Palate

NARCIS (Netherlands)

Oosterkamp, Barbara C. M.; Dijkstra, Pieter U.; Remmelink, Hendrik J.; van Oort, Robert P.; Sandham, John

2010-01-01

Objective To compare dental aesthetics and function of orthodontic space closure versus prosthetic replacement of upper lateral incisors in patients with bilateral cleft lip and palate The predominant mode of prosthetic replacement was resin-bonded bridges Patients and Methods The retrospective

Cryopreserved Cadaveric Arterial Allograft for Arterial Reconstruction in Patients with Prosthetic Infection.

Science.gov (United States)

Lejay, Anne; Delay, Charline; Girsowicz, Elie; Chenesseau, Bettina; Bonnin, Emilie; Ghariani, Mohamed-Zied; Thaveau, Fabien; Georg, Yannick; Geny, Bernard; Chakfe, Nabil

2017-11-01

The aim of this study was to report outcomes of cryopreserved arterial allografts used as a vascular substitute in the setting of prosthetic material infection. A retrospective analysis of prospectively collected data was conducted including all consecutive interventions performed with cryopreserved arterial allografts used for vascular reconstruction in the setting of prosthetic material infection between January 2005 and December 2014. Five year outcomes included allograft related re-interventions, survival, primary patency, and limb salvage rates. Fifty-three procedures were performed using cryopreserved allografts for vascular prosthetic infection: 25 procedures (47%) were performed at aorto-iliac level (Group 1) and 28 procedures (53%) at peripheral level (Group 2). The mean follow-up was 52 months. Five year allograft related re-intervention was 55% in Group 1 (6 allograft ruptures and 5 allograft aneurysm degenerations) and 33% in Group 2 (2 allograft ruptures and 7 allograft aneurysm degenerations). Five year survival was 40% and 68%, primary patency was 89% and 59% and limb salvage was 100% and 89% for Group 1 and 2 respectively. Use of cryopreserved arterial allografts provides acceptable results but is tempered by suboptimal 5 year outcomes with high re-intervention rates. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Recurrent pannus formation causing prosthetic aortic valve dysfunction: Is excision without valve re-replacement applicable?

Directory of Open Access Journals (Sweden)

Darwazah Ahmad K

2012-06-01

Full Text Available Abstract Prosthetic valve dysfunction at aortic position is commonly caused by pannus formation. The exact etiology is not known. It arises from ventricular aspect of the prosthesis encroaching its leaflets causing stenosis or it may remain localized causing left ventricular outflow tract obstruction without affecting valve function. The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement. A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve. Management of our case presents several questions, whether recurrence of pannus is caused by sparing the prosthetic valve, is it simply an exaggeration of an inflammatory healing process in certain individuals or is it ideal to re-replace the valve despite a well preserved function.

[Ectodermal Capdepont syndrome and oral prosthetic rehabilitation. About a clinical case].

Science.gov (United States)

Kumpanya, P; Matshumba, M; Sekele, I B; Mayunga, M; Lutula, P S; Ntumba, M K

2015-03-01

The authors describe the ectodermal Capdepont syndrome as an anomaly characterized by anhidrosis, hypotrichosis and anodontia diagnosed in a 22 year-old adult. In front of this anodontia, oral prosthetic rehabilitation remains the only solution.

Design and clinical outcome of a novel 3D-printed prosthetic joint replacement for the human temporomandibular joint.

Science.gov (United States)

Ackland, David; Robinson, Dale; Lee, Peter Vee Sin; Dimitroulis, George

2018-05-11

Stock prosthetic temporomandibular joint replacements come in limited sizes, and do not always encompass the joint anatomy that presents clinically. The aims of this study were twofold. Firstly, to design a personalized prosthetic total joint replacement for the treatment of a patient's end-stage temporomandibular joint osteoarthritis, to implant the prosthesis into the patient, and assess clinical outcome 12-months post-operatively; and secondly, to evaluate the influence of changes in prosthetic condyle geometry on implant load response during mastication. A 48-year-old female patient with Grade-5 osteoarthritis to the left temporomandibular joint was recruited, and a prosthesis developed to match the native temporomandibular joint anatomy. The prosthesis was 3D printed, sterilized and implanted into the patient, and pain and function measured 12-months post-operatively. The prosthesis load response during a chewing-bite and maximum-force bite was evaluated using a personalized multi-body musculoskeletal model. Simulations were performed after perturbing condyle thickness, neck length and head sphericity. Increases in prosthetic condyle neck length malaligned the mandible and perturbed temporomandibular joint force. Changes in condylar component thickness greatly influenced fixation screw stress response, while a more eccentric condylar head increased prosthetic joint-contact loading. Post-operatively, the prosthetic temporomandibular joint surgery reduced patient pain from 7/10 to 1/10 on a visual analog scale, and increased intercisal opening distance from 22 mm to 38 mm. This study demonstrates effectiveness of a personalized prosthesis that may ultimately be adapted to treat a wide-range of end-stage temporomandibular joint conditions, and highlights sensitivity of prosthesis load response to changes in condylar geometry. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Prosthetic Workflow in the Digital Era

Directory of Open Access Journals (Sweden)

Lidia Tordiglione

2016-01-01

Full Text Available The purpose of this retrospective study was to clinically evaluate the benefits of adopting a full digital workflow for the implementation of fixed prosthetic restorations on natural teeth. To evaluate the effectiveness of these protocols, treatment plans were drawn up for 15 patients requiring rehabilitation of one or more natural teeth. All the dental impressions were taken using a Planmeca PlanScan® (Planmeca OY, Helsinki, Finland intraoral scanner, which provided digital casts on which the restorations were digitally designed using Exocad® (Exocad GmbH, Germany, 2010 software and fabricated by CAM processing on 5-axis milling machines. A total of 28 single crowns were made from monolithic zirconia, 12 vestibular veneers from lithium disilicate, and 4 three-quarter vestibular veneers with palatal extension. While the restorations were applied, the authors could clinically appreciate the excellent match between the digitally produced prosthetic design and the cemented prostheses, which never required any occlusal or proximal adjustment. Out of all the restorations applied, only one exhibited premature failure and was replaced with no other complications or need for further scanning. From the clinical experience gained using a full digital workflow, the authors can confirm that these work processes enable the fabrication of clinically reliable restorations, with all the benefits that digital methods bring to the dentist, the dental laboratory, and the patient.

Illusory movement perception improves motor control for prosthetic hands.

Science.gov (United States)

Marasco, Paul D; Hebert, Jacqueline S; Sensinger, Jon W; Shell, Courtney E; Schofield, Jonathon S; Thumser, Zachary C; Nataraj, Raviraj; Beckler, Dylan T; Dawson, Michael R; Blustein, Dan H; Gill, Satinder; Mensh, Brett D; Granja-Vazquez, Rafael; Newcomb, Madeline D; Carey, Jason P; Orzell, Beth M

2018-03-14

To effortlessly complete an intentional movement, the brain needs feedback from the body regarding the movement's progress. This largely nonconscious kinesthetic sense helps the brain to learn relationships between motor commands and outcomes to correct movement errors. Prosthetic systems for restoring function have predominantly focused on controlling motorized joint movement. Without the kinesthetic sense, however, these devices do not become intuitively controllable. We report a method for endowing human amputees with a kinesthetic perception of dexterous robotic hands. Vibrating the muscles used for prosthetic control via a neural-machine interface produced the illusory perception of complex grip movements. Within minutes, three amputees integrated this kinesthetic feedback and improved movement control. Combining intent, kinesthesia, and vision instilled participants with a sense of agency over the robotic movements. This feedback approach for closed-loop control opens a pathway to seamless integration of minds and machines. Copyright © 2018 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

Prosthetic rehabilitation of a patient after partial maxillectomy: A clinical report

OpenAIRE

Rodrigues, Shobha J.; Saldanha, Sharon

2011-01-01

Malignant melanoma of the oral cavity is very rare. This clinical report describes a method for prosthetic rehabilitation of a patient with malignant melanoma of the palate following partial maxillectomy with a closed hollow interim obturator.

Effects of prosthesis use on the capability to control myoelectric robotic prosthetic hands.

Science.gov (United States)

Atzori, Manfredo; Hager, Anne-Gabrielle Mittaz; Elsig, Simone; Giatsidis, Giorgio; Bassetto, Franco; Muller, Henning

2015-08-01

The natural control of robotic prosthetic hands with non-invasive techniques is still a challenge: myoelectric prostheses currently give some control capabilities; the application of pattern recognition techniques is promising and recently started to be applied in practice but still many questions are open in the field. In particular, the effects of clinical factors on movement classification accuracy and the capability to control myoelectric prosthetic hands are analyzed in very few studies. The effect of regularly using prostheses on movement classification accuracy has been previously studied, showing differences between users of myoelectric and cosmetic prostheses. In this paper we compare users of myoelectric and body-powered prostheses and intact subjects. 36 machine-learning methods are applied on 6 amputees and 40 intact subjects performing 40 movements. Then, statistical analyses are performed in order to highlight significant differences between the groups of subjects. The statistical analyses do not show significant differences between the two groups of amputees, while significant differences are obtained between amputees and intact subjects. These results constitute new information in the field and suggest new interpretations to previous hypotheses, thus adding precious information towards natural control of robotic prosthetic hands.

Multidisciplinary Treatment Approach for Prosthetic Vascular Graft Infection in the Thoracic Aortic Area

Science.gov (United States)

Watanabe, Yoshinori

2015-01-01

Prosthetic vascular graft infection in the thoracic aortic area is a rare but serious complication. Adequate management of the complication is essential to increase the chance of success of open surgery. While surgical site infection is suggested as the root cause of the complication, it is also related to decreased host tolerance, especially as found in elderly patients. The handling of prosthetic vascular graft infection has been widely discussed to date. This paper mainly provides a summary of literature reports published within the past 5 years to discuss issues related to multidisciplinary treatment approaches, including surgical site infection, timing of onset, diagnostic methods, causative pathogens, auxiliary diagnostic methods, antibiotic treatment, anti-infective structures of vascular prostheses, surgical treatment, treatment strategy against infectious aortic aneurysms, future surgical treatment, postoperative systemic therapy, and antimicrobial stewardship. A thorough understanding of these issues will enable us to prevent prosthetic vascular graft infection in the thoracic aortic area as far as possible. In the event of its occurrence, the early introduction of appropriate treatment is expected to cure the disease without worsening of the underlying pathological condition. PMID:26356686

Treatment Challenges of Prosthetic Hip Infection with Associated Iliacus Muscle Abscess: Report of 5 Cases and Literature Review.

Science.gov (United States)

Lawrenz, Joshua M; Mesko, Nathan W; Higuera, Carlos A; Molloy, Robert M; Simpfendorfer, Claus; Babic, Maja

2017-01-01

Prosthetic joint infection is an unfortunate though well-recognized complication of total joint arthroplasty. An iliacus and/or iliopsoas muscle abscess is a rarely documented presentation of hip prosthetic joint infection. It is thought an unrecognized retroperitoneal nidus of infection can be a source of continual seeding of the prosthetic hip joint, prolonging attempts to eradicate infection despite aggressive debridement and explant attempts. The current study presents five cases demonstrating this clinical scenario, and discusses various treatment challenges. In each case we report the patient's clinical history, pertinent imaging, management and outcome. Diagnosis of the iliacus muscle abscess was made using computed tomography imaging. In brief, the mean number of total drainage procedures (open and percutaneous) per patient was 4.2, and outcomes consisted of one patient with a hip girdlestone, two patients with delayed revisions, and two patients with retained prosthesis. All patients ended with functional pain and on oral antibiotic suppression with an average follow up of 18 months. This article highlights an iliacus muscle abscess as an unrecognized source of infection to a prosthetic hip. It demonstrates resilience to standard treatment protocols for prosthetic hip infection, and is associated with poor patient outcomes. Aggressive surgical debridement appears to remain critical to treatment success, and early retroperitoneal debridement of the abscess should be considered.

A three-dimensional finite element study on the stress distribution pattern of two prosthetic abutments for external hexagon implants.

Science.gov (United States)

Moreira, Wagner; Hermann, Caio; Pereira, Jucélio Tomás; Balbinoti, Jean Anacleto; Tiossi, Rodrigo

2013-10-01

The purpose of this study was to evaluate the mechanical behavior of two different straight prosthetic abutments (one- and two-piece) for external hex butt-joint connection implants using three-dimensional finite element analysis (3D-FEA). Two 3D-FEA models were designed, one for the two-piece prosthetic abutment (2 mm in height, two-piece mini-conical abutment, Neodent) and another one for the one-piece abutment (2 mm in height, Slim Fit one-piece mini-conical abutment, Neodent), with their corresponding screws and implants (Titamax Ti, 3.75 diameter by 13 mm in length, Neodent). The model simulated the single restoration of a lower premolar using data from a computerized tomography of a mandible. The preload (20 N) after torque application for installation of the abutment and an occlusal loading were simulated. The occlusal load was simulated using average physiological bite force and direction (114.6 N in the axial direction, 17.1 N in the lingual direction and 23.4 N toward the mesial at an angle of 75° to the occlusal plan). The regions with the highest von Mises stress results were at the bottom of the initial two threads of both prosthetic abutments that were tested. The one-piece prosthetic abutment presented a more homogeneous behavior of stress distribution when compared with the two-piece abutment. Under the simulated chewing loads, the von Mises stresses for both tested prosthetic-abutments were within the tensile strength values of the materials analyzed which thus supports the clinical use of both prosthetic abutments.

Incremental benefit of 3D transesophageal echocardiography: a case of a mass overlying a prosthetic mitral valve.

Science.gov (United States)

Tauras, James M; Zhang, Zhihang; Taub, Cynthia C

2011-05-01

A young woman with a mechanical mitral valve and prosthetic mitral stenosis underwent multiple imaging modalities (including transthoracic ECHO, fluoroscopy, and two-dimensional transesophageal ECHO) to determine the cause of her stenosis. Only three-dimensional transesophageal echocardiography demonstrated the full size and extent of an obstructing mass on the strut and sewing ring of the prosthetic mitral valve. © 2011, Wiley Periodicals, Inc.

Consumer satisfaction with the services of prosthetics and orthotics facilities

NARCIS (Netherlands)

Bosmans, Joline; Geertzen, Jan; Dijkstra, Pieter U.

2009-01-01

Consumer satisfaction with the services provided in a prosthetics and orthotics (PO) facility has seldom been studied. The aim of this study was to analyze consumer satisfaction regarding the services provided by 15 PO facilities in The Netherlands. Consumers (n=1,364) of these PO facilities who

Apparent culture-negative prosthetic valve endocarditis caused by Peptostreptococcus magnus

NARCIS (Netherlands)

van der Vorm, E. R.; Dondorp, A. M.; van Ketel, R. J.; Dankert, J.

2000-01-01

In two patients with prosthetic valve endocarditis due to Peptostreptococcus magnus, blood cultures in the BacT/Alert and BACTEC 9240 systems were signal negative. The capability of the BacT/Alert system to detect various Peptostreptococcus species was assessed. P. magnus and P. anaerobius could not

Method of making self-cleaning skin-like prosthetic polymer surfaces

Science.gov (United States)

Simpson, John T.; Ivanov, Ilia N.; Shibata, Jason

2017-06-06

An external covering and method of making an external covering for hiding the internal endoskeleton of a mechanical (e.g., prosthetic) device that exhibits skin-like qualities is provided. The external covering generally comprises an internal bulk layer in contact with the endoskeleton of the prosthetic device and an external skin layer disposed about the internal bulk layer. The external skin layer is comprised of a polymer composite with carbon nanotubes embedded therein. The outer surface of the skin layer has multiple cone-shaped projections that provide the external skin layer with superhydrophobicity. The carbon nanotubes are preferably vertically aligned between the inner surface and outer surface of the external skin layer in order to provide the skin layer with the ability to transmit heat. Superhydrophobic powders may optionally be used as part of the polymer composite or applied as a coating to the surface of the skin layer to enhance superhydrophobicity.

International normalized ratio self-management lowers the risk of thromboembolic events after prosthetic heart valve replacement.

Science.gov (United States)

Eitz, Thomas; Schenk, Soren; Fritzsche, Dirk; Bairaktaris, Andreas; Wagner, Otto; Koertke, Heinrich; Koerfer, Reiner

2008-03-01

Although prosthetic valves are durable and easy to implant, the need for lifetime warfarin-based anticoagulation restricts their exclusive usage. We investigated if anticoagulation self-management improves outcome in a single-center series. Between 1994 and 1998, 765 patients with prosthetic valve replacements were prospectively enrolled and randomized to receive conventional anticoagulation management by their primary physician (group 1, n = 295) or to pursue anticoagulation self-management (group 2, n = 470). A study head office was implemented to coordinate and monitor anticoagulation protocols, international normalized ratios (INR), and adverse events. Patients were instructed on how to obtain and test their own blood samples and to adjust warfarin dosages according to the measured INR (target range, 2.5 to 4). Mean INR values were slightly yet significantly smaller in group 1 than in group 2 (2.8 +/- 0.7 vs 3.0 +/- .6, p events were similar in both groups. Time-related multivariate analysis identified INR self-management and higher INR as independent predictors for better outcome. Anticoagulation self-management can improve INR profiles up to 2 years after prosthetic valve replacement and reduce adverse events. Current indications of prosthetic rather than biologic valve implantations may be extended if the benefit of INR self-management is shown by future studies with longer follow-up.

Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?

Science.gov (United States)

Cheng, Allen C.; Buising, Kirsty L.; Choong, Peter F. M.

2012-01-01

Prosthetic joint infections remain a major complication of arthroplasty. At present, local and international guidelines recommend cefazolin as a surgical antibiotic prophylaxis at the time of arthroplasty. This retrospective cohort study conducted across 10 hospitals over a 3-year period (January 2006 to December 2008) investigated the epidemiology and microbiological etiology of prosthetic joint infections. There were 163 cases of prosthetic joint infection identified. From a review of the microbiological culture results, methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci were isolated in 45% of infections. In addition, polymicrobial infections, particularly those involving Gram-negative bacilli and enterococcal species, were common (36%). The majority (88%) of patients received cefazolin as an antibiotic prophylaxis at the time of arthroplasty. In 63% of patients in this cohort, the microorganisms subsequently obtained were not susceptible to the antibiotic prophylaxis administered. The results of this study highlight the importance of ongoing reviews of the local ecology of prosthetic joint infection, demonstrating that the spectrum of pathogens involved is broad. The results should inform empirical antibiotic therapy. This report also provokes discussion about infection control strategies, including changing surgical antibiotic prophylaxis to a combination of glycopeptide and cefazolin, to reduce the incidence of infections due to methicillin-resistant staphylococci. PMID:22314530

Effects of alignment on the roll-over shapes of prosthetic feet.

Science.gov (United States)

Hansen, Andrew

2008-12-01

Recent work suggests that a prosthetic ankle-foot component's roll-over shape - the effective rocker it conforms to between initial contact and opposite initial contact (the 'roll-over' interval of walking) - is closely linked to its final alignment in the prosthesis (as determined by a skilled prosthetist using heuristic techniques). If true, this information may help to determine the appropriate alignment for a lower limb prosthesis before it is built, or a priori. Knowledge is needed for future models that will incorporate the roll-over shape including the relative effect of alignment on the roll-over shape's radius of curvature and arc length. The purpose of this study was to evaluate the hypotheses that: (i) Changes in prosthesis alignment alter the position and orientation of a foot's roll-over shape in prosthesis-based coordinates, and (ii) these changes occur without changing the radius of curvature or arc length of the roll-over shape. To examine the hypotheses, this study examined the effects of nine alignment settings on the roll-over shapes of two prosthetic feet. The idea that alignment changes move and rotate roll-over shapes of prosthetic feet in prosthesis coordinates is supported by this work, but the hypothesis that the radius of curvature and arc length do not change for different alignments is not strongly supported by the data. A revised approach is presented that explains some of the changes to the roll-over shape parameters due to changes in rotational alignment.

FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis

Energy Technology Data Exchange (ETDEWEB)

Kwee, Thomas C. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Kwee, Robert M. [University Medical Center Maastricht, Department of Radiology, Maastricht (Netherlands); Alavi, Abass [Hospital of the University of Pennsylvania, Division of Nuclear Medicine, Philadelphia, PA (United States)

2008-11-15

The aim of this study was to systematically review and metaanalyze published data on the diagnostic performance of {sup 18}F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) in detecting prosthetic hip or knee joint infection. A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Two reviewers independently assessed the methodological quality of each study. A metaanalysis of the reported sensitivity and specificity of each study was performed. Subgroup analyses were performed if results of individual studies were heterogeneous. The inclusion criteria were met by 11 studies; there was a total sample size of 635 prostheses. Overall, the studies had good methodological quality. Pooled sensitivity and specificity of FDG-PET for the detection of prosthetic hip or knee joint infection were 82.1% (95%CI = 68.0-90.8%) and 86.6% (95%CI = 79.7-91.4%), respectively. Heterogeneity among the results of individual studies was present (I {sup 2} = 68.8%). Diagnostic performance was influenced by type of joint prostheses (hip prostheses vs. knee prostheses) and type of reconstruction method used (filtered back vs. iterative) (p = 0.0164 and p = 0.0235, respectively). In this metaanalysis, overall diagnostic performance of FDG-PET was moderate to high. Caution is warranted, however, because results of individual studies were heterogeneous and could not be fully explored. Future studies should further explore potential causes of heterogeneity and validate the use of FDG-PET for diagnosing prosthetic joint infection. (orig.)

FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis

International Nuclear Information System (INIS)

Kwee, Thomas C.; Kwee, Robert M.; Alavi, Abass

2008-01-01

The aim of this study was to systematically review and metaanalyze published data on the diagnostic performance of 18 F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) in detecting prosthetic hip or knee joint infection. A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Two reviewers independently assessed the methodological quality of each study. A metaanalysis of the reported sensitivity and specificity of each study was performed. Subgroup analyses were performed if results of individual studies were heterogeneous. The inclusion criteria were met by 11 studies; there was a total sample size of 635 prostheses. Overall, the studies had good methodological quality. Pooled sensitivity and specificity of FDG-PET for the detection of prosthetic hip or knee joint infection were 82.1% (95%CI = 68.0-90.8%) and 86.6% (95%CI = 79.7-91.4%), respectively. Heterogeneity among the results of individual studies was present (I 2 = 68.8%). Diagnostic performance was influenced by type of joint prostheses (hip prostheses vs. knee prostheses) and type of reconstruction method used (filtered back vs. iterative) (p = 0.0164 and p = 0.0235, respectively). In this metaanalysis, overall diagnostic performance of FDG-PET was moderate to high. Caution is warranted, however, because results of individual studies were heterogeneous and could not be fully explored. Future studies should further explore potential causes of heterogeneity and validate the use of FDG-PET for diagnosing prosthetic joint infection. (orig.)

EFFECT OF POLYMER PROSTHETIC CONSTRUCTION TREATED WITH GLOW-DISCHARGE PLASMA ON ORAL MUCOSA (CLINICAL CASE

Directory of Open Access Journals (Sweden)

E. O. Kudasova

2017-01-01

Full Text Available Prosthetic material should induce minimal pathological reaction when in contact with the oral mucosa, especially during oral rehabilitation of patients with tumors of the oral mucosa. The article presents monitoring of a patient after surgery for cancer of the buccal mucosa at the stage of orthopedic rehabilitation. Treatment plan proposed complex oral rehabilitation. A maxillary complete removable denture was manufactured as well as metalloceramic and partial mandibular dentures. Plasma chemical modification of the removable dentures was planned after correction of the prosthetics and primary adaptation. Removable dentures were applied at the maxilla and mandibula. Per our recommendations, the patient was examined weekly for a month and monthly for 6 months. No new tumors or pathological elements were observed.Conclusions. Changes in critical surface tension of the removable dentures made of acrylic plastic improve their biological characteristics as demonstrated by positive clinical dynamics. Prosthetic constructions with hydrophilic surface are recommended in complex clinical cases when patients with tumors of the oral mucosa require dentures.

The efficacy of the Ankle Mimicking Prosthetic Foot prototype 4.0 during walking: Physiological determinants.

Science.gov (United States)

De Pauw, Kevin; Cherelle, Pierre; Roelands, Bart; Lefeber, Dirk; Meeusen, Romain

2018-04-01

Evaluating the effectiveness of a novel prosthetic device during walking is an important step in product development. To investigate the efficacy of a novel quasi-passive ankle prosthetic device, Ankle Mimicking Prosthetic Foot 4.0, during walking at different speeds, using physiological determinants in transtibial and transfemoral amputees. Nonrandomized crossover design for amputees. Six able-bodied subjects, six unilateral transtibial amputees, and six unilateral transfemoral amputees underwent a 6-min walk test at normal speed, followed by series of 2-min walking at slow, normal, and fast speeds. The intensity of effort and subjective measures were determined. Amputees performed all walking tests on a treadmill with current and novel prostheses. Shapiro-Wilk normality tests and parametric and nonparametric tests were conducted (p 4.0 is a novel quasi-passive ankle prosthesis with state-of-the-art technological parts. Subjective measures show the importance of this technology, but the intensity of effort during walking still remains higher compared to current passive prostheses, especially in transfemoral amputees.

Welding of Prosthetic Alloys / Spawanie Stopów Protetycznych Typu Co-Cr

Directory of Open Access Journals (Sweden)

Wojciechowska M.

2015-12-01

Full Text Available This paper presents the techniques of joining metal denture elements, used in prosthetic dentistry: the traditional soldering technique with a gas burner and a new technique of welding with a laser beam; the aim of the study was to make a comparative assessment of the quality of the joints in view of the possibility of applying them in prosthetic structures. Fractographic examinations were conducted along with tensile strength and impact strength tests, and the quality of the joints was assessed compared to the solid metal. The experiments have shown that the metal elements used to make dentures, joined by the technique which employs a laser beam, have better strength properties than those achieved with a gas burner.

In vitro activity of ceftaroline against staphylococci from prosthetic joint infection.

Science.gov (United States)

Park, Kyung-Hwa; Greenwood-Quaintance, Kerryl E; Patel, Robin

2016-02-01

We tested the in vitro activity of ceftaroline by Etest against staphylococci recovered from patients with prosthetic joint infection, including 97 Staphylococcus aureus isolates (36%, oxacillin resistant) and 74 Staphylococcus epidermidis isolates (74%, oxacillin resistant). Ceftaroline inhibited all staphylococci at ≤0.5 μg/mL. The ceftaroline MIC(90/50) values for methicillin-susceptible S. aureus, methicillin-susceptible S. epidermidis, methicillin-resistant S. aureus, and methicillin-resistant S. epidermidis were 0.19/0.125, 0.094/0.047, 0.5/0.38, and 0.38/0.19 μg/mL, respectively. Based on these in vitro findings, ceftaroline should be further evaluated as a potential therapeutic option for the treatment of prosthetic joint infection caused by methicillin-susceptible and methicillin-resistant S. aureus and S. epidermidis. Copyright © 2016 Elsevier Inc. All rights reserved.

A Mobile Motion Analysis System Using Intertial Sensors for Analysis of Lower Limb Prosthetics

Energy Technology Data Exchange (ETDEWEB)

Mueller, John Kyle P [ORNL; Ericson, Milton Nance [ORNL; Farquhar, Ethan [ORNL; Lind, Randall F [ORNL; Evans III, Boyd Mccutchen [ORNL

2011-01-01

Soldiers returning from the global war on terror requiring lower leg prosthetics generally have different concerns and requirements than the typical lower leg amputee. These subjects are usually young, wish to remain active and often desire to return to active military duty. As such, they demand higher performance from their prosthetics, but are at risk for chronic injury and joint conditions in their unaffected limb. Motion analysis is a valuable tool in assessing the performance of new and existing prosthetic technologies as well as the methods in fitting these devices to both maximize performance and minimize risk of injury for the individual soldier. We are developing a mobile, low-cost motion analysis system using inertial measurement units (IMUs) and two custom force sensors that detect ground reaction forces and moments on both the unaffected limb and prosthesis. IMUs were tested on a robot programmed to simulate human gait motion. An algorithm which uses a kinematic model of the robot and an extended Kalman filter (EKF) was used to convert the rates and accelerations from the gyro and accelerometer into joint angles. Compared to encoder data from the robot, which was considered the ground truth in this experiment, the inertial measurement system had a RMSE of <1.0 degree. Collecting kinematic and kinetic data without the restrictions and expense of a motion analysis lab could help researchers, designers and prosthetists advance prosthesis technology and customize devices for individuals. Ultimately, these improvements will result in better prosthetic performance for the military population.

Enhanced ultrasound for advanced diagnostics, ultrasound tomography for volume limb imaging and prosthetic fitting

Science.gov (United States)

Anthony, Brian W.

2016-04-01

Ultrasound imaging methods hold the potential to deliver low-cost, high-resolution, operator-independent and nonionizing imaging systems - such systems couple appropriate algorithms with imaging devices and techniques. The increasing demands on general practitioners motivate us to develop more usable and productive diagnostic imaging equipment. Ultrasound, specifically freehand ultrasound, is a low cost and safe medical imaging technique. It doesn't expose a patient to ionizing radiation. Its safety and versatility make it very well suited for the increasing demands on general practitioners, or for providing improved medical care in rural regions or the developing world. However it typically suffers from sonographer variability; we will discuss techniques to address user variability. We also discuss our work to combine cylindrical scanning systems with state of the art inversion algorithms to deliver ultrasound systems for imaging and quantifying limbs in 3-D in vivo. Such systems have the potential to track the progression of limb health at a low cost and without radiation exposure, as well as, improve prosthetic socket fitting. Current methods of prosthetic socket fabrication remain subjective and ineffective at creating an interface to the human body that is both comfortable and functional. Though there has been recent success using methods like magnetic resonance imaging and biomechanical modeling, a low-cost, streamlined, and quantitative process for prosthetic cup design and fabrication has not been fully demonstrated. Medical ultrasonography may inform the design process of prosthetic sockets in a more objective manner. This keynote talk presents the results of progress in this area.

Prosthetic rehabilitation of a patient after partial maxillectomy: A clinical report

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Shobha J Rodrigues

2011-01-01

Full Text Available Malignant melanoma of the oral cavity is very rare. This clinical report describes a method for prosthetic rehabilitation of a patient with malignant melanoma of the palate following partial maxillectomy with a closed hollow interim obturator.

Optical fiber Bragg grating-instrumented silicone liner for interface pressure measurement within prosthetic sockets of lower-limb amputees

Science.gov (United States)

Al-Fakih, Ebrahim; Arifin, Nooranida; Pirouzi, Gholamhossein; Mahamd Adikan, Faisal Rafiq; Shasmin, Hanie Nadia; Abu Osman, Noor Azuan

2017-08-01

This paper presents a fiber Bragg grating (FBG)-instrumented prosthetic silicone liner that provides cushioning for the residual limb and can successfully measure interface pressures inside prosthetic sockets of lower-limb amputees in a simple and practical means of sensing. The liner is made of two silicone layers between which 12 FBG sensors were embedded at locations of clinical interest. The sensors were then calibrated using a custom calibration platform that mimics a real-life situation. Afterward, a custom gait simulating machine was built to test the liner performance during an amputee's simulated gait. To validate the findings, the results were compared to those obtained by the commonly used F-socket mats. As the statistical findings reveal, both pressure mapping methods measured the interface pressure in a consistent way, with no significant difference (P-values ≥0.05). This pressure mapping technique in the form of a prosthetic liner will allow prosthetics professionals to quickly and accurately create an overall picture of the interface pressure distribution inside sockets in research and clinical settings, thereby improving the socket fit and amputee's satisfaction.

Leukocyte and bacteria imaging in prosthetic joint infection

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AWJM Glaudemans

2013-01-01

Full Text Available There has been a significant increase in the number of joint prosthesis replacements worldwide. Although relatively uncommon, complications can occur with the most serious being an infection. Various radiological and nuclear imaging techniques are available to diagnose prosthetic joint infections (PJI. In this review article, we describe the pathophysiology of PJI, the principles of nuclear medicine imaging and the differences between Single Photon Emission Computed Tomography (SPECT and Positron Emission Tomography (PET. The value of nuclear medicine techniques for clinical practice is also discussed.Then we provide an overview of the most often used radionuclide imaging techniques that may be helpful in diagnosing prosthetic joint infection: the 67Ga-citrate, labelled white blood cells in vitro and in vivo (monoclonal antibodies directed against specific targets on the leukocytes, and 18F-fluorodeoxyglucose (18F-FDG. We describe their working methods, the pitfalls, and the interpretation criteria. Furthermore, we review recent advances in imaging bacteria, a molecular imaging method that holds promises for the detection of occult infections. We conclude proposing two diagnostic flow-charts, based on data in the literature, that could help the clinicians to choose the best nuclear imaging method when they have a patient with suspicion of or with proven PJI.

Application of multi-modality image coregistration in paediatric prosthetic endocarditis

International Nuclear Information System (INIS)

Kitsos, T.; Chung, D.K.; Howman-Giles, R.; Lau, Y.H.; University of Technology, Sydney, NSW

2003-01-01

This is a case where coregistration of Gallium and chest CT scans provided important clinical information which had a significant impact on management decisions. A 13-year-old girl from Noumea was transferred to our hospital for further management of S.haemolyticus bacteraemia. She had a history of complex congenital heart disease, requiring several cardiac surgical procedures. Seven months earlier she had a patch repair of the ventricular septum and formation of a right ventricle to pulmonary artery conduit. On admission she was generally unwell and had hemoptysis. She had fever to 39.9 deg C, oximetry of 83 per cent on room air, finger clubbing and a cardiac murmur. Chest X-ray and CT scans showed widespread pulmonary consolidation with bilateral pleural effusions. An echocardiogram showed no evidence of endocarditis. The crucial diagnostic dilemma was whether she had pneumonia or prosthetic endocarditis: the latter was more ominous and entailed high risk surgery. A Gallium whole body scan with chest SPECT showed focal localisation in the right mid chest. However, its location could not be confidently defined. A specifically developed computer program was used to co-register the Gallium SPECT and chest CT scans. The co-registered images conclusively localised the Gallium scan lesion to the prosthetic pulmonary outflow conduit, consistent with endocarditis. This triggered referral for cardiac MRI, which confirmed the diagnosis. In summary co-registration allowed precise structural localisation of focal Gallium uptake in the prosthetic pulmonary outflow conduit, with profound impact on the patient's diagnosis and subsequent management. This is an example of the potential benefits of co-registering structural and functional imaging modalities. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

[Guided and computer-assisted implant surgery and prosthetic: The continuous digital workflow].

Science.gov (United States)

Pascual, D; Vaysse, J

2016-02-01

New continuous digital workflow protocols of guided and computer-assisted implant surgery improve accuracy of implant positioning. The design of the future prosthesis is based on the available prosthetic space, gingival height and occlusal relationship with the opposing and adjacent teeth. The implant position and length depend on volume, density and bone quality, gingival height, tooth-implant and implant-implant distances, implant parallelism, axis and type of the future prosthesis. The crown modeled on the software will therefore serve as a guide to the future implant axis and not the reverse. The guide is made by 3D printing. The software determines surgical protocol with the drilling sequences. The unitary or plural prosthesis, modeled on the software and built before surgery, is loaded directly after implant placing, if needed. These protocols allow for a full continuity of the digital workflow. The software provides the surgeon and the dental technician a total freedom for the prosthetic-surgery guide design and the position of the implants. The prosthetic project, occlusal and aesthetic, taking the bony and surgical constraints into account, is optimized. The implant surgery is simplified and becomes less "stressful" for the patient and the surgeon. Guided and computer-assisted surgery with continuous digital workflow is becoming the technique of choice to improve the accuracy and quality of implant rehabilitation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Biologically inspired multi-layered synthetic skin for tactile feedback in prosthetic limbs.

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Osborn, Luke; Nguyen, Harrison; Betthauser, Joseph; Kaliki, Rahul; Thakor, Nitish

2016-08-01

The human body offers a template for many state-of-the-art prosthetic devices and sensors. In this work, we present a novel, sensorized synthetic skin that mimics the natural multi-layered nature of mechanoreceptors found in healthy glabrous skin to provide tactile information. The multi-layered sensor is made up of flexible piezoresistive textiles that act as force sensitive resistors (FSRs) to convey tactile information, which are embedded within a silicone rubber to resemble the compliant nature of human skin. The top layer of the synthetic skin is capable of detecting small loads less than 5 N whereas the bottom sensing layer responds reliably to loads over 7 N. Finite element analysis (FEA) of a simplified human fingertip and the synthetic skin was performed. Results suggest similarities in behavior during loading. A natural tactile event is simulated by loading the synthetic skin on a prosthetic limb. Results show the sensors' ability to detect applied loads as well as the ability to simulate neural spiking activity based on the derivative and temporal differences of the sensor response. During the tactile loading, the top sensing layer responded 0.24 s faster than the bottom sensing layer. A synthetic biologically-inspired skin such as this will be useful for enhancing the functionality of prosthetic limbs through tactile feedback.

Neural-Network Control Of Prosthetic And Robotic Hands

Science.gov (United States)

Buckley, Theresa M.

1991-01-01

Electronic neural networks proposed for use in controlling robotic and prosthetic hands and exoskeletal or glovelike electromechanical devices aiding intact but nonfunctional hands. Specific to patient, who activates grasping motion by voice command, by mechanical switch, or by myoelectric impulse. Patient retains higher-level control, while lower-level control provided by neural network analogous to that of miniature brain. During training, patient teaches miniature brain to perform specialized, anthropomorphic movements unique to himself or herself.

Esthetics with prosthetics in case of maxillary canine transposition: A ...

African Journals Online (AJOL)

Esthetics with prosthetics in case of maxillary canine transposition: A clinical report. ... provides a helpful Frequently Asked Questions about PDFs. Alternatively, you can download the PDF file directly to your computer, from where it can be opened using a PDF reader. To download the PDF, click the Download link above.

Technetium-99m-labeled annexin V imaging for detecting prosthetic joint infection in a rabbit model.

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Tang, Cheng; Wang, Feng; Hou, Yanjie; Lu, Shanshan; Tian, Wei; Xu, Yan; Jin, Chengzhe; Wang, Liming

2015-05-01

Accurate and timely diagnosis of prosthetic joint infection is essential to initiate early treatment and achieve a favorable outcome. In this study, we used a rabbit model to assess the feasibility of technetium-99m-labeled annexin V for detecting prosthetic joint infection. Right knee arthroplasty was performed on 24 New Zealand rabbits. After surgery, methicillin-susceptible Staphylococcus aureus was intra-articularly injected to create a model of prosthetic joint infection (the infected group, n = 12). Rabbits in the control group were injected with sterile saline (n = 12). Seven and 21 days after surgery, technetium-99m-labeled annexin V imaging was performed in 6 rabbits of each group. Images were acquired 1 and 4 hours after injection of technetium-99m-labeled annexin V (150 MBq). The operated-to-normal-knee activity ratios were calculated for quantitative analysis. Seven days after surgery, increased technetium-99m-labeled annexin V uptake was observed in all cases. However, at 21 days a notable decrease was found in the control group, but not in the infected group. The operated-to-normal-knee activity ratios of the infected group were 1.84 ± 0.29 in the early phase and 2.19 ± 0.34 in the delay phase, both of which were significantly higher than those of the control group (P = 0.03 and P = 0.02). The receiver operator characteristic curve analysis showed that the operated-to-normal-knee activity ratios of the delay phase at 21 days was the best indicator, with an accuracy of 80%. In conclusion, technetium-99m-labeled annexin V imaging could effectively distinguish an infected prosthetic joint from an uninfected prosthetic joint in a rabbit model.

A mechatronics platform to study prosthetic hand control using EMG signals.

Science.gov (United States)

Geethanjali, P

2016-09-01

In this paper, a low-cost mechatronics platform for the design and development of robotic hands as well as a surface electromyogram (EMG) pattern recognition system is proposed. This paper also explores various EMG classification techniques using a low-cost electronics system in prosthetic hand applications. The proposed platform involves the development of a four channel EMG signal acquisition system; pattern recognition of acquired EMG signals; and development of a digital controller for a robotic hand. Four-channel surface EMG signals, acquired from ten healthy subjects for six different movements of the hand, were used to analyse pattern recognition in prosthetic hand control. Various time domain features were extracted and grouped into five ensembles to compare the influence of features in feature-selective classifiers (SLR) with widely considered non-feature-selective classifiers, such as neural networks (NN), linear discriminant analysis (LDA) and support vector machines (SVM) applied with different kernels. The results divulged that the average classification accuracy of the SVM, with a linear kernel function, outperforms other classifiers with feature ensembles, Hudgin's feature set and auto regression (AR) coefficients. However, the slight improvement in classification accuracy of SVM incurs more processing time and memory space in the low-level controller. The Kruskal-Wallis (KW) test also shows that there is no significant difference in the classification performance of SLR with Hudgin's feature set to that of SVM with Hudgin's features along with AR coefficients. In addition, the KW test shows that SLR was found to be better in respect to computation time and memory space, which is vital in a low-level controller. Similar to SVM, with a linear kernel function, other non-feature selective LDA and NN classifiers also show a slight improvement in performance using twice the features but with the drawback of increased memory space requirement and time

One-year incidence of prosthetic joint infection in total hip arthroplasty

DEFF Research Database (Denmark)

Gundtoft, P H; Pedersen, A B; Schønheyder, H C

2017-01-01

OBJECTIVE: To examine the trend of Prosthetic Joint Infections (PJI) following primary total hip arthroplasty (THA) and the antimicrobial resistance of the bacteria causing these infections. MATERIALS AND METHODS: We identified a population-based cohort of patients in the Danish Hip Arthroplasty...

Implantable electronics of a closed-loop system for controlling prosthetic hands

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Nikas Antonios

2017-09-01

Full Text Available This paper presents the design of implantable electronics as a part of a system for prosthetic hand control. Purpose of the implant is the sensing of electrical signals originating from biological tissue and the actuation of the same, therefore closing the loop and allowing for an improved control of the prosthetic hand. The implant contains two integrated circuits for eight channel EMG monitoring and four channel stimulation, respectively. An on-board microcontroller allows for local pre-processing. All intracorporeal to extracorporeal communications are running through and are directed by the main processing platform. The external components of the control system include, in addition to the main processing and control platform, the inductive power transfer circuits and the pressure sensors for the sensory feedback. Different assembly and encapsulation options are taken into account for the implantable electronics and are unified in a single PCB design.

Prevention of Infection in Orthopedic Prosthetic Surgery.

Science.gov (United States)

Chirca, Ioana; Marculescu, Camelia

2017-06-01

Total joint arthroplasty is a generally safe orthopedic procedure; however, infection is a potentially devastating complication. Multiple risk factors have been identified for development of prosthetic joint infections. Identification of patients at risk and preoperative correction of known risk factors, such as smoking, diabetes mellitus, anemia, malnutrition, and decolonization of Staphylococcus carriers, represent well-established actions to decrease the infection risk. Careful operative technique, proper draping and skin preparation, and appropriate selection and dosing of antimicrobials for perioperative prophylaxis are also very important in prevention of infection. Published by Elsevier Inc.

Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report.

Science.gov (United States)

Brandão, Mariana; Almeida, Jorge; Ferraz, Rita; Santos, Lurdes; Pinho, Paulo; Casanova, Jorge

2016-09-01

Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. Candida albicans is the most common etiological agent for this rare but increasingly frequent condition. We present a case of fungal prosthetic valve endocarditis due to C. albicans following aortic and pulmonary valve replacement in a 38-year-old woman with a history of surgically corrected tetralogy of Fallot, prior infective endocarditis and acute renal failure with need for catheter-based hemodialysis. Antifungal therapy with liposomal amphotericin B was initiated prior to cardiac surgery, in which the bioprostheses were replaced by homografts, providing greater resistance to recurrent infection. During hospitalization, a mycotic aneurysm was diagnosed following an episode of acute arterial ischemia, requiring two vascular surgical interventions. Despite the complications, the patient's outcome was good and she was discharged on suppressive antifungal therapy with oral fluconazole for at least a year. The reported case illustrates multiple risk factors for fungal endocarditis, as well as complications and predictors of poor prognosis, demonstrating its complexity. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Propionibacterium avidum as an Etiological Agent of Prosthetic Hip Joint Infection.

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Peter Wildeman

Full Text Available Propionibacterium acnes is well-established as a possible etiologic agent of prosthetic joint infections (PJIs. Other Propionibacterium spp. have occasionally been described as a cause of PJIs, but this has not previously been the case for P. avidum despite its capacity to form biofilm. We describe two patients with prosthetic hip joint infections caused by P. avidum. Both patients were primarily operated with an anteriorly curved skin incision close to the skin crease of the groin, and both were obese. Initial treatment was performed according to the DAIR procedure (debridement, antibiotics, and implant retention. In case 1, the outcome was successful, but in case 2, a loosening of the cup was present 18 months post debridement. The P. avidum isolate from case 1 and two isolates from case 2 (obtained 18 months apart were selected for whole genome sequencing. The genome of P. avidum obtained from case 1 was approximately 60 kb larger than the genomes of the two isolates of case 2. These latter isolates were clonal with the exception of SNPs in the genome. All three strains possessed the gene cluster encoding exopolysaccharide synthesis. P. avidum has a pathogenic potential and the ability to cause clinically relevant infections, including abscess formation, in the presence of foreign bodies such as prosthetic joint components. Skin incision in close proximity to the groin or deep skin crease, such as the anteriorly curved skin incision approach, might pose a risk of PJIs by P. avidum, especially in obese patients.

Performance of optimised prosthetic ankle designs that are based on a hydraulic variable displacement actuator (VDA)

OpenAIRE

Gardiner, JD; Bari, AZ; Kenney, LPJ; Twiste, M; Moser, D; Zahedi, S; Howard, D

2017-01-01

Current energy storage and return (ESR) prosthetic\\ud feet only marginally reduce the cost of amputee locomotion\\ud compared to basic solid ankle cushioned heel (SACH) feet,\\ud possibly due to their lack of push-off at the end of stance. To our knowledge, a prosthetic ankle that utilises a hydraulic variable displacement actuator (VDA) to improve push-off performance has not previously been proposed. Therefore, here we report a design optimisation and simulation feasibility study for a VDA ba...

Indium-111 leukocyte localization in infected prosthetic graft

Energy Technology Data Exchange (ETDEWEB)

Purnell, G.L.; Walker, C.W.; Allison, J.W.; Dalrymple, G.V. (Univ. of Arkansas for Medical Sciences, Little Rock (USA))

1990-08-01

Infective endocarditis can be difficult to prove, even in the face of strong clinical suspicion. A case in which standard methods of diagnosis failed to demonstrate endocarditis in a patient with recurrent Staphylococcus aureus bacteremia and porcine aortic valve is reported. An In-111 labelled leukocyte SPECT study demonstrated uptake in the aortic root and leaflets, and autopsy demonstrated vegetations on the leaflets. In-111 may prove useful in demonstrating endocarditis in patients with prosthetic valve infection.

Indium-111 leukocyte localization in infected prosthetic graft

International Nuclear Information System (INIS)

Purnell, G.L.; Walker, C.W.; Allison, J.W.; Dalrymple, G.V.

1990-01-01

Infective endocarditis can be difficult to prove, even in the face of strong clinical suspicion. A case in which standard methods of diagnosis failed to demonstrate endocarditis in a patient with recurrent Staphylococcus aureus bacteremia and porcine aortic valve is reported. An In-111 labelled leukocyte SPECT study demonstrated uptake in the aortic root and leaflets, and autopsy demonstrated vegetations on the leaflets. In-111 may prove useful in demonstrating endocarditis in patients with prosthetic valve infection

Diagnosis of arterial prosthetic graft infection by 111In oxine white blood cell scans

International Nuclear Information System (INIS)

McKeown, P.P.; Miller, D.C.; Jamieson, S.W.; Mitchell, R.S.; Reitz, B.A.; Olcott, C.; Mehigan, J.T.; Silberstein, R.J.; McDougall, I.R.

1982-01-01

Early and accurate diagnosis of infected prosthetic arterial grafts is difficult, despite the application of diverse diagnostic modalities. Delay in making the diagnosis is largely responsible for the high amputation and mortality rates associated with this complication. In nine patients with suspected graft infections, 111 In white blood cell scanning was useful and accurate. Graft infection was proved in five cases and ruled out in three. One false-positive scan was due to a sigmoid diverticular abscess overlying the graft. 111 In white blood cell scans may improve the accuracy of diagnosing infected prosthetic grafts, which may result in better limb and patient salvage rates

Prosthetic Complications and Maintenance Requirements in Locator-attached Implant-Supported Overdentures: A Retrospective Study.

Science.gov (United States)

Engelhardt, Frank; Zeman, Florian; Behr, Michael; Hahmel, Sebastian

2016-03-01

Retrospective data of 32 patients supplied with implant-supported and Locator-attached overdentures were screened for prosthetic complications and maintenance requirements, which were recorded and statistically analyzed. Mean observation time was 4.78 ± 1.72) years. Loss of retention was the most frequently observed event (n = 22). Damage and exchange of the insert holders (n = 4) and loosening of locator attachments (n = 2) and fracture of the insert holder (n = 2) were uncommon events; no loss of locator attachments was observed. Loss of retention in Locator-attached overdentures is frequent; correlating patient-specific parameters with prosthetic complications is necessary to define recommendations for the use of Locator attachments.

Orientation of handle for successful prosthetic treatment in patients with an anatomic compromise after a maxillectomy.

Science.gov (United States)

Sumita, Yuka I; Hattori, Mariko; Elbashti, Mahmoud E; Taniguchi, Hisashi

2017-05-01

This clinical technique provides a key procedure for successful prosthetic treatment in patients with an anatomical compromise after a maxillectomy. When making a preliminary impression, the clinician must keep the handle of the stock tray parallel to the patient's interpupillary line extraorally to maintain the correct position of the tray and to make a record of the inclination of the occlusal plane. This simple consideration during this first step of making a preliminary impression can be an important guide for both dentists and dental technicians. Information about the correct positioning of the tray and the inclination of the occlusal plane obtained by using a stock tray handle will greatly reduce the stress experienced by dentists, dental technicians, and patients during the fabrication of the prosthesis and will ultimately lead to successful prosthetic treatment in patients with anatomic compromise resulting from a maxillectomy. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Body mass and weight thresholds for increased prosthetic joint infection rates after primary total joint arthroplasty.

Science.gov (United States)

Lübbeke, Anne; Zingg, Matthieu; Vu, Diemlan; Miozzari, Hermes H; Christofilopoulos, Panayiotis; Uçkay, Ilker; Harbarth, Stephan; Hoffmeyer, Pierre

2016-01-01

Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate. We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories: prosthetic joint infection. The mean follow-up time was 6.5 years (0.5-18 years). 111 prosthetic joint infections were observed: 68 postoperative, 16 hematogenous, and 27 of undetermined cause. Incidence rates were similar in the first 3 BMI categories (infection from the early postoperative period onward (adjusted HR = 2.1, 95% CI: 1.3-3.6). BMI ≥ 35 or weight ≥ 100 kg may serve as a cutoff for higher perioperative dosage of antibiotics.

A Quality Function Deployment (QFD) approach to designing a prosthetic myoelectric hand

OpenAIRE

Erika Sofía Olaya Escobar; Carlos Julio Cortés Rodríguez; Óscar Germán Duarte Velasco

2005-01-01

This paper presents a Quality Function Deployment (QFD) model based on computing with words. It is specifically used in the House of Quality (HOQ) construction phase. It illustrates the methodology employed in designing a prosthetic myoelectric hand.

A STUDY OF INDICATIONS, COMPLICATIONS OF PROSTHETIC VALVES AND PROGNOSIS AFTER TREATMENT OF STUCK VALVE

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Y. V. Subba Reddy

2017-03-01

Full Text Available BACKGROUND Implantation of prosthetic cardiac valves to treat haemodynamically significant valvular diseases has become common; however, it is associated with complications. Thus, this study was intended to evaluate the indications for implantation of prosthetic valve and complications after its implantation and prognosis after treatment of one of its complication, i.e. stuck valve. MATERIALS AND METHODS This was a single-centered study wherein 50 patients who came to the emergency department with stuck valve were assessed. The 2D echocardiography was performed in all patients. Thrombolysis was done and the gradients were reassessed. Further response to treatment and development of complications before and after treatment were observed. RESULTS Of total patients, 60% were females. Mean age group was 30-40 yrs. Most of them were asymptomatic for 6 years and there was lack of compliance in 90% of patients. Most common indication for valve replacement was mitral stenosis (60% followed by mitral regurgitation (20%, aortic regurgitation and aortic stenosis (10% and combined mitral and tricuspid regurgitation (10%. Commonest valve was St. Jude (90%. Pannus was observed in 10% patients and thrombus was observed in 50% patients. Most patients had gradients 45/20 mmHg across mitral valve. In about 90% patients, gradients decreased after thrombolysis (12/5 mmHg. The complications after thrombolysis were hemiparesis (4%, death before thrombolysis (6% and death after thrombolysis (4%. CONCLUSION Considering these results, it can be concluded that prosthetic valves are seldom associated with some complications. Further, thrombolysis can be effective in patients with prosthetic valve thrombosis.

Aortic valve insufficiency in the teenager and young adult: the role of prosthetic valve replacement.

Science.gov (United States)

Bradley, Scott M

2013-10-01

The contents of this article were presented in the session "Aortic insufficiency in the teenager" at the congenital parallel symposium of the 2013 Society of Thoracic Surgeons (STS) annual meeting. The accompanying articles detail the approaches of aortic valve repair and the Ross procedure.(1,2) The current article focuses on prosthetic valve replacement. For many young patients requiring aortic valve surgery, either aortic valve repair or a Ross procedure provides a good option. The advantages include avoidance of anticoagulation and potential for growth. In other patients, a prosthetic valve is an appropriate alternative. This article discusses the current state of knowledge regarding mechanical and bioprosthetic valve prostheses and their specific advantages relative to valve repair or a Ross procedure. In current practice, young patients requiring aortic valve surgery frequently undergo valve replacement with a prosthetic valve. In STS adult cardiac database, among patients ≤30 years of age undergoing aortic valve surgery, 34% had placement of a mechanical valve, 51% had placement of a bioprosthetic valve, 9% had aortic valve repair, and 2% had a Ross procedure. In the STS congenital database, among patients 12 to 30 years of age undergoing aortic valve surgery, 21% had placement of a mechanical valve, 18% had placement of a bioprosthetic valve, 30% had aortic valve repair, and 24% had a Ross procedure. In the future, the balance among these options may be altered by design improvements in prosthetic valves, alternatives to warfarin, the development of new patch materials for valve repair, and techniques to avoid Ross autograft failure.

111 In-labeled leukocytes in the detection of prosthetic vascular graft infections

International Nuclear Information System (INIS)

Williamson, M.R.; Boyd, C.M.; Read, R.C.; Thompson, B.W.; Barnes, R.W.; Shah, H.R.; Balachandran, S.; Ferris, E.J.

1986-01-01

Making a clinical diagnosis of infection in prosthetic vascular grafts is difficult but when undiagnosed, this condition has a high mortality rate. Using Indium-111-labeled white-blood cells, 30 scans were performed in 21 patients suspected of having a prosthetic graft infection. The diagnosis of infected graft was confirmed by surgery in all cases, and lack of infection was established by resolution of symptoms with conservative therapy. Twenty-four hour scans of autologous Indium-111 leukocytes were obtained, and correlative CT studies were done in 11 cases. There were 13 infected grafts at surgery (purulent material present), and scans were positive in all (100% sensitivity); of 17 scans, there were 15 true negatives and two false positives (88% specificity). Using the criteria of gas or fluid around the graft, the sensitivity of CT was only 37% in a small subset of these patients. One-half of the cases in which infection was suspected clinically had no infection and had negative scans. Various types of grafts and graft materials were used, and there was no correlation with presence or absence of infection on the basis of the type of graft. Extragraft infection sites were found in five patients. In conclusion, use of Indium-111 leukocytes has been found to be an accurate and valuable diagnostic method for evaluation of suspected prosthetic vascular graft infection, and to have higher diagnostic accuracy than CT

An Approach for Pattern Recognition of EEG Applied in Prosthetic Hand Drive

Directory of Open Access Journals (Sweden)

Xiao-Dong Zhang

2011-12-01

Full Text Available For controlling the prosthetic hand by only electroencephalogram (EEG, it has become the hot spot in robotics research to set up a direct communication and control channel between human brain and prosthetic hand. In this paper, the EEG signal is analyzed based on multi-complicated hand activities. And then, two methods of EEG pattern recognition are investigated, a neural prosthesis hand system driven by BCI is set up, which can complete four kinds of actions (arm’s free state, arm movement, hand crawl, hand open. Through several times of off-line and on-line experiments, the result shows that the neural prosthesis hand system driven by BCI is reasonable and feasible, the C-support vector classifiers-based method is better than BP neural network on the EEG pattern recognition for multi-complicated hand activities.

Influence of pelvic position on radiographic measurements of the prosthetic acetabular component

International Nuclear Information System (INIS)

Thoren, B.; Sahlstedt, B.; Uppsala Univ.

1990-01-01

A change in the position of a prosthetic acetabular component between two different radiographic examinations indicates loosening, and may be observed as tilting or migration of the socket. To determine the apparent changes in socket position caused by improper positioning of the pelvis, a full-scale model of a pelvis with attached prosthetic sockets was examined radiographically in different positions. The projected alignment of the Charnley socket indicator wire against the inter-tuberosity line was markedly influenced by the positioning of the pelvis. An alternative way of measuring the alignment is to use the long axis of the projected ellipse of the outer circumferential groove in the socket polyethylene. The thus defined socket alignment was not influenced by the positioning of the pelvis within the investigated range. No apparent socket migration was recorded within the range of pelvic rotation and inclination studied. (orig.)

Global changes in Staphylococcus aureus gene expression during human prosthetic joint infection

DEFF Research Database (Denmark)

Xu, Yijuan; Nielsen, Per Halkjær; Nielsen, Jeppe Lund

2016-01-01

and Environmental Engineering, Aalborg University, Denmark 2: Danish Technological Institute, Aarhus, Denmark Aim: ”The aim of this study was to gain insight into the in vivo expression of virulence and metabolic genes of Staphylococcus aureus in a prosthetic joint infection in a human subject” Method: ”Deep RNA......Global changes in Staphylococcus aureus gene expression during human prosthetic joint infection Xu, Yijuan1; Nielsen, Per H.1; Nielsen, Jeppe L.1; Thomsen, Trine R. 1,2; Nielsen, Kåre L.1 and the PRIS study group 1: Center for Microbial Communities, Department of Biotechnology, Chemistry...... involved overexpression of various enzymes related to cell-wall synthesis and multidrug efflux pumps. Interestingly, these efflux pumps are only known to be related to fluoroquinolone resistance. Many of the genes encoding virulence factors were upregulated, including toxins and superantigen-like proteins...

Detection of a prosthetic aortic valvular abscess with indium-111-labeled leukocytes

Energy Technology Data Exchange (ETDEWEB)

Oates, E.; Sarno, R.C.

1988-10-01

An unsuspected annular abscess at the base of a prosthetic aortic valve in a patient with endocarditis was identified by indium-111-labeled leukocyte scintigraphy alone. This highly sensitive and specific technique expediently demonstrated the surgically proven inflammatory focus.

Detection of a prosthetic aortic valvular abscess with indium-111-labeled leukocytes

International Nuclear Information System (INIS)

Oates, E.; Sarno, R.C.

1988-01-01

An unsuspected annular abscess at the base of a prosthetic aortic valve in a patient with endocarditis was identified by indium-111-labeled leukocyte scintigraphy alone. This highly sensitive and specific technique expediently demonstrated the surgically proven inflammatory focus

Sensory feedback in upper limb prosthetics.

Science.gov (United States)

Antfolk, Christian; D'Alonzo, Marco; Rosén, Birgitta; Lundborg, Göran; Sebelius, Fredrik; Cipriani, Christian

2013-01-01

One of the challenges facing prosthetic designers and engineers is to restore the missing sensory function inherit to hand amputation. Several different techniques can be employed to provide amputees with sensory feedback: sensory substitution methods where the recorded stimulus is not only transferred to the amputee, but also translated to a different modality (modality-matched feedback), which transfers the stimulus without translation and direct neural stimulation, which interacts directly with peripheral afferent nerves. This paper presents an overview of the principal works and devices employed to provide upper limb amputees with sensory feedback. The focus is on sensory substitution and modality matched feedback; the principal features, advantages and disadvantages of the different methods are presented.

Local signaling from a retinal prosthetic in a rodent retinitis pigmentosa model in vivo

Science.gov (United States)

Fransen, James W.; Pangeni, Gobinda; Pardue, Machelle T.; McCall, Maureen A.

2014-08-01

Objective. In clinical trials, retinitis pigmentosa patients implanted with a retinal prosthetic device show enhanced spatial vision, including the ability to read large text and navigate. New prosthetics aim to increase spatial resolution by decreasing pixel/electrode size and limiting current spread. To examine spatial resolution of a new prosthetic design, we characterized and compared two photovoltaic array (PVA) designs and their interaction with the retina after subretinal implantation in transgenic S334ter line 3 rats (Tg S334ter-3). Approach. PVAs were implanted subretinally at two stages of degeneration and assessed in vivo using extracellular recordings in the superior colliculus (SC). Several aspects of this interaction were evaluated by varying duration, irradiance and position of a near infrared laser focused on the PVA. These characteristics included: activation threshold, response linearity, SC signal topography and spatial localization. The major design difference between the two PVA designs is the inclusion of local current returns in the newer design. Main results. When tested in vivo, PVA-evoked response thresholds were independent of pixel/electrode size, but differ between the new and old PVA designs. Response thresholds were independent of implantation age and duration (⩽7.5 months). For both prosthesis designs, threshold intensities were within established safety limits. PVA-evoked responses require inner retina synaptic transmission and do not directly activate retinal ganglion cells. The new PVA design evokes local retinal activation, which is not found with the older PVA design that lacks local current returns. Significance. Our study provides in vivo evidence that prosthetics make functional contacts with the inner nuclear layer at several stages of degeneration. The new PVA design enhances local activation within the retina and SC. Together these results predict that the new design can potentially harness the inherent processing within

From satisfaction to expectation: the patient's perspective in lower limb prosthetic care.

NARCIS (Netherlands)

Linde, H. van der; Hofstad, C.J.; Geertzen, J.H.; Postema, K.; Limbeek, J. van

2007-01-01

PURPOSE: To obtain information about the wishes and experiences of patients with a lower limb amputation with regard to prosthetic prescription and their exchange of information with the healthcare providers. METHOD: Design: Cross-sectional questionnaire. Setting: Outpatient clinic of a

From satisfaction to expectation : The patient's perspective in lower limb prosthetic care

NARCIS (Netherlands)

Van der Linde, Harmen; Hofstad, Cheriel J.; Geertzen, Jan H. B.; Postema, Klaas; Van Limbeek, Jacques

2007-01-01

Purpose. To obtain information about the wishes and experiences of patients with a lower limb amputation with regard to prosthetic prescription and their exchange of information with the healthcare providers. Method. Design: Cross-sectional questionnaire. Setting: Outpatient clinic of a

A Quality Function Deployment (QFD approach to designing a prosthetic myoelectric hand

Directory of Open Access Journals (Sweden)

Erika Sofía Olaya Escobar

2005-05-01

Full Text Available This paper presents a Quality Function Deployment (QFD model based on computing with words. It is specifically used in the House of Quality (HOQ construction phase. It illustrates the methodology employed in designing a prosthetic myoelectric hand.

Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections.

Science.gov (United States)

Genovese, Elizabeth A; Avgerinos, Efthymios D; Baril, Donald T; Makaroun, Michel S; Chaer, Rabih A

2016-12-01

There is limited investigation into the use of bio-absorbable antibiotic beads for the treatment of prosthetic vascular graft infections. Our goal was to investigate the rates of infection eradication, graft preservation, and limb salvage in patients who are not candidates for graft explant or extensive reconstruction. A retrospective review of patients implanted with antibiotic impregnated bio-absorbable calcium sulfate beads at a major university center was conducted. Six patients with prosthetic graft infections were treated with bio-absorbable antibiotics beads from 2012-2014. Grafts included an aortobifemoral, an aorto-hepatic/superior mesenteric artery, and four extra-anatomic bypasses. Pathogens included Gram-positive and Gram-negative bacteria. Half of the patients underwent graft explant with reconstruction and half debridement of the original graft, all with antibiotic bead placement around the graft. Mean follow-up was 7.3 ± 8.3 months; all patients had infection resolution, healed wounds, and 100% graft patency, limb salvage, and survival. This report details the successful use of bio-absorbable antibiotic beads for the treatment prosthetic vascular graft infections in patients at high risk for graft explant or major vascular reconstruction. At early follow-up, we demonstrate successful infection suppression, graft preservation, and limb salvage with the use of these beads in a subset of vascular patients. © The Author(s) 2016.

Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections

Science.gov (United States)

Genovese, Elizabeth A; Avgerinos, Efthymios D; Baril, Donald T; Makaroun, Michel S; Chaer, Rabih A

2017-01-01

Objective There is limited investigation into the use of bio-absorbable antibiotic beads for the treatment of prosthetic vascular graft infections. Our goal was to investigate the rates of infection eradication, graft preservation, and limb salvage in patients who are not candidates for graft explant or extensive reconstruction. Methods A retrospective review of patients implanted with antibiotic impregnated bio-absorbable calcium sulfate beads at a major university center was conducted. Results Six patients with prosthetic graft infections were treated with bio-absorbable antibiotics beads from 2012–2014. Grafts included an aortobifemoral, an aorto-hepatic/superior mesenteric artery, and four extra-anatomic bypasses. Pathogens included Gram-positive and Gram-negative bacteria. Half of the patients underwent graft explant with reconstruction and half debridement of the original graft, all with antibiotic bead placement around the graft. Mean follow-up was 7.3±8.3 months; all patients had infection resolution, healed wounds, and 100% graft patency, limb salvage, and survival. Conclusion This report details the successful use of bio-absorbable antibiotic beads for the treatment prosthetic vascular graft infections in patients at high risk for graft explant or major vascular reconstruction. At early follow-up, we demonstrate successful infection suppression, graft preservation, and limb salvage with the use of these beads in a subset of vascular patients. PMID:26896286

Cryopreserved Human Allografts for the Reconstruction of Aortic and Peripheral Prosthetic Graft Infection.

Science.gov (United States)

Bossi, Matteo; Tozzi, Matteo; Franchin, Marco; Ferraro, Stefania; Rivolta, Nicola; Ferrario, Massimo; Guttadauro, Chiara; Castelli, Patrizio; Piffaretti, Gabriele

2017-12-25

Background : This study aimed to present cases with cryopreserved human allografts (CHAs) for vascular reconstruction in both aortic and peripheral infected prosthetic grafts. Materials and Methods : This is a single center, observational descriptive study with retrospective analysis. In all cases, the infected prosthetic graft material was completely removed. At discharge, patients were administered anticoagulants. Follow-up examinations included clinical visits, echo-color-Doppler ultrasounds, or computed tomography angiography within 30 days and at 3, 6, and 12 months after the treatment, and then twice per year. Results : We treated 21 patients (90% men, n=19) with the mean age of 71±12 years and mean interval between the initial operation and replacement with CHA of 30 months [range, 1-216; interquartile range (IQR), 2-36]. In-hospital mortality was 14% (n=3); no CHA-related complication led to death. Limb salvage was 100%. No patient was lost at the median follow-up of 14 months (range, 2-61; IQR, 6-39). No rupture, aneurysmal degeneration, or re-infection occurred. Estimated freedom from CHA-related adverse events (95% confidence interval, 43-63) was 95% at 3 years. Conclusion : In our experience, CHAs are a viable option for prosthetic graft infections and provide satisfactory clinical results and favorable stability because of a very low rate of CHA-related adverse events during follow-up.

Visualization of a prosthetic vascular graft due to platelet contamination during 111Indium-labeled leukocyte scintigraphy

International Nuclear Information System (INIS)

Oates, E.; Ramberg, K.

1988-01-01

A prosthetic axillo-femoral bypass graft was visualized during 111 In-labeled leukocyte scintigraphy in a patient referred for possible abdominal abscess. The presence of significant cardiac blood-pool activity raised the possibility that this uptake was due to deposition of contaminating labeled platelets rather than labeled leukocytes. An analysis of a small sample of the patient's blood confirmed that the circulating activity was due to labeled platelets. Increased activity along prosthetic vascular grafts in patients undergoing 111 In-labeled leukocyte scintigraphy may be due to adherent platelet, and not indicative of infection

Candida glabrata prosthetic joint infection, successfully treated with anidulafungin: A case report and review of the literature.

Science.gov (United States)

Koutserimpas, Christos; Samonis, George; Velivassakis, Emmanouil; Iliopoulou-Kosmadaki, Stylliani; Kontakis, Georgios; Kofteridis, Diamantis P

2018-04-01

Non-albicans Candida prosthetic joint infection (PJI) is extremely rare. A case of a Candida glabrata knee PJI is a 68-year-old splenectomised female smoker, suffering from chronic obstructive pulmonary disease (COPD) and alcoholism is reported. The patient presented with a peri-prosthetic fracture, 15 years after total knee replacement surgery. Cultures of the intraoperative peri-prosthetic tissue and materials yielded C. glabrata, as well as a methicillin-resistant S. epidermitis. The patient was treated with anidulafungin and vancomycin. The knee prosthetic joint was removed and cement-spacer with vancomycin and gentamycin was placed. Additionally, an external fixation was performed. A second stage revision surgery was planned, after completion of the antimicrobial and antifungal treatment. The patient is followed up for 4 months without signs, symptoms or findings of infection. PJI Candida infections require a high clinical suspicion index. It is of utmost importance to report these cases, since there is no consensus yet of the proper antifungal treatment. Furthermore, a literature review regarding treatment of those cases is provided. First-line treatment with an echinocandin seems most proper, due to their fungicidal properties, their effectiveness against biofilm, as well as their minimal toxicity, making them ideal for long-term use. Further experience is needed, for better understanding the disease's pathogenesis and optimal treatment. © 2017 Blackwell Verlag GmbH.

Impact of depressive symptoms on prosthetic status--results of the study of health in Pomerania (SHIP).

Science.gov (United States)

Samietz, Stefanie A; Kindler, Stefan; Schwahn, Christian; Polzer, Ines; Hoffmann, Wolfgang; Kocher, Thomas; Grabe, Hans Jörgen; Mundt, Torsten; Biffar, Reiner

2013-05-01

Previous investigations have confirmed that every fifth dental patient suffers from clinically significant depressive symptoms. However, the putative impact of depressive symptoms on the prosthetic status has not been addressed in these studies. The objective of this study was to investigate the association between depressive symptoms and prosthetic status based on data from the Study of Health in Pomerania (SHIP-0). Data from 2,135 participants aged 30 to 59 years were analyzed. A classification (six classes regarding the number and position of missing teeth per jaw) was used to identify the degree of prosthetic status (no/suboptimal/optimal tooth replacement). The presence of depressive symptoms was assessed with a modified version of von Zerssen's complaints scale. Screening for lifetime diagnoses of mental disorders was performed with the Composite International Diagnostic-Screener (CID-S). Multivariable logistic regressions including several confounders were calculated. A significant protective dose-response effect of depressive symptoms on prosthetic status was found only in men for the lower jaw [0-1 depressive symptoms: odds ratio (OR) = 3.84, 95 % confidence interval (CI, 1.65-8.92), p < 0.01; 2-3: OR = 2.87 (CI, 1.22-6.74), p < 0.05; reference, ≥8; adjusted for age, school education, smoking status, household income, marital status, living without a partner, risky alcohol consumption, obesity, diabetes, and physical activity]. There was no such association in women or for the upper jaw. The analyses using the CID-S confirmed these results. In the lower jaw, men with depressive symptoms had a better prosthetic status than men without depressive symptoms suggesting a higher level of concern regarding their personal health. If dentists might have an opportunity to identify men with depressive symptoms they can provide a wide range of treatment options that may enhance patients' self-esteem and contribute to the patient' well-being. Furthermore, depressive

Novel imaging strategies for the detection of prosthetic heart valve obstruction and endocarditis

NARCIS (Netherlands)

W. Tanis (Wilco); R.P.J. Budde (Ricardo); I.A.C. van der Bilt (Ivo); B. Delemarre; G. Hoohenker; J.-K. Van Rooden; A.M. Scholtens (Asbjørn M.); J. Habets; S.A.J. Chamuleau (Steven)

2016-01-01

textabstractProsthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission

Tooth loss, prosthetic status and treatment needs among industrial workers in Belgaum, Karnataka, India.

Science.gov (United States)

Patil, Vishal V; Shigli, Kamal; Hebbal, Mamata; Agrawal, Neha

2012-01-01

The health of industrial workers often goes uncared for due to their stressful working conditions, busy schedules and poor economic conditions. A cross-sectional survey was conducted to determine the prevalence of tooth loss, prosthetic status and treatment needs among industrial workers in Belgaum, Karnataka, India according to the criteria described in the World Health Organization (WHO) Oral Health Assessment form (1997). A total of 614 workers participated in the study. Information was obtained regarding their oral hygiene practice. The presence or absence of habits, and the frequency and duration since the last visit to a dentist were recorded followed by clinical examination. Chi-square test was used to determine the association between the variables and tooth loss. There was a statistically significant difference between the number of missing teeth in different age groups, methods of cleaning, smoking habits and visits to the dentist. Regarding prosthetic status, only one worker had a fixed prosthesis in the mandibular arch. The study revealed that tooth loss was associated with oral hygiene practices, habits and visits to the dentist. Poor prosthetic status and high treatment needs were observed. This study emphasized the need for improved dental health awareness and availability of dental facilities to industrial workers.

Unilateral lower-limb loss: prosthetic device use and functional outcomes in servicemembers from Vietnam war and OIF/OEF conflicts.

Science.gov (United States)

Gailey, Robert; McFarland, Lynne V; Cooper, Rory A; Czerniecki, Joseph; Gambel, Jeffrey M; Hubbard, Sharon; Maynard, Charles; Smith, Douglas G; Raya, Michele; Reiber, Gayle E

2010-01-01

Rehabilitation goals following major combat-associated limb loss in World War II and the Vietnam war focused on treatment of the injury and a return to civilian life. The goal for Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) servicemembers is to restore function to the greatest possible degree and, if they desire, return them to Active Duty, by providing them with extensive rehabilitation services and a variety of prosthetic devices. Our study determines the usefulness of these diverse types of prosthetic devices for restoring functional capability and documents prosthesis use and satisfaction. We compare servicemembers and veterans with major combat-associated unilateral lower-limb loss: 178 from the Vietnam war and 172 from OIF/OEF conflicts. Of survey participants with unilateral lower-limb loss, 84% of the Vietnam group and 94% of the OIF/OEF group currently use at least one prosthetic device. Reasons for rejection varied by type of device, but common reasons were pain, prosthesis too heavy, and poor fit. Abandonment is infrequent (11% Vietnam group, 4% OIF/OEF group). Future efforts should aim to improve prosthetic-device design, decrease pain, and improve quality of life for these veterans and servicemembers.

Differential contributions of specimen types, culturing, and 16S rRNA sequencing in diagnosis of prosthetic joint infections

DEFF Research Database (Denmark)

Larsen, Lone Heimann; Khalid, Vesal; Xu, Yijuan

2018-01-01

to variations in specimen sampling. In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). Project specimens included joint...... fluid (JF), bone biopsy specimens (BB), soft-tissue biopsy specimens (STB), and swabs (SW) from the prosthesis, collected in situ, and sonication fluid collected from prosthetic components (PC). Specimens were cultured for 6 (conventional) or 14 days, and 16S rRNA sequencing was performed at study...... completion. Of the 156 patients enrolled, 111 underwent 114 surgical revisions (cases) due to indications of either PJI (n = 43) or AF (n = 71). Conventional tissue biopsy cultures confirmed PJI in 28/43 (65%) cases and refuted AF in 3/71 (4%) cases; one case was not evaluable. Based on these results, minor...

Novel imaging strategies for the detection of prosthetic heart valve obstruction and endocarditis

NARCIS (Netherlands)

Tanis, W; Budde, R P J; van der Bilt, I A C; Delemarre, B; Hoohenkerk, G; van Rooden, J-K; Scholtens, A M; Habets, J; Chamuleau, S

Prosthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission tomography including

The Gore-Tex prosthetic ligament as a salvage procedure in deficient knees

NARCIS (Netherlands)

Roolker, W.; Patt, T. W.; van Dijk, C. N.; Vegter, M.; Marti, R. K.

2000-01-01

The purpose of this study was to evaluate the results of prosthetic ligament replacement of the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) with the Gore-Tex polytetrafluorethyene prosthesis (W.L. Gore and Co., Flagstaff, Ariz. ) in 52 patients (54 knees). All patients

Spark erosion implant prosthetics in the management of an acquired maxillofacial defect.

Science.gov (United States)

Bloem, T J; Baxter, W D; Vivas, J

1996-03-01

The concept and use of spark erosion (EDM) prosthetics in implant prosthodontics has been described and demonstrated in its application to a patient suffering maxillofacial trauma. The advantages and disadvantages of this technology have been discussed for the edification of the restorative and surgical provider.

Conservative treatment of vascular prosthetic graft infection is associated with high mortality

NARCIS (Netherlands)

Saleem, Ben R.; Meetwaldt, Robbert; Tielliu, Ignace F. J.; Verhoeven, Eric L. G.; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

BACKGROUND: The aim of this study was to identify patient-related and/or disease-related factors that influence outcomes in patients with vascular prosthetic graft infections. METHODS: Through the hospital patient administration system, between January 1997 and December 2007, a total of 44 patients

Efficacy of Antibiotic Suppressive Therapy in Patients with a Prosthetic Joint Infection

NARCIS (Netherlands)

Wouthuyzen-Bakker, Marjan; Nijman, Jasperina M; Kampinga, Greetje A; van Assen, Sander; Jutte, Paul C

2017-01-01

Introduction: For chronic prosthetic joint infections (PJI), complete removal of the infected prosthesis is necessary in order to cure the infection. Unfortunately, a subgroup of patients is not able to undergo a revision surgery due to high surgical risk. Alternatively, these patients can be

Experimental Study of Real-Time Classification of 17 Voluntary Movements for Multi-Degree Myoelectric Prosthetic Hand

Directory of Open Access Journals (Sweden)

Trongmun Jiralerspong

2017-11-01

Full Text Available The myoelectric prosthetic hand is a powerful tool developed to help people with upper limb loss restore the functions of a biological hand. Recognizing multiple hand motions from only a few electromyography (EMG sensors is one of the requirements for the development of prosthetic hands with high level of usability. This task is highly challenging because both classification rate and misclassification rate worsen with additional hand motions. This paper presents a signal processing technique that uses spectral features and an artificial neural network to classify 17 voluntary movements from EMG signals. The main highlight will be on the use of a small set of low-cost EMG sensor for classification of a reasonably large number of hand movements. The aim of this work is to extend the capabilities to recognize and produce multiple movements beyond what is currently feasible. This work will also show and discuss about how tailoring the number of hand motions for a specific task can help develop a more reliable prosthetic hand system. Online classification experiments have been conducted on seven male and five female participants to evaluate the validity of the proposed method. The proposed algorithm achieves an overall correct classification rate of up to 83%, thus, demonstrating the potential to classify 17 movements from 6 EMG sensors. Furthermore, classifying 9 motions using this method could achieve an accuracy of up to 92%. These results show that if the prosthetic hand is intended for a specific task, limiting the number of motions can significantly increase the performance and usability.

Prosthetic valve endocarditis after transcatheter aortic valve implantation

DEFF Research Database (Denmark)

Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H

2015-01-01

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural......%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate...

Potentiometric stripping analysis of lead and cadmium leaching from dental prosthetic materials and teeth

Directory of Open Access Journals (Sweden)

GORAN M. NIKOLIC

2004-07-01

Full Text Available Potentiometric stipping analysis (PSA was applied for the determination of lead and cadmium leaching from dental prosthetic materials and teeth. The soluble lead content in finished dental implants was found to be much lower than that of the individual components used for their preparation. Cadmium was not detected in dental implants and materials under the defined conditions. The soluble lead and cadmium content of teeth was slightly lower than the lead and cadmium content in whole teeth (w/w reported by other researchers, except in the case of a tooth with removed amalgam filling. The results of this work suggest that PSA may be a good method for lead and cadmium leaching studies for investigation of the biocompatibility of dental prosthetic materials.

Prosthetic rehabilitation of oral submucous fibrosis patients: A systematic review of published case reports and case series.

Directory of Open Access Journals (Sweden)

Shankargouda Patil

Full Text Available Oral submucous fibrosis (OSF is an insidious chronic condition characterized by restricted mouth opening. Prosthetic rehabilitation is challenging for OSF patients as obtaining a good impression requires adequate mouth opening. The aim of the present review is to systematically present the data from case reports published in the English-language literature.A comprehensive search of the literature databases (PubMed, Medline, SCOPUS, Web of Science and Google Scholar along with the references of published articles on prosthetic rehabilitation in OSF patients published to date was conducted. Keywords included a combination of 'Oral submucous fibrosis', 'prosthesis', 'dentures' and/or 'restricted mouth opening'. Citations from selected references and bibliographic linkages taken from similar cases were included in this review. The inclusion criteria selected for case reports on prosthetic rehabilitation in OSF patients, and cases of restricted mouth opening due to causes other than OSF were excluded from the study.A total of 21 cases were identified and analysed from 17 papers published in the English-language literature. Of these, 9 cases employed the sectional denture technique, 4 cases emphasized the need-based treatment approach in which conventional methods were modified, and 4 cases used mouth exercising devices. Finally, 1 case each involved, flexible denture, oral screen prosthesis, oral stents, surgery in conjunction with dentures.Prosthetic rehabilitation in OSF patients is a multifaceted approach and should be patient specific, although sectional dentures have achieved the best results.

Prosthetic rehabilitation of oral submucous fibrosis patients: A systematic review of published case reports and case series.

Science.gov (United States)

Patil, Shankargouda; Sarode, Sachin Chakradhar; Sarode, Gargi S; Bhandi, Shilpa; Awan, Kamran Habib; Ferrari, Marco

2017-01-01

Oral submucous fibrosis (OSF) is an insidious chronic condition characterized by restricted mouth opening. Prosthetic rehabilitation is challenging for OSF patients as obtaining a good impression requires adequate mouth opening. The aim of the present review is to systematically present the data from case reports published in the English-language literature. A comprehensive search of the literature databases (PubMed, Medline, SCOPUS, Web of Science and Google Scholar) along with the references of published articles on prosthetic rehabilitation in OSF patients published to date was conducted. Keywords included a combination of 'Oral submucous fibrosis', 'prosthesis', 'dentures' and/or 'restricted mouth opening'. Citations from selected references and bibliographic linkages taken from similar cases were included in this review. The inclusion criteria selected for case reports on prosthetic rehabilitation in OSF patients, and cases of restricted mouth opening due to causes other than OSF were excluded from the study. A total of 21 cases were identified and analysed from 17 papers published in the English-language literature. Of these, 9 cases employed the sectional denture technique, 4 cases emphasized the need-based treatment approach in which conventional methods were modified, and 4 cases used mouth exercising devices. Finally, 1 case each involved, flexible denture, oral screen prosthesis, oral stents, surgery in conjunction with dentures. Prosthetic rehabilitation in OSF patients is a multifaceted approach and should be patient specific, although sectional dentures have achieved the best results.

Identification of critical zones in the flow through prosthetic heart valves

Science.gov (United States)

Lopez, A.; Ledesma, R.; Zenit, R.; Pulos, G.

2008-11-01

The hemodynamic properties of prosthetic heart valves can cause blood damage and platelet activation due to the non- physiological flow patterns. Blood recirculation and elevated shear stresses are believed to be responsible for these complications. The objective of this study is to identify and quantify the conditions for which recirculation and high stress zones appear. We have performed a comparative study between a mechanical monoleaflet and biological valve. In order to generate the flow conditions to test the prosthesis, we have built a hydraulic circuit which reproduces the human systemic circulation, on the basis of the Windkessel model. This model is based on an electrical analogy which consists of an arterial resistance and compliance. Using PIV 3D- Stereo measurements, taken downstream from the prosthetic heart valves, we have reconstructed the full phase-averaged tridimensional velocity field. Preliminary results show that critical zones are more prominent in mechanical prosthesis, indicating that valves made with bio-materials are less likely to produce blood trauma. This is in accordance with what is generally found in the literature.

Prosthetic above-knee femoropopliteal bypass grafting: five-year results of a randomized trial.

Science.gov (United States)

Green, R M; Abbott, W M; Matsumoto, T; Wheeler, J R; Miller, N; Veith, F J; Money, S; Garrett, H E

2000-03-01

This trial was designed to identify factors affecting patency rates of primary prosthetic above-knee femoropopliteal bypass grafts at 5 years. A multi-institutional, prospective trial randomized 240 patients to compare patency rates of Gore-tex and Hemashield above-knee femoropopliteal bypass grafts at 5 years. Univariate comparisons of patency between levels of each prognostic variable were made with the Kaplan-Meier method. Variables that had a univariate P value less than.25 or those known to be important were submitted to a Cox regression analysis. The patient survival rate at 5 years was 59.4%. There were no differences in primary or secondary patency rates at 5 years between the two graft materials (primary, 45% vs 43% and secondary, 68% vs 68%). The risk for graft occlusion was significantly increased for patients younger than 65 years (2.1; P =.001) and for grafts with a diameter less than 7 mm (1.65; P =.0219). Variables with no apparent independent effect on patency rates were smoking status, runoff, diabetes mellitus, sex, presenting symptoms, and postoperative treatment with aspirin or Coumadin. Noninvasive test results were not predictive of subsequent graft function. Although the type of prosthetic used for above-knee femoropopliteal bypass grafts does not affect 5-year patency rates, age and graft size do influence results. These factors should be considered before a prosthetic bypass grafting procedure. Furthermore, these data should serve as a contemporary standard, with which evolving and conventional procedures can be compared.

[Prosthetic replacement of missing teeth. Indications for fixed and removable dental prostheses

NARCIS (Netherlands)

Witter, D.J.; Gerritsen, A.E.; Baat, C. de; Creugers, N.H.J.

2014-01-01

Prosthetic replacement of missing teeth aims to improve health. This can be achieved by improving the patient's well-being and quality of life and by restoring the biological balance in terms ofocclusal and mandibular stability in the occlusal and the orofacial system. In occlusal systems with a

A photogrammetry-based system for 3D surface reconstruction of prosthetics and orthotics.

Science.gov (United States)

Li, Guang-kun; Gao, Fan; Wang, Zhi-gang

2011-01-01

The objective of this study is to develop an innovative close range digital photogrammetry (CRDP) system using the commercial digital SLR cameras to measure and reconstruct the 3D surface of prosthetics and orthotics. This paper describes the instrumentation, techniques and preliminary results of the proposed system. The technique works by taking pictures of the object from multiple view angles. The series of pictures were post-processed via feature point extraction, point match and 3D surface reconstruction. In comparison with the traditional method such as laser scanning, the major advantages of our instrument include the lower cost, compact and easy-to-use hardware, satisfactory measurement accuracy, and significantly less measurement time. Besides its potential applications in prosthetics and orthotics surface measurement, the simple setup and its ease of use will make it suitable for various 3D surface reconstructions.

Effect of the Remelting on Transformations in Co-Cr-Mo Prosthetics Alloy

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Kacprzyk B.

2013-09-01

Full Text Available In the article we were studing the impact of the remelting on transformations in Co-Cr-Mo prosthetics alloy. The TDA curves were analyzed, the microstructure was examined, the analysis of the chemical composition and hardness using the Brinell method was made. It was found that the obtained microstructure of the alloys that we studied do not differ significantly. In all four samples, microscopic images were similar to each other. The volume, size and distribution of the phases remain similar. Analysis of the chemical composition showed that all the samples fall within the compositions provided for the test alloy. Further to this the hardness of the samples, regardless of the number of remeltings did not show any significant fluctuations and remained within the error limit.After analyzing all the results, it can be concluded that the remeltings of the alloys should not have a significant impact on their properties. Secondarily melted alloys can be used for prosthetics works.

Prosthetic rehabilitation of large mid-facial defect with magnet-retained silicone prosthesis

Directory of Open Access Journals (Sweden)

Kirti Jajoo Shrivastava

2015-01-01

Full Text Available Rehabilitation of maxillofacial defect patients is a challenging task. The most common prosthetic treatment problem with such patients is, getting adequate retention, stability, and support. In cases of large maxillofacial defect, movement of the prosthesis is inevitable. The primary objectives in rehabilitating the maxillofacial defect patients are to restore the function of mastication, deglutition, speech, and to achieve normal orofacial appearance. This clinical report describes maxillofacial prosthetic rehabilitation of large midfacial defect including orbit along with its contents, zygoma and soft tissues including half of the nose, cheeks, upper lip of left side, accompanying postsurgical microstomia and orofacial communication, which resulted from severe fungal infection mucormycosis. The defect in this case was restored with magnet retained two piece maxillofacial prosthesis having hollow acrylic resin framework and an overlying silicone facial prosthesis. The retention of prosthesis was further enhanced with the use of spectacles. This type of combination prosthesis enhanced the cosmesis and functional acceptability of prosthesis.

Fuzzy linguistic hedges for the selection of manufacturing process for prosthetic sockets

Directory of Open Access Journals (Sweden)

Richa Pandey

2014-08-01

Full Text Available In this paper, a comparison is presented between two prime methods of producing prosthetic sockets by using the fuzzy linguistic hedges approach on the qualitative feedback of Indian prosthetic users. Recent trends indicate that the Indian manufacturers have tried to adopt the newer technologies like reverse engineering (RE approach to achieve the desired goals. However, the satisfaction of the user is of utmost importance for the unique and customized products for rehabilitation. In order to analyze the effectiveness of the manufacturing approaches, user case studies are taken, based on the linguistic feedbacks, and a comparative study is conducted. Thirteen users from four different manufacturing units are taken for study and sockets made by conventional as well as RE are experimented. Fuzzy membership functions are constructed using the linguistic hedges based on the user feedbacks. An analytical hierarchy process (AHP is applied to arrive at a decision to select the manufacturing process for user satisfaction and manufacturing excellence.

Improving rehabilitation treatment in a local setting : a case study of prosthetic rehabilitation

NARCIS (Netherlands)

van Twillert, Sacha; Postema, Klaas; Geertzen, Jan H. B.; Hemminga, Titia; Lettinga, Ant T.

2009-01-01

Objective: To contribute to the discussion on the research-practice gap by illustrating obstacles and opportunities that arise in an evidence-informed improvement process of prosthetic rehabilitation in a local setting. Setting: Dutch rehabilitation centre. Presupposition: The improvement process

Improved Diagnosis of Prosthetic Joint Infection by Culturing Periprosthetic Tissue Specimens in Blood Culture Bottles.

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Peel, Trisha N; Dylla, Brenda L; Hughes, John G; Lynch, David T; Greenwood-Quaintance, Kerryl E; Cheng, Allen C; Mandrekar, Jayawant N; Patel, Robin

2016-01-05

Despite known low sensitivity, culture of periprosthetic tissue specimens on agars and in broths is routine. Culture of periprosthetic tissue samples in blood culture bottles (BCBs) is potentially more convenient, but it has been evaluated in a limited way and has not been widely adopted. The aim of this study was to compare the sensitivity and specificity of inoculation of periprosthetic tissue specimens into blood culture bottles with standard agar and thioglycolate broth culture, applying Bayesian latent class modeling (LCM) in addition to applying the Infectious Diseases Society of America (IDSA) criteria for prosthetic joint infection. This prospective cohort study was conducted over a 9-month period (August 2013 to April 2014) at the Mayo Clinic, Rochester, MN, and included all consecutive patients undergoing revision arthroplasty. Overall, 369 subjects were studied; 117 (32%) met IDSA criteria for prosthetic joint infection, and 82% had late chronic infection. Applying LCM, inoculation of tissues into BCBs was associated with a 47% improvement in sensitivity compared to the sensitivity of conventional agar and broth cultures (92.1 versus 62.6%, respectively); this magnitude of change was similar when IDSA criteria were applied (60.7 versus 44.4%, respectively; P = 0.003). The time to microorganism detection was shorter with BCBs than with standard media (P Prosthetic joint infections are a devastating complication of arthroplasty surgery. Despite this, current microbiological techniques to detect and diagnose infections are imperfect. This study examined a new approach to diagnosing infections, through the inoculation of tissue samples from around the prosthetic joint into blood culture bottles. This study demonstrated that, compared to current laboratory practices, this new technique increased the detection of infection. These findings are important for patient care to allow timely and accurate diagnosis of infection. Copyright © 2016 Peel et al.

Multi-Axis Prosthetic Knee Resembles Alpine Skiing Movements of an Intact Leg

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Demšar, Ivan; Duhovnik, Jože; Lešnik, Blaž; Supej, Matej

2015-01-01

The purpose of the study was to analyse the flexion angles of the ski boot, ankle and knee joints of an above-knee prosthesis and to compare them with an intact leg and a control group of skiers. One subject with an above-knee amputation of the right leg and eight healthy subjects simulated the movement of a skiing turn by performing two-leg squats in laboratory conditions. By adding additional loads in proportion to body weight (BW; +1/3 BW, +2/3 BW, +3/3 BW), various skiing regimes were simulated. Change of Flexion Angle (CoFA) and Range of Motion (RoM) in the ski boot, ankle and knee joints were calculated and compared. An average RoM in the skiing boot on the side of prosthesis (4.4 ± 1.1°) was significantly lower compared to an intact leg (5.9 ± 1.8°) and the control group (6.5 ± 2.3°). In the ankle joint, the average RoM was determined to be 13.2±2.9° in the prosthesis, 12.7 ± 2.8° in an intact leg and 14.8±3.6 in the control group. However, the RoM of the knee joint in the prosthesis (42.2 ± 4.2°) was significantly larger than that of the intact leg (34.7 ± 4.4°). The average RoM of the knee joint in the control group was 47.8 ± 5.4°. The influences of additional loads on the kinematics of the lower extremities were different on the side of the prosthesis and on the intact leg. In contrast, additional loads did not produce any significant differences in the control group. Although different CoFAs in the ski boot, ankle and knee joints were used, an above-knee prosthesis with a built-in multi-axis prosthetic knee enables comparable leg kinematics in simulated alpine skiing. Key points The RoM in the ski boot on the side of the prosthetic leg was smaller than the RoM of the intact leg and the control group of healthy subjects. The RoM in the ankle joint of prosthetic leg was comparable to that of the intact leg and the control group of healthy subjects. The RoM in the prosthetic knee joint was greater than the RoM in the knee joint of the

Improvement of disintegrable properties of bone prosthetic phosphate cements

International Nuclear Information System (INIS)

Kaneda, Mitsumasa

2007-01-01

The author added a viscoelastic binder or bio-disintegrable polymer filler in αDT-cement (DTC) base, which consisting of α-tricalcium phosphate, tetracalcium phosphate and dicalcium phosphate anhydrous, in order to examine whether disintegrable properties of the bone prosthetic materials could be improved. The additive for the former binder was hydroxypropyl-cellulose and the latter filler, poly-(DL-lactide-co-glycolide) and they were mixed in various proportions with the base. At both sides of the cranial coronary suture of Japanese white rabbit, cavities (4 in total) were made at anteroposterior sites where those prosthetic cements were filled. At 1, 2 and 4 weeks later, the operated bone region was dissected out, its soft X-ray image was taken by the machine OMC603 (OHMICRON), and three-dimensional (3D) micro-focused XCT images, by Shimadzu SMX-130CT-SV. The trabecular thickness, bone volume and tissue volume ratio were calculated from the latter images by the trabecular structural measure software TRI/3Dbon (ROTAC). Disintegration rate of the cements was tested in water. Disintegrable properties were found to affect osteogenesis by giving the space for it, and thereby the choice of the ratio of the binder and disintegrable filler in the DTC makes it possible to design the most suitable cement needed. (R.T.)

Candida Prosthetic Joint Infection. A Review of Treatment Methods.

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Cobo, Fernando; Rodríguez-Granger, Javier; Sampedro, Antonio; Aliaga-Martínez, Luis; Navarro-Marí, José María

2017-01-01

Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans , followed by C. parapsilosis . Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.

Synovial Calprotectin: An Inexpensive Biomarker to Exclude a Chronic Prosthetic Joint Infection.

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Wouthuyzen-Bakker, Marjan; Ploegmakers, Joris J W; Ottink, Karsten; Kampinga, Greetje A; Wagenmakers-Huizenga, Lucie; Jutte, Paul C; Kobold, Anneke C M

2018-04-01

To diagnose or exclude a chronic prosthetic joint infection (PJI) can be a clinical challenge. Therefore, sensitive and specific biomarkers are needed in the diagnostic work-up. Calprotectin is a protein with antimicrobial properties and is released by activated neutrophils, making it a specific marker for infection. Because of its low costs and ability to obtain a quantitative value as a point of care test, it is an attractive marker to use in clinical practice. In addition, the test is already used in routine care in most hospitals for other indications and therefore easy to implement. Between June 2015 and June 2017 we collected synovial fluid of all consecutive patients who underwent revision surgery of a prosthetic joint because of chronic pain with or without prosthetic loosening. Synovial calprotectin was measured using a lateral flow immunoassay. A PJI was defined by the diagnostic criteria described by the Musculoskeletal Infection Society. Fifty-two patients with chronic pain were included. A PJI was diagnosed in 15 of 52 (29%) patients. The median calprotectin in the PJI group was 859 mg/L (interquartile range 86-1707) vs 7 mg/L (interquartile range 3-25) in the control group (P < .001). With a cut-off value of 50 mg/L, synovial calprotectin showed a sensitivity, specificity, positive predictive value, and negative predictive value of 86.7%, 91.7%, 81.3%, and 94.4%, respectively. Synovial calprotectin is a useful and cheap biomarker to use in the diagnostic work-up of patients with chronic pain, especially to exclude a PJI prior to revision surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Integrating cell-free biosyntheses of heme prosthetic group and apoenzyme for the synthesis of functional P450 monooxygenase.

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Kwon, Yong-Chan; Oh, In-Seok; Lee, Nahum; Lee, Kyung-Ho; Yoon, Yeo Joon; Lee, Eun Yeol; Kim, Byung-Gee; Kim, Dong-Myung

2013-04-01

Harnessing the isolated protein synthesis machinery, cell-free protein synthesis reproduces the cellular process of decoding genetic information in artificially controlled environments. More often than not, however, generation of functional proteins requires more than simple translation of genetic sequences. For instance, many of the industrially important enzymes require non-protein prosthetic groups for biological activity. Herein, we report the complete cell-free biogenesis of a heme prosthetic group and its integration with concurrent apoenzyme synthesis for the production of functional P450 monooxygenase. Step reactions required for the syntheses of apoenzyme and the prosthetic group have been designed so that these two separate pathways take place in the same reaction mixture, being insulated from each other. Combined pathways for the synthesis of functional P450 monooxygenase were then further integrated with in situ assay reactions to enable real-time measurement of enzymatic activity during its synthesis. Copyright © 2012 Wiley Periodicals, Inc.

Vancomycin-Rifampin Combination Therapy Has Enhanced Efficacy against an Experimental Staphylococcus aureus Prosthetic Joint Infection

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Niska, Jared A.; Shahbazian, Jonathan H.; Ramos, Romela Irene; Francis, Kevin P.; Bernthal, Nicholas M.

2013-01-01

Treatment of prosthetic joint infections often involves a two-stage exchange, with implant removal and antibiotic spacer placement followed by systemic antibiotic therapy and delayed reimplantation. However, if antibiotic therapy can be improved, one-stage exchange or implant retention may be more feasible, thereby decreasing morbidity and preserving function. In this study, a mouse model of prosthetic joint infection was used in which Staphylococcus aureus was inoculated into a knee joint containing a surgically placed metallic implant extending from the femur. This model was used to evaluate whether combination therapy of vancomycin plus rifampin has increased efficacy compared with vancomycin alone against these infections. On postoperative day 7, vancomycin with or without rifampin was administered for 6 weeks with implant retention. In vivo bioluminescence imaging, ex vivo CFU enumeration, X-ray imaging, and histologic analysis were carried out. We found that there was a marked therapeutic benefit when vancomycin was combined with rifampin compared with vancomycin alone. Taken together, our results suggest that the mouse model used could serve as a valuable in vivo preclinical model system to evaluate and compare efficacies of antibiotics and combinatory therapy for prosthetic joint infections before more extensive studies are carried out in human subjects. PMID:23917317

Psychometric evaluation of self-report outcome measures for prosthetic applications

OpenAIRE

Hafner, Brian J.; Morgan, Sara J.; Askew, Robert L.; Salem, Rana

2016-01-01

Documentation of clinical outcomes is increasingly expected in delivery of prosthetic services and devices. However, many outcome measures suitable for use in clinical care and research have not been psychometrically tested with prosthesis users. The aim of this study was to determine test-retest reliability, mode-of-administration (MoA) equivalence, standard error of measurement (SEM), and minimal detectable change (MDC) of standardized, self-report instruments that assess constructs of impo...

The influence of standards and clinical guidelines on prosthetic and orthotic service quality: a scoping review.

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Sadeghi-Demneh, Ebrahim; Forghany, Saeed; Onmanee, Pornsuree; Trinler, Ursula; Dillon, Michael P; Baker, Richard

2017-06-20

Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.

Success rates for initial eradication of peri-prosthetic knee infection treated with a two-stage procedure.

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Kaminski, Andrzej; Citak, Mustafa; Schildhauer, Thomas Armin; Fehmer, Tobias

2014-01-01

In Germany, rates of primary total knee arthroplasty procedures and exchange arthroplasty procedures continue to rise. Late-onset peri-prosthetic infection constitutes a serious complication whose management may be dependent upon the spectrum of micro-organisms involved. The aim of this study was to provide a retrospective analysis of the effectiveness of initial eradication measures performed as part of a two-stage procedure. Between 2002 and 2008, a total of 328 patients who had received a first-time diagnosis of chronic peri-prosthetic knee infection following total knee arthroplasty (TKA) subsequently underwent surgery at our clinic. The surgical approach consisted of a two-stage procedure, with the initial procedure consisting of the removal of the prosthesis and radical debridement, followed by insertion of an antibiotic-loaded static spacer. The effectiveness of the procedure was assessed after six weeks, with each patient undergoing a number of clinical and laboratory-based tests, including knee joint aspiration. Staphylococcus aureus strains were responsible for 68% (n=223) of the total number of cases of peri-prosthetic knee infection. 19% of cases (n=62) showed evidence of gram-negative bacteria, while MRSA accounted for 15% (n=49) of cases. Six weeks after completion of the above-named treatment regimen, eradication of infection was considered successful in 289 patients (88.1%). Eradication was unsuccessful in 22% of MRSA infections (n=11) and 7% of MSSA infections (n=23). The treatment regimen outlined in this report is capable of achieving satisfactory results in the management of late-onset peri-prosthetic knee infection, with one exception: patients with infections caused by MRSA showed high failure rates.

Lactococcus garvieae Endocarditis on a Prosthetic Biological Aortic Valve.

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Tsur, A; Slutzki, T; Flusser, D

2015-09-01

Lactococcus garvieae (LG) endocarditis is a rare disease in humans. There are only about 16 reported cases in the world. We report a 76-year-old male patient with LG endocarditis. In depth interview with the patient revealed that 2 weeks prior to admission, he had eaten sushi containing raw fish. Unlike many of the other infections reported, which were on a native mitral valve, our patient's vegetation was on a prosthetic aortic valve. © 2014 Blackwell Verlag GmbH.

Performance of Optimized Prosthetic Ankle Designs That Are Based on a Hydraulic Variable Displacement Actuator (VDA).

Science.gov (United States)

Gardiner, James; Bari, Abu Zeeshan; Kenney, Laurence; Twiste, Martin; Moser, David; Zahedi, Saeed; Howard, David

2017-12-01

Current energy storage and return prosthetic feet only marginally reduce the cost of amputee locomotion compared with basic solid ankle cushioned heel feet, possibly due to their lack of push-off at the end of stance. To the best of our knowledge, a prosthetic ankle that utilizes a hydraulic variable displacement actuator (VDA) to improve push-off performance has not previously been proposed. Therefore, here we report a design optimization and simulation feasibility study for a VDA-based prosthetic ankle. The proposed device stores the eccentric ankle work done from heel strike to maximum dorsiflexion in a hydraulic accumulator and then returns the stored energy to power push-off. Optimization was used to establish the best spring characteristic and gear ratio between ankle and VDA. The corresponding simulations show that, in level walking, normal push-off is achieved and, per gait cycle, the energy stored in the accumulator increases by 22% of the requirements for normal push-off. Although the results are promising, there are many unanswered questions and, for this approach to be a success, a new miniature, low-losses, and lightweight VDA would be required that is half the size of the smallest commercially available device.

The Effect of the Prosthetic Group on the Pharmacologic Properties of 18F-labeled Rhodamine B, a Potential Myocardial Perfusion Agent for PET

Science.gov (United States)

Bartholomä, Mark D.; Gottumukkala, Vijay; Zhang, Shaohui; Baker, Amanda; Dunning, Patricia; Fahey, Frederic H.; Treves, S. Ted; Packard, Alan B.

2013-01-01

We recently reported the development of the 2-[18F]fluoroethyl ester of rhodamine B as a potential positron emission tomography (PET) tracer for myocardial perfusion imaging. This compound, which was prepared using a [18F]fluoroethyl prosthetic group, has significant uptake in the myocardium in rats, but also demonstrates relatively high liver uptake and is rapidly hydrolyzed in vivo in mice. We have now prepared 18F-labeled rhodamine B using three additional prosthetic groups (propyl, diethylene glycol, and triethylene glycol) and found that the prosthetic group has a significant effect on the in vitro and in vivo properties of these compounds. Of the esters prepared to date, the diethylene glycol ester is superior in terms of in vitro stability and pharmacokinetics. These observations suggest that the prosthetic group plays a significant role in determining the pharmacological properties of 18F-labeled compounds. They also support the value of continued investigation of 18F-labeled rhodamines as PET radiopharmaceuticals for myocardial perfusion imaging. PMID:23210516

Prosthetic replacement of the infrahepatic inferior vena cava for leiomyosarcoma.

Science.gov (United States)

Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Giacobbi, Daniela; Papaspyropoulos, Vassilios; Ceccanei, Gianluca

2006-09-01

Resection of the infrahepatic inferior vena cava associated with prosthetic graft replacement for caval leiomyosarcoma is an acceptable procedure to obtain prolonged and good-quality survival. A consecutive sample clinical study with a mean follow-up of 40 months. The surgical department of an academic tertiary center and an affiliated secondary care center. Eleven patients, with a mean age of 51 years, who have primary leiomyosarcoma of the infrahepatic inferior vena cava. All of the patients underwent radical resection of the tumor en bloc with the affected segment of the vena cava. Reconstruction consisted of 10 cavocaval polytetrafluoroethylene grafts and 1 cavobiliac graft. An associated right nephrectomy was performed in 2 cases. The left renal vein was reimplanted in the graft in 3 cases. Cumulative disease-specific survival, disease-free survival, and graft patency rates expressed by standard life-table analysis. No patients died in the postoperative period. The cumulative (SE) disease-specific survival rate was 53% (21%) at 5 years. The cumulative (SE) disease-free survival rate was 44% (19%) at 5 years. The cumulative (SE) graft patency rate was 67% (22%) at 5 years. Radical resection followed by prosthetic graft reconstruction is a valuable method for treating primary leiomyosarcoma of the infrahepatic inferior vena cava.

Early prosthetic aortic valve infection identified with the use of positron emission tomography in a patient with lead endocarditis.

Science.gov (United States)

Amraoui, Sana; Tlili, Ghoufrane; Sohal, Manav; Bordenave, Laurence; Bordachar, Pierre

2016-12-01

18-Fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) scanning has recently been proposed as a diagnostic tool for lead endocarditis (LE). FDG PET/CT might be also useful to localize associated septic emboli in patients with LE. We report an interesting case of a LE patient with a prosthetic aortic valve in whom a trans-esophageal echocardiogram did not show associated aortic endocarditis. FDG PET/CT revealed prosthetic aortic valve infection. A second TEE performed 2 weeks after identified aortic vegetation. A longer duration of antimicrobial therapy with serial follow-up echocardiography was initiated. There was also increased uptake in the sigmoid colon, corresponding to focal polyps resected during a colonoscopy. FDG PET/CT scanning seems to be highly sensitive for prosthetic aortic valve endocarditis diagnosis. This promising diagnostic tool may be beneficial in LE patients, by identifying septic emboli and potential sites of pathogen entry.

Effects of cilostazol and k-134 on reconstructive surgery using prosthetic grafts in the abdominal aorta of beagle dogs.

Science.gov (United States)

Inoue, Yoshinori; Sugano, Norihide; Jibiki, Masatoshi; Kudo, Toshifumi; Iwai, Takehisa

2008-01-01

Problems associated with prosthetic graft replacement are stenosis at the anastomosis site and thrombus formation on the inner surface. Cilostazol is known to have antiplatelet activity and inhibit vascular smooth muscle cell proliferation and neointima thickening. A cilostazol derivative, (-)-6-[3-[3-cyclopropyl-3-[(1R,2R)-2-hydroxycyclohexyl]ureido]-propoxy]-2-(1H)-quinolinone (K-134), has more potent anti-platelet activity and anti-neointimal thickening activity than cilostazol in the in-vitro platelet aggregation and in-vivo anti-hyperplastic activity assay. The aim of this study was to investigate effects of cilostazol and K-134 on thrombus formation and neointimal thickening at the site of prosthetic graft replacement. Beagle dogs underwent infrarenal abdominal aortic resection with straight Dacron graft replacement, which were allocated to the control, cilostazol, and K-134 groups. Two dogs were dead without confirming the cause of death. After 6 months, all dogs were necropsied. All prosthetic grafts were patent in each group. Ratios of red thrombus to prosthetic graft area were 0.3+/-6.4%, and 3.3+/-4.5% in the cilostazol and K-134 groups, respectively, which were significant different from that in the control group (24.4+/-16.8%). However, no clear difference was seen among the 3 groups with respect to neointimal thickness (control group, 0.70+/-0.13 mm; cilostazol group, 0.59+/-0.14 mm; K-134 group, 0.67+/-0.14 mm). Cilostazol and K-134 significantly inhibited thrombus formation on the inner surface of the prosthetic graft at 6 months after graft replacement. Neointimal thickening on the inner surface was slight even in control-group animals, and the effects of cilostazol and K-134 on such thickening were unclear.

Prosthetic Valve Endocarditis - Successful Management With Antimicrobial Treatment

Directory of Open Access Journals (Sweden)

Ashokan Nambiar C

2015-07-01

Full Text Available Middle aged male was admitted with high fever, rigor and chills of 2 days duration. He was seen in the clinic two years back for syncope. He gave history of Mitral (Starr-Edward and Aortic (Medtronic valve replacement ten years earlier from another center and was on regular anticoagulation with dose-adjusted acenocoumarol. On evaluation he had normal prosthetic valve function by trans-thoracic echo, but Holter monitoring showed Paroxysmal Atrial Fibrillation. He had mild wall motion abnormalities and left ventricular dysfunction suggestive of coronary artery disease also and was put on additional Metoprolol.

Alternative causes of bioreaction to prosthetic heart valves: three cases with pannus formation.

Science.gov (United States)

Karakoyun, Süleyman; Gürsoy, Ozan Mustafa; Kalçık, Macit; Coban Kökten, Sermin; Ozkan, Mehmet

2014-01-01

Pannus formation is an infrequent but serious complication of prosthetic heart valve surgery. The cause of pannus is recognized as a bioreaction to the prostheses; histological investigations have shown that pannus comprises collagen and elastic tissues containing endothelial cells, chronic inflammatory cells, and myofibroblasts. However, the detailed mechanism of its formation has not been fully demonstrated. We aimed to evaluate the potential role of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP-2) in the pathogenesis of pannus formation in three patients with mechanical prosthetic heart valves. Pannus specimens removed from the prostheses were fixed in 10% neutral-buffered formalin for 24 hours after surgical removal and paraffin-embedded using standard procedures. Serial sections were cut at 4 µm for immunohistochemistry analysis. Hematoxylin and eosin (HE) was used in the histological analysis. VEGF and MMP-2 were studied in the immunohistochemistry analysis. Three patients with mechanical prosthetic obstruction due to pannus overgrowth underwent redo valve surgery. In the first and second patients, the mitral prosthesis was explanted along with the pannus overgrowth. The third patient had both aortic and mitral prostheses; the aortic prosthesis was explanted with obstructive pannus formation, whereas the mitral valve was spared with excision of the nonobstructive pannus. The immunohistochemical study demonstrated the expressions of MMP-2 and VEGF in all of the pannus specimens acquired from these cases. VEGF and MMP-2 may play a role in the mechanism of pannus formation as the elements of the chronic active inflammatory process.

Three-dimensional flow structures past a bio-prosthetic valve in an in-vitro model of the aortic root.

Science.gov (United States)

Hasler, David; Obrist, Dominik

2018-01-01

The flow field past a prosthetic aortic valve comprises many details that indicate whether the prosthesis is functioning well or not. It is, however, not yet fully understood how an optimal flow scenario would look, i.e. which subtleties of the fluid dynamics in place are essential regarding the durability and compatibility of a prosthetic valve. In this study, we measured and analyzed the 3D flow field in the vicinity of a bio-prosthetic heart valve in function of the aortic root size. The measurements were conducted within aortic root phantoms of different size, mounted in a custom-built hydraulic setup, which mimicked physiological flow conditions in the aorta. Tomographic particle image velocimetry was used to measure the 3D instantaneous velocity field at various instances. Several 3D fields (e.g. instantaneous and mean velocity, 3D shear rate) were analyzed and compared focusing on the impact of the aortic root size, but also in order to gain general insight in the 3D flow structure past the bio-prosthetic valve. We found that the diameter of the aortic jet relative to the diameter of the ascending aorta is the most important parameter in determining the characteristics of the flow. A large aortic cross-section, relative to the cross-section of the aortic jet, was associated with higher levels of turbulence intensity and higher retrograde flow in the ascending aorta.

Novel imaging strategies for the Detection of Prosthetic Heart Valve Obstruction and Endocarditis

NARCIS (Netherlands)

Tanis, W.

2014-01-01

Valvular heart disease is accompanied by a high mortality/morbidity and often requires prosthetic heart valve (PHV) replacement in order to improve quality of life and survival. The major drawback of both mechanical and biological PHV implantations is development of dysfunction, which is a life

Intermittent acute aortic valve regurgitation: A case report of a prosthetic valve dysfunction

NARCIS (Netherlands)

S.E. Karagiannis (Stefanos); G. Karatasakis (George); K. Spargias (Konstantinos); L. Louka; D. Poldermans (Don); D.V. Cokkinos (Dennis)

2008-01-01

textabstractComplications of any mechanical prosthesis include thrombus or pannus formation. In our case report we demonstrate that prosthetic aortic valve regurgitation due to pannus formation may be intermittent and non-cyclic in pattern and therefore not obvious at the time of original clinical

Prosthetic rehabilitation for a patient with microstomia: a case report

Directory of Open Access Journals (Sweden)

Moslehifard E

2011-04-01

Full Text Available "nFabrication of dental prosthesis for patients with microstomia has long been a problem for dentists. Microstomia is defined as an abnormally small oral orifice. Prosthetic rehabilitation of microstomia patients presents difficulties at all stages, from the preliminary impressions to fabrication of prosthesis. This study described a method for making impressions for patients with limited opening of the oral cavity which the use of a full-size impression tray was not possible.

A novel polymeric prosthetic heart valve: design, manufacture, and testing

OpenAIRE

Brubert, Jacob

2016-01-01

In this thesis a flexible leaflet polymeric prosthetic aortic heart valve was designed, manufactured, and tested. The prosthesis was designed with the aim of overcoming the need for anticoagulant therapy, which is required for current mechanical prostheses; while also having lifelong durability, which current bioprosthetic heart valves are not able to achieve. Inspired by the anisotropic architecture of collagen in the natural valve, a shortlist of polystyrene based block copolymers (BCPs), w...

Tensile strength and impact resistance properties of materials used in prosthetic check sockets, copolymer sockets, and definitive laminated sockets.

Science.gov (United States)

Gerschutz, Maria J; Haynes, Michael L; Nixon, Derek M; Colvin, James M

2011-01-01

Prosthetic sockets serve as the interface between people with amputations and their prostheses. Although most materials used to make prosthetic sockets have been used for many years, knowledge of these materials' properties is limited, especially after they are subjected to fabrication processes. This study evaluated tensile and impact properties of the current state-of-the-art materials used to fabricate prosthetic check sockets, copolymer sockets, and definitive laminated sockets. Thermolyn Rigid and Orfitrans Stiff check socket materials produced significantly lower tensile strength and impact resistance than polyethylene terephthalate glycol (PETG). Copolymer socket materials exhibited greater resistance to impact forces than the check socket materials but lower tensile strengths than PETG. The heated molding processes, for the check socket and copolymer materials, reduced both tensile strength and elongation at break. Definitive laminated sockets were sorted according to fabrication techniques. Nyglass material had significantly higher elongation, indicating a more ductile material than carbon-based laminations. Carbon sockets with pigmented resin had higher tensile strength and modulus at break than nonpigmented carbon sockets. Elongation at yield and elongation at break were similar for both types of carbon-based laminations. The material properties determined in this study provide a foundation for understanding and improving the quality of prosthetic sockets using current fabrication materials and a basis for evaluating future technologies.

Long-term clinical and prosthetic outcomes of soft liner and clip attachments for bar/implant overdentures: a randomised controlled clinical trial.

Science.gov (United States)

ELsyad, M A; Shaheen, N H; Ashmawy, T M

2017-06-01

Long-term clinical and prosthetic outcomes of soft liner attachments for bar/implant overdentures were not sufficiently investigated. The aim of this trial was to evaluate clinical and prosthetic outcomes of resilient liner and clip attachments for bar/implant-retained mandibular overdenture after 7 years. Thirty edentulous male participants received two implants in the canine areas of the mandible. Three months later, implants were splinted with a resilient bar. Mandibular overdentures were connected to the bars with either clip (CR group, n = 15) or resilient liner (RR group, n = 15) attachments. Plaque index (PI), gingival index (GI), probing depth (PD), vertical bone loss (VBL), horizontal bone loss (HBLO) and prosthetic complications (PCs) were evaluated at denture delivery (T0), 6 (T 6m ), 12 (T1), 24 (T2), 36 (T3), 48 (T4), 60 (T5), 72 (T6) and 84 (T7) months after insertion. PI and GI increased significantly with time for CR and decreased significantly for RR (P overdentures than clip attachments in terms of peri-implant tissue health and prosthetic complications after 7 years. © 2017 John Wiley & Sons Ltd.

Transparent biocompatible sensor patches for touch sensitive prosthetic limbs

KAUST Repository

Nag, Anindya

2016-12-26

The paper presents the fabrication of transparent, flexible sensor patches developed using a casting technique with polydimethylsiloxane (PDMS) as substrate and a nanocomposite of carbon nanotubes (CNTs) and PDMS as interdigital electrodes. The electrodes act as strain sensitive capacitor. The prototypes were used as touch sensitive sensors attached to the limbs. Experiments results show the sensitivity of the patches towards tactile sensing. The results are very promising and can play a key role in the development of a cost efficient sensing system attached to prosthetic limbs.

Transparent biocompatible sensor patches for touch sensitive prosthetic limbs

KAUST Repository

Nag, Anindya; Mukhopadhyay, Subhas; Kosel, Jü rgen

2016-01-01

The paper presents the fabrication of transparent, flexible sensor patches developed using a casting technique with polydimethylsiloxane (PDMS) as substrate and a nanocomposite of carbon nanotubes (CNTs) and PDMS as interdigital electrodes. The electrodes act as strain sensitive capacitor. The prototypes were used as touch sensitive sensors attached to the limbs. Experiments results show the sensitivity of the patches towards tactile sensing. The results are very promising and can play a key role in the development of a cost efficient sensing system attached to prosthetic limbs.

Differentiation between solid-ankle cushioned heel and energy storage and return prosthetic foot based on step-to-step transition cost.

Science.gov (United States)

Wezenberg, Daphne; Cutti, Andrea G; Bruno, Antonino; Houdijk, Han

2014-01-01

Decreased push-off power by the prosthetic foot and inadequate roll-over shape of the foot have been shown to increase the energy dissipated during the step-to-step transition in human walking. The aim of this study was to determine whether energy storage and return (ESAR) feet are able to reduce the mechanical energy dissipated during the step-to-step transition. Fifteen males with a unilateral lower-limb amputation walked with their prescribed ESAR foot (Vari-Flex, Ossur; Reykjavik, Iceland) and with a solid-ankle cushioned heel foot (SACH) (1D10, Ottobock; Duderstadt, Germany), while ground reaction forces and kinematics were recorded. The positive mechanical work on the center of mass performed by the trailing prosthetic limb was larger (33%, p = 0.01) and the negative work performed by the leading intact limb was lower (13%, p = 0.04) when walking with the ESAR foot compared with the SACH foot. The reduced step-to-step transition cost coincided with a higher mechanical push-off power generated by the ESAR foot and an extended forward progression of the center of pressure under the prosthetic ESAR foot. Results can explain the proposed improvement in walking economy with this kind of energy storing and return prosthetic foot.

A neurorobotic platform for locomotor prosthetic development in rats and mice

Science.gov (United States)

von Zitzewitz, Joachim; Asboth, Leonie; Fumeaux, Nicolas; Hasse, Alexander; Baud, Laetitia; Vallery, Heike; Courtine, Grégoire

2016-04-01

Objectives. We aimed to develop a robotic interface capable of providing finely-tuned, multidirectional trunk assistance adjusted in real-time during unconstrained locomotion in rats and mice. Approach. We interfaced a large-scale robotic structure actuated in four degrees of freedom to exchangeable attachment modules exhibiting selective compliance along distinct directions. This combination allowed high-precision force and torque control in multiple directions over a large workspace. We next designed a neurorobotic platform wherein real-time kinematics and physiological signals directly adjust robotic actuation and prosthetic actions. We tested the performance of this platform in both rats and mice with spinal cord injury. Main Results. Kinematic analyses showed that the robotic interface did not impede locomotor movements of lightweight mice that walked freely along paths with changing directions and height profiles. Personalized trunk assistance instantly enabled coordinated locomotion in mice and rats with severe hindlimb motor deficits. Closed-loop control of robotic actuation based on ongoing movement features enabled real-time control of electromyographic activity in anti-gravity muscles during locomotion. Significance. This neurorobotic platform will support the study of the mechanisms underlying the therapeutic effects of locomotor prosthetics and rehabilitation using high-resolution genetic tools in rodent models.

Immediate natural tooth pontic: A viable yet temporary prosthetic solution: A patient reported outcome

Directory of Open Access Journals (Sweden)

Sudhir Bhandari

2012-01-01

Conclusion: The concept of immediate pontic placement is surely a viable treatment option and promises an excellent transient esthetic solution for a lost tooth as well as enables good preparation of the extraction site for future prosthetic replacement.

Intracortical inhibition is modulated by phase of prosthetic rehabilitation in transtibial amputees

Directory of Open Access Journals (Sweden)

Brenton eHordacre

2015-05-01

Full Text Available Reorganisation of primary motor cortex (M1 is well described in long-term lower limb amputees. In contrast cortical reorganisation during the rehabilitation period after amputation is poorly understood. Thirteen transtibial amputees and thirteen gender matched control participants of similar age were recruited. Transcranial magnetic stimulation was used to assess corticomotor and intracortical excitability of M1 bilaterally. Neurophysiological assessments were conducted at admission, prosthetic casting, first walk and discharge. Gait variability at discharge was assessed as a functional measure. Compared to controls, amputees had reduced short-latency intracortical inhibition for the ipsilateral M1 at admission (p=0.01. Analysis across rehabilitation revealed short-latency intracortical inhibition was reduced for the contralateral M1 at first walk compared to discharge (p=0.003. For the ipsilateral M1 both short and long-latency intracortical inhibition were reduced at admission (p<0.05 and prosthetic casting (p<0.02. Analysis of the neurophysiology and gait function revealed several interesting relationships. For the contralateral M1, reduced inhibition at admission (p=0.04 and first walk (p=0.05 was associated with better gait function. For the ipsilateral M1, reduced inhibition at discharge (p=0.05 was associated with poor gait function. This study characterised intracortical excitability in rehabilitating amputees. A dichotomous relationship between reduced intracortical inhibition for each M1 and gait function was observed at different times. Intracortical inhibition may be an appropriate cortical biomarker of gait function in lower limb amputees during rehabilitation, but requires further investigation. Understanding M1 intracortical excitability of amputees undertaking prosthetic rehabilitation provides insight into brain reorganisation in the sub-acute post amputation period and may guide future studies seeking to improve rehabilitation

Prosthetic vascular graft infection through a median sternotomy: a multicentre review †.

Science.gov (United States)

Oda, Tatsuya; Minatoya, Kenji; Kobayashi, Junjiro; Okita, Yutaka; Akashi, Hidetoshi; Tanaka, Hiroyuki; Kawaharada, Nobuyoshi; Saiki, Yoshikatsu; Kuniyoshi, Yukio; Nishimura, Kunihiro

2015-06-01

The aim of this study is to analyse the treatment outcomes of thoracic prosthetic graft infection. A retrospective chart review was conducted at six hospitals and included the records of 68 patients treated for postoperative prosthetic vascular graft infection (mean age: 62.3 ± 15.1, male 51) from January 2000 to December 2013. The number of patients and the locations of the treated infections were as follows: 13 for aortic root, 16 for ascending aorta, 35 for aortic arch and 4 for aortic root to arch. In-hospital infection occurred in 43 patients and after discharge in 25. The mean follow-up time was 2.0 ± 2.3 years. The follow-up rate was 94.1%. The most commonly isolated micro-organism was Staphylococcus aureus (72.1%). Rereplacement of infectious graft was performed in 18 patients (Dacron graft in 12, homograft in 4 and rifampicin-bonded Dacron graft in 2). The overall hospital mortality rate was 35.3% (24/68). The mortality rate among the patients with graft rereplacement was 33.3% (6/18), with pedicled muscle flaps or pedicled omental flaps to cover the graft 25.9% (7/27), with irrigation 55.0% (11/20) and on antibiotic therapy only 0% (0/3). Our multivariate analysis demonstrated that the risk factors of hospital death increased in the absence of pedicled flaps (muscle or omentum) to cover the graft (P = 0.001), age over 55 (P = 0.003), time from onset of initial operation prosthetic vascular graft infection have not been satisfactory. However, the use of pedicled muscle or omental flaps to cover the graft could improve the outcomes. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Comparison of Masticatory and Swallowing Functional Outcomes in Surgically and Prosthetically Rehabilitated Maxillectomy Patients.

Science.gov (United States)

Sreeraj, R; Krishnan, Vinod; V, Manju; Thankappan, Krishnakumar

This study compared masticatory and swallowing functional outcomes in maxillectomy patients who underwent surgical and prosthetic rehabilitation or prosthetic rehabilitation only following surgical resection. This comparative cross-sectional study involved 20 maxillectomy patients and compared their masticatory and swallowing functions following combined surgical and prosthodontic management vs an exclusively prosthodontic approach. Masticatory performance was measured by an originally modified sieve method using hydrocolloid material, and video fluoroscopic examination was employed for swallowing assessments. Masticatory performance was significantly better in the patient group treated with flaps and removable denture prostheses compared to patients treated with obturator prosthesis alone. Swallowing outcomes were comparable in both groups. Flap reconstruction followed by an obturator prosthesis seems to be a preferable option when planning for functional rehabilitation in maxillectomy patients. Further research is needed to substantiate the functional outcomes noted in this study.

Lightweight custom composite prosthetic components using an additive manufacturing-based molding technique.

Science.gov (United States)

Leddy, Michael T; Belter, Joseph T; Gemmell, Kevin D; Dollar, Aaron M

2015-01-01

Additive manufacturing techniques are becoming more prominent and cost-effective as 3D printing becomes higher quality and more inexpensive. The idea of 3D printed prosthetics components promises affordable, customizable devices, but these systems currently have major shortcomings in durability and function. In this paper, we propose a fabrication method for custom composite prostheses utilizing additive manufacturing, allowing for customizability, as well the durability of professional prosthetics. The manufacturing process is completed using 3D printed molds in a multi-stage molding system, which creates a custom finger or palm with a lightweight epoxy foam core, a durable composite outer shell, and soft urethane gripping surfaces. The composite material was compared to 3D printed and aluminum materials using a three-point bending test to compare stiffness, as well as gravimetric measurements to compare weight. The composite finger demonstrates the largest stiffness with the lowest weight compared to other tested fingers, as well as having customizability and lower cost, proving to potentially be a substantial benefit to the development of upper-limb prostheses.

A radiologic study of an ancient Egyptian mummy with a prosthetic toe.

Science.gov (United States)

Brier, Bob; Vinh, Phuong; Schuster, Michael; Mayforth, Howard; Johnson Chapin, Emily

2015-06-01

A radiologic examination (both CT and traditional X-ray) of two mummies curated at the Albany Institute of History and Art revealed the identity of the mummified remains as well as details of the person's life style parameters (markers of occupational stress). These mummies, brought to the Institute over 100 years ago, were unstudied until 1989. This preliminary study led to the misappropriation of the remains, and subsequent switching of the remains within their coffins. Recent and more detailed analyses lead to the correct identification of sex, a re-association of the remains to their interment coffins, as well as a detailed analysis of occupational markers. A prosthetic toe was identified in one of the mummies which lead to the functional exploration of prosthetics in the past including their use as part of funerary processing in ancient Egypt. Finally, details of the embalming process place the wrapped mummy within the time frame identified on the coffin of the mummy identified as Ankhefenmut as well as confirming his social status. © 2015 Wiley Periodicals, Inc.

From birth till palatoplasty: Prosthetic procedural limitations and safeguarding infants with palatal cleft

Directory of Open Access Journals (Sweden)

Sudhir Bhandari

2018-01-01

Full Text Available The most imminent issue to be addressed in a child born with cleft lip and/or palate is restoration of normal feeding. Early surgical treatment for cleft repair is crucial but may need to be postponed until certain age and weight gain is attained in an infant. When other feeding interventions fail in these children, prosthetic obturation of the defect with feeding instructions in the interim period is indicated to ward off the prevailing concerns. However, the entire prosthetic management presents a significant challenge with respect to the child's age, scope of iatrogenic injury to the delicate oral tissues, and potential for life-threatening situation during the procedures. This article draws attention toward preemptive measures which should be undertaken in the clinical setting during the fabrication of obturator to ascertain a desirable outcome without experiencing a grave complication that may arise due to ignorance and/or lack of facilities.

Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal

OpenAIRE

Nikola Džakula; Josip Kranjčić; Denis Vojvodić

2016-01-01

The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The tw...

Prosthetic joint infection caused by Trueperella bernardiae.

Science.gov (United States)

Gilarranz, Raul; Chamizo, Francisco; Horcajada, Iballa; Bordes-Benítez, Ana

2016-09-01

Trueperella bernardiae is a Gram-positive coryneform bacilli which role as human pathogen is unknown because it has been usually considered a contaminant. Furthermore its identification by biochemical test was difficult. We describe a prosthetic joint infection in a women who years ago underwent a total knee replacement with superinfection and necrosis of the patellar tendon as major complications. In the sample of synovial fluid collected grew a gram-positive bacilli which was identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) as T. bernardiae. The patient was treated with ciprofloxacin and currently preserves the prosthesis without signs of infection. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Maxillofacial prosthetic rehalibilation of the oral cancer patient

International Nuclear Information System (INIS)

Wolfaardt, J.F.; Monteith, B.D.

1982-01-01

The victim of orofacial cancer is frequently subjected to severe morphological and functional disturbance: a condition which the maxillofacial prosthetist can do much to alleviate through the use of various prosthetic devices. The successful rehabilitation of these patients, however, is often compromised by the presence of psychosocial and other problems, the solution of which extends beyond the limits of a single clinical discipline. The modern approach to orofacial cancer, therefore, is organised within the context of interdisciplinary co-operation: each phase of patient management being planed and executed according to the co-ordinated efforts of the various members of a head and neck cancer team

Infection imaging with 99mTc-biotin in patients with prosthetic hip replacement

International Nuclear Information System (INIS)

Villa, G.; Mariani, G.; Augeri, C.; Pipino, F.; Paganelli, G.; Chinol, M.

2002-01-01

Full text: Although the incidence of infection in prosthetic hip joint replacements has decreased from about 10-15 % to about 0.5-2 % over the last 20 years, the total number of infections has actually increased because of the large number of patients undergoing the procedure. The most frequent clinical presentation of this complication is functional impairment and pain, with or without fever and other signs and/or symptoms of infection. The main is differentiating true infection from simple loosening with inflammation of the implanted stem. Scintigraphy with radiolabeled autologous leukocytes (WBC) represents the 'gold standard' nuclear medicine procedure for imaging infection. However, this procedure is time-consuming, expensive, and involves some biological hazard. Preliminary data, obtained during validation of the avidin/111In-biotin approach, have suggested some potential of 111ln-biotin per se to accumulate at sites of infection. In this pilot study we explored the potential of 99mTc-biotin as an infection imaging agent in pts with orthopedic infections. N4-lys-biotin was labeled with 1110 MBq. Sixteen pts bearing a total of 20 prosthetic hip replacements were enrolled in the study (9 women and 7 men, mean age 73.2 yrs). Eight pts had previously undergone removal of their hip prosthesis because of infection, while infection was suspected in the remaining 8 pts. Scintigraphy was recorded 20 min, then 1, 4 and 24 hr after the i.v. injection of 99mTc-biotin. Within 48 hrs of the 99mTc-biotin study, all pts also underwent scintigraphy with 99mTc-HMPAO-WBC. Out of the 20 hips evaluated, 15 turned out to be infected while in the remaining 5 cases pain was only caused by bone-prosthetic loosening and/or conditions other than infection. In 12/15 infected sites scintigraphy was concordantly positive with both procedures, 99mTc-biotin yielding higher target-to-nontarget ratios than 99mTc-HMPAO-WBC in 4 cases and similar values in the other cases. Discordant patterns

Psychometric evaluation of self-report outcome measures for prosthetic applications.

Science.gov (United States)

Hafner, Brian J; Morgan, Sara J; Askew, Robert L; Salem, Rana

2016-01-01

Documentation of clinical outcomes is increasingly expected in delivery of prosthetic services and devices. However, many outcome measures suitable for use in clinical care and research have not been psychometrically tested with prosthesis users. The aim of this study was to determine test-retest reliability, mode-of-administration (MoA) equivalence, standard error of measurement (SEM), and minimal detectable change (MDC) of standardized, self-report instruments that assess constructs of importance to people with lower limb loss. Prosthesis users (n = 201) were randomly assigned to groups based on MoA (i.e., paper, electronic, or mixed-mode). Participants completed two surveys 2 to 3 d apart. Instruments included the Prosthetic Limb Users Survey of Mobility, Prosthesis Evaluation Questionnaire-Mobility Subscale, Activities-Specific Balance Confidence Scale, Quality of Life in Neurological Conditions-Applied Cognition/General Concerns, Patient-Reported Outcomes Measurement Information System Profile, and Socket Comfort Score. Intraclass correlation coefficients indicated all instruments are appropriate for group-level comparisons and select instruments are suitable for individual-level applications. Several instruments showed evidence of possible floor and ceiling effects. All were equivalent across MoAs. SEM and MDC were quantified to facilitate interpretation of outcomes and change scores. These results can enhance clinicians' and researchers' ability to select, apply, and interpret scores from instruments administered to prosthesis users.

Prosthetic joint infection development of an evidence-based diagnostic algorithm.

Science.gov (United States)

Mühlhofer, Heinrich M L; Pohlig, Florian; Kanz, Karl-Georg; Lenze, Ulrich; Lenze, Florian; Toepfer, Andreas; Kelch, Sarah; Harrasser, Norbert; von Eisenhart-Rothe, Rüdiger; Schauwecker, Johannes

2017-03-09

Increasing rates of prosthetic joint infection (PJI) have presented challenges for general practitioners, orthopedic surgeons and the health care system in the recent years. The diagnosis of PJI is complex; multiple diagnostic tools are used in the attempt to correctly diagnose PJI. Evidence-based algorithms can help to identify PJI using standardized diagnostic steps. We reviewed relevant publications between 1990 and 2015 using a systematic literature search in MEDLINE and PUBMED. The selected search results were then classified into levels of evidence. The keywords were prosthetic joint infection, biofilm, diagnosis, sonication, antibiotic treatment, implant-associated infection, Staph. aureus, rifampicin, implant retention, pcr, maldi-tof, serology, synovial fluid, c-reactive protein level, total hip arthroplasty (THA), total knee arthroplasty (TKA) and combinations of these terms. From an initial 768 publications, 156 publications were stringently reviewed. Publications with class I-III recommendations (EAST) were considered. We developed an algorithm for the diagnostic approach to display the complex diagnosis of PJI in a clear and logically structured process according to ISO 5807. The evidence-based standardized algorithm combines modern clinical requirements and evidence-based treatment principles. The algorithm provides a detailed transparent standard operating procedure (SOP) for diagnosing PJI. Thus, consistently high, examiner-independent process quality is assured to meet the demands of modern quality management in PJI diagnosis.

Energy flow analysis of amputee walking shows a proximally-directed transfer of energy in intact limbs, compared to a distally-directed transfer in prosthetic limbs at push-off.

Science.gov (United States)

Weinert-Aplin, R A; Howard, D; Twiste, M; Jarvis, H L; Bennett, A N; Baker, R J

2017-01-01

Reduced capacity and increased metabolic cost of walking occurs in amputees, despite advances in prosthetic componentry. Joint powers can quantify deficiencies in prosthetic gait, but do not reveal how energy is exchanged between limb segments. This study aimed to quantify these energy exchanges during amputee walking. Optical motion and forceplate data collected during walking at a self-selected speed for cohorts of 10 controls, 10 unilateral trans-tibial, 10 unilateral trans-femoral and 10 bilateral trans-femoral amputees were used to determine the energy exchanges between lower limb segments. At push-off, consistent thigh and shank segment powers were observed between amputee groups (1.12W/kg vs. 1.05W/kg for intact limbs and 0.97W/kg vs. 0.99W/kg for prosthetic limbs), and reduced prosthetic ankle power, particularly in trans-femoral amputees (3.12W/kg vs. 0.87W/kg). Proximally-directed energy exchange was observed in the intact limbs of amputees and controls, while prosthetic limbs displayed distally-directed energy exchanges at the knee and hip. This study used energy flow analysis to show a reversal in the direction in which energy is exchanged between prosthetic limb segments at push-off. This reversal was required to provide sufficient energy to propel the limb segments and is likely a direct result of the lack of push-off power at the prosthetic ankle, particularly in trans-femoral amputees, and leads to their increased metabolic cost of walking. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

Embedded System for Prosthetic Control Using Implanted Neuromuscular Interfaces Accessed Via an Osseointegrated Implant.

Science.gov (United States)

Mastinu, Enzo; Doguet, Pascal; Botquin, Yohan; Hakansson, Bo; Ortiz-Catalan, Max

2017-08-01

Despite the technological progress in robotics achieved in the last decades, prosthetic limbs still lack functionality, reliability, and comfort. Recently, an implanted neuromusculoskeletal interface built upon osseointegration was developed and tested in humans, namely the Osseointegrated Human-Machine Gateway. Here, we present an embedded system to exploit the advantages of this technology. Our artificial limb controller allows for bioelectric signals acquisition, processing, decoding of motor intent, prosthetic control, and sensory feedback. It includes a neurostimulator to provide direct neural feedback based on sensory information. The system was validated using real-time tasks characterization, power consumption evaluation, and myoelectric pattern recognition performance. Functionality was proven in a first pilot patient from whom results of daily usage were obtained. The system was designed to be reliably used in activities of daily living, as well as a research platform to monitor prosthesis usage and training, machine-learning-based control algorithms, and neural stimulation paradigms.

Single- and dual-energy quantitative CT adjacent to acetabular prosthetic components

DEFF Research Database (Denmark)

Mussmann, Bo Redder; Andersen, Poul Erik; Torfing, Trine

2017-01-01

and to compare BMD measurements in single and dual energy CT (SECT and DECT). Methods and Materials: 10 male patients with uncemented hip prosthetics were scanned and rescanned using 120 kVp SECT and DECT with virtual monochromatic images reconstructed at 130 keV. Hemispherical ROIs were defined slice...... that the intraobserver agreement of the scan modes is equal. BMD cannot be measured interchangeably with SECT and DECT....

Cinema and Prosthetic Memory: The Case of the Korean War

OpenAIRE

Keene, Judith

2010-01-01

This paper assesses the explanatory possibilities of the concept of prosthetic memory, with cinema as the enabler of popular understanding, when applied to the Korean War. The essay examines why it was that the conflict in Korea for many decades occupied a memory void and whether the explanations that have been offered for other similar “forgotten “wars are useful in relation to Korea. The analysis sugggests that cinema may be important in the formation of popular understanding but that th...

An Innovative Three Part Prosthetic Rehabilitation of Class-1V Facial Defect

OpenAIRE

Balu, K.

2013-01-01

Loss of maxillo facial structures due to neoplasm, trauma and accidents gives inconsolable mental, physical and psychological agony to a person’s dignified life in his living society. Surgical reconstruction was not feasible for all cases and certain cases needs prosthetic rehabilitation. In this clinical case report, an innovative, simple three part maxillo orbital prosthesis fabrication using magnets was explained.

Effect of the prosthetic group on the pharmacologic properties of 18F-labeled rhodamine B, a potential myocardial perfusion agent for positron emission tomography (PET).

Science.gov (United States)

Bartholomä, Mark D; Gottumukkala, Vijay; Zhang, Shaohui; Baker, Amanda; Dunning, Patricia; Fahey, Frederic H; Treves, S Ted; Packard, Alan B

2012-12-27

We recently reported the development of the 2-[(18)F]fluoroethyl ester of rhodamine B as a potential positron emission tomography (PET) tracer for myocardial perfusion imaging. This compound, which was prepared using a [(18)F]fluoroethyl prosthetic group, has significant uptake in the myocardium in rats but also demonstrates relatively high liver uptake and is rapidly hydrolyzed in vivo in mice. We have now prepared (18)F-labeled rhodamine B using three additional prosthetic groups (propyl, diethylene glycol, and triethylene glycol) and found that the prosthetic group has a significant effect on the in vitro and in vivo properties of these compounds. Of the esters prepared to date, the diethylene glycol ester is superior in terms of in vitro stability and pharmacokinetics. These observations suggest that the prosthetic group plays a significant role in determining the pharmacological properties of (18)F-labeled compounds. They also support the value of continued investigation of (18)F-labeled rhodamines as PET radiopharmaceuticals for myocardial perfusion imaging.

F-18-Fluorodeoxyglucose Positron Emission Tomography/CT Scanning in Diagnosing Vascular Prosthetic Graft Infection

NARCIS (Netherlands)

Saleem, Ben R.; Pol, Robert A.; Slart, Riemer H. J. A.; Reijnen, Michel M. P. J.; Zeebregts, Clark J.

2014-01-01

Vascular prosthetic graft infection (VPGI) is a severe complication after vascular surgery. CT-scan is considered the diagnostic tool of choice in advanced VPGI. The incidence of a false-negative result using CT is relatively high, especially in the presence of low-grade infections.

Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty.

Science.gov (United States)

Saffo, Zaid; Ognjan, Anthony

2016-01-01

The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a

The evidence-base for elevated vacuum in lower limb prosthetics: Literature review and professional feedback.

Science.gov (United States)

Gholizadeh, H; Lemaire, E D; Eshraghi, A

2016-08-01

An optimal suspension system can improve comfort and quality of life in people with limb loss. To guide practice on prosthetic vacuum suspension systems, assessment of the current evidence and professional opinion are required. PubMed, Web of Science, and Google Scholar databases were explored to find related articles. Search terms were amputees, artificial limb, prosthetic suspension, prosthetic liner, vacuum, and prosthesis. The results were refined by vacuum socket or vacuum assisted suspension or sub-atmospheric suspension. Study design, research instrument, sample size, and outcome measures were reviewed. An online questionnaire was also designed and distributed worldwide among professionals and prosthetists (www.ispoint.org, OANDP-L, LinkedIn, personal email). 26 articles were published from 2001 to March 2016. The number of participants averaged 7 (SD=4) for transtibial and 6 (SD=6) for transfemoral amputees. Most studies evaluated the short-term effects of vacuum systems by measuring stump volume changes, gait parameters, pistoning, interface pressures, satisfaction, balance, and wound healing. 155 professionals replied to the questionnaire and supported results from the literature. Elevated vacuum systems may have some advantages over the other suspension systems, but may not be appropriate for all people with limb loss. Elevated vacuum suspension could improve comfort and quality of life for people with limb loss. However, future investigations with larger sample sizes are needed to provide strong statistical conclusions and to evaluate long-term effects of these systems. Copyright © 2016. Published by Elsevier Ltd.

Effects of a 3D segmental prosthetic system for tricuspid valve annulus remodelling on the right coronary artery: a human cadaveric coronary angiography study.

Science.gov (United States)

Riki-Marishani, Mohsen; Gholoobi, Arash; Sazegar, Ghasem; Aazami, Mathias H; Hedjazi, Aria; Sajjadian, Maryam; Ebrahimi, Mahmoud; Aghaii-Zade Torabi, Ahmad

2017-09-01

A prosthetic system to repair secondary tricuspid valve regurgitation was developed. The conceptual engineering of the current device is based on 3D segmental remodelling of the tricuspid valve annulus in lieu of reductive annuloplasty. This study was designed to investigate the operational safety of the current prosthetic system with regard to the anatomical integrity of the right coronary artery (RCA) in fresh cadaveric human hearts. During the study period, from January to April 2016, the current prosthetic system was implanted on the tricuspid valve annulus in fresh cadaveric human hearts that met the study's inclusion criteria. The prepared specimens were investigated via selective coronary angiography of the RCA in the catheterization laboratory. The RCA angiographic anatomies were categorized as normal, distorted, kinked or occluded. Sixteen specimens underwent implantation of the current prosthetic system. The mean age of the cadaveric human hearts was 43.24 ± 15.79 years, with vehicle accident being the primary cause of death (59%). A dominant RCA was noticed in 62.5% of the specimens. None of the specimens displayed any injury, distortion, kinking or occlusion in the RCA due to the implantation of the prostheses. In light of the results of the present study, undertaken on fresh cadaveric human heart specimens, the current segmental prosthetic system for 3D remodelling of the tricuspid valve annulus seems to be safe vis-à-vis the anatomical integrity of the RCA. Further in vivo studies are needed to investigate the functional features of the current prosthetic system with a view to addressing the complex pathophysiology of secondary tricuspid valve regurgitation. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Prosthetic rehabilitation using adhesive bridge and fixed-fixed bridge on the maxilla and telescopic crown overdenture on mandible

Directory of Open Access Journals (Sweden)

Indah Sulistiawaty

2016-12-01

Full Text Available Prosthetic rehabilitation is the rehabilitation process of masticatory and esthetics function for patients missing teeth and alveolar bone by means of manufacture and installation of dentures. The prosthetic rehabilitation commonly used include denture adhesive bridge, fixed-fixed bridge, as well as telescopic overdenture. Adhesive bridge is bridge denture consisting of single pontic and two retainer wings attached to the abutment using cement or resin. Fixed-fixed bridge is a bridge denture with rigid connectors on both ends of the pontics, whereas the telescopic crown Overdenture is a removable denture that uses linked precision on the original tooth in the form of primary coping on abutment and secondary coping on the denture. To expose the procedures of prosthetic rehabilitation using adhesive bridge and fixed-fixed bridge on the maxilla and telescopic crown Overdenture on mandible. Male patients aged 32 years came with complaints of difficulty to chew food because he had lost some teeth behind. In the maxilla, teeth are lost in the region of 15 and 16 performed by making the fixed-fixed bridge with abutment teeth 14 and 17. Loss of teeth in the region of 26, performed the manufacture of adhesive bridge with a box preparation on the occlusal 25 and 27. In the mandible, tooth loss in the region of 36,37,46, and 47 performed manufacture of telescopic crown Overdenture with primer coping on the teeth 35.38, 45, and 48 and the secondary coping on a metal frame. Prosthetic rehabilitation especially in the case of loss of back teeth is very important because with the denture patients can chew properly and maintain the stomatognathic system.

A dynamic model-based approach to motion and deformation tracking of prosthetic valves from biplane x-ray images.

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Wagner, Martin G; Hatt, Charles R; Dunkerley, David A P; Bodart, Lindsay E; Raval, Amish N; Speidel, Michael A

2018-04-16

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure in which a prosthetic heart valve is placed and expanded within a defective aortic valve. The device placement is commonly performed using two-dimensional (2D) fluoroscopic imaging. Within this work, we propose a novel technique to track the motion and deformation of the prosthetic valve in three dimensions based on biplane fluoroscopic image sequences. The tracking approach uses a parameterized point cloud model of the valve stent which can undergo rigid three-dimensional (3D) transformation and different modes of expansion. Rigid elements of the model are individually rotated and translated in three dimensions to approximate the motions of the stent. Tracking is performed using an iterative 2D-3D registration procedure which estimates the model parameters by minimizing the mean-squared image values at the positions of the forward-projected model points. Additionally, an initialization technique is proposed, which locates clusters of salient features to determine the initial position and orientation of the model. The proposed algorithms were evaluated based on simulations using a digital 4D CT phantom as well as experimentally acquired images of a prosthetic valve inside a chest phantom with anatomical background features. The target registration error was 0.12 ± 0.04 mm in the simulations and 0.64 ± 0.09 mm in the experimental data. The proposed algorithm could be used to generate 3D visualization of the prosthetic valve from two projections. In combination with soft-tissue sensitive-imaging techniques like transesophageal echocardiography, this technique could enable 3D image guidance during TAVR procedures. © 2018 American Association of Physicists in Medicine.

Real-time three-dimensional transesophageal echocardiography in valve disease: comparison with surgical findings and evaluation of prosthetic valves.

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Sugeng, Lissa; Shernan, Stanton K; Weinert, Lynn; Shook, Doug; Raman, Jai; Jeevanandam, Valluvan; DuPont, Frank; Fox, John; Mor-Avi, Victor; Lang, Roberto M

2008-12-01

Recently, a novel real-time 3-dimensional (3D) matrix-array transesophageal echocardiographic (3D-MTEE) probe was found to be highly effective in the evaluation of native mitral valves (MVs) and other intracardiac structures, including the interatrial septum and left atrial appendage. However, the ability to visualize prosthetic valves using this transducer has not been evaluated. Moreover, the diagnostic accuracy of this new technology has never been validated against surgical findings. This study was designed to (1) assess the quality of 3D-MTEE images of prosthetic valves and (2) determine the potential value of 3D-MTEE imaging in the preoperative assessment of valvular pathology by comparing images with surgical findings. Eighty-seven patients undergoing clinically indicated transesophageal echocardiography were studied. In 40 patients, 3D-MTEE images of prosthetic MVs, aortic valves (AVs), and tricuspid valves (TVs) were scored for the quality of visualization. For both MVs and AVs, mechanical and bioprosthetic valves, the rings and leaflets were scored individually. In 47 additional patients, intraoperative 3D-MTEE diagnoses of MV pathology obtained before initiating cardiopulmonary bypass were compared with surgical findings. For the visualization of prosthetic MVs and annuloplasty rings, quality was superior compared with AV and TV prostheses. In addition, 3D-MTEE imaging had 96% agreement with surgical findings. Three-dimensional matrix-array transesophageal echocardiographic imaging provides superb imaging and accurate presurgical evaluation of native MV pathology and prostheses. However, the current technology is less accurate for the clinical assessment of AVs and TVs. Fast acquisition and immediate online display will make this the modality of choice for MV surgical planning and postsurgical follow-up.

Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminated Mycobacterium chimaera infections subsequent to open heart surgery.

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Kohler, Philipp; Kuster, Stefan P; Bloemberg, Guido; Schulthess, Bettina; Frank, Michelle; Tanner, Felix C; Rössle, Matthias; Böni, Christian; Falk, Volkmar; Wilhelm, Markus J; Sommerstein, Rami; Achermann, Yvonne; Ten Oever, Jaap; Debast, Sylvia B; Wolfhagen, Maurice J H M; Brandon Bravo Bruinsma, George J; Vos, Margreet C; Bogers, Ad; Serr, Annerose; Beyersdorf, Friedhelm; Sax, Hugo; Böttger, Erik C; Weber, Rainer; van Ingen, Jakko; Wagner, Dirk; Hasse, Barbara

2015-10-21

We identified 10 patients with disseminated Mycobacterium chimaera infections subsequent to open-heart surgery at three European Hospitals. Infections originated from the heater-cooler unit of the heart-lung machine. Here we describe clinical aspects and treatment course of this novel clinical entity. Interdisciplinary care and follow-up of all patients was documented by the study team. Patients' characteristics, clinical manifestations, microbiological findings, and therapeutic measures including surgical reinterventions were reviewed and treatment outcomes are described. The 10 patients comprise a 1-year-old child and nine adults with a median age of 61 years (range 36-76 years). The median duration from cardiac surgery to diagnosis was 21 (range 5-40) months. All patients had prosthetic material-associated infections with either prosthetic valve endocarditis, aortic graft infection, myocarditis, or infection of the prosthetic material following banding of the pulmonary artery. Extracardiac manifestations preceded cardiovascular disease in some cases. Despite targeted antimicrobial therapy, M. chimaera infection required cardiosurgical reinterventions in eight patients. Six out of 10 patients experienced breakthrough infections, of which four were fatal. Three patients are in a post-treatment monitoring period. Healthcare-associated infections due to M. chimaera occurred in patients subsequent to cardiac surgery with extracorporeal circulation and implantation of prosthetic material. Infections became clinically apparent after a time lag of months to years. Mycobacterium chimaera infections are easily missed by routine bacterial diagnostics and outcome is poor despite long-term antimycobacterial therapy, probably because biofilm formation hinders eradication of pathogens. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Effect of clinical parameters on the control of myoelectric robotic prosthetic hands.

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Atzori, Manfredo; Gijsberts, Arjan; Castellini, Claudio; Caputo, Barbara; Hager, Anne-Gabrielle Mittaz; Elsig, Simone; Giatsidis, Giorgio; Bassetto, Franco; Müller, Henning

2016-01-01

Improving the functionality of prosthetic hands with noninvasive techniques is still a challenge. Surface electromyography (sEMG) currently gives limited control capabilities; however, the application of machine learning to the analysis of sEMG signals is promising and has recently been applied in practice, but many questions still remain. In this study, we recorded the sEMG activity of the forearm of 11 male subjects with transradial amputation who were mentally performing 40 hand and wrist movements. The classification performance and the number of independent movements (defined as the subset of movements that could be distinguished with >90% accuracy) were studied in relationship to clinical parameters related to the amputation. The analysis showed that classification accuracy and the number of independent movements increased significantly with phantom limb sensation intensity, remaining forearm percentage, and temporal distance to the amputation. The classification results suggest the possibility of naturally controlling up to 11 movements of a robotic prosthetic hand with almost no training. Knowledge of the relationship between classification accuracy and clinical parameters adds new information regarding the nature of phantom limb pain as well as other clinical parameters, and it can lay the foundations for future "functional amputation" procedures in surgery.

Stiffness and position control of a prosthetic wrist by means of an EMG interface

NARCIS (Netherlands)

Rao, S.; Carloni, Raffaella; Stramigioli, Stefano

In this paper, we present a novel approach for decoding electromyographic signals from an amputee and for interfacing them with a prosthetic wrist. The model for the interface makes use of electromyographic signals from electrodes placed in agonistic and antagonistic sides of the forearm. The model

Pilot Study for OCT Guided Design and Fit of a Prosthetic Device for Treatment of Corneal Disease

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Hong-Gam T. Le

2012-01-01

Full Text Available Purpose. To assess optical coherence tomography (OCT for guiding design and fit of a prosthetic device for corneal disease. Methods. A prototype time domain OCT scanner was used to image the anterior segment of patients fitted with large diameter (18.5–20 mm prosthetic devices for corneal disease. OCT images were processed and analyzed to characterize corneal diameter, corneal sagittal height, scleral sagittal height, scleral toricity, and alignment of device. Within-subject variance of OCT-measured parameters was evaluated. OCT-measured parameters were compared with device parameters for each eye fitted. OCT image correspondence with ocular alignment and clinical fit was assessed. Results. Six eyes in 5 patients were studied. OCT measurement of corneal diameter (coefficient of variation, %, cornea sagittal height (%, and scleral sagittal height (% is highly repeatable within each subject. OCT image-derived measurements reveal strong correlation between corneal sagittal height and device corneal height ( and modest correlation between scleral and on-eye device toricity (. Qualitative assessment of a fitted device on OCT montages reveals correspondence with slit lamp images and clinical assessment of fit. Conclusions. OCT imaging of the anterior segment is suitable for custom design and fit of large diameter (18.5–20 mm prosthetic devices used in the treatment of corneal disease.

Prosthetic joint infections: radionuclide state-of-the-art imaging

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Gemmel, Filip [AZ Alma Campus Sijsele, Department of Nuclear Medicine, Sijsele-Damme (Belgium); Wyngaert, Hans van den [AZ Alma Campus Sijsele, Department of Orthopaedic Surgery, Sijsele-Damme (Belgium); Love, Charito [Albert Einstein College of Medicine of Yeshiva University, Division of Nuclear Medicine and Radiology, Bronx, NY (United States); Welling, M.M. [Leiden University Medical Center, Scientist Molecular Imaging, Department of Radiology, Section of Nuclear Medicine C2-203, Leiden (Netherlands); Gemmel, Paul [Ghent University, The Faculty of Economics and Business Administration, Ghent (Belgium); Palestro, Christopher J. [Hofstra North Shore-Long Island Jewish Health System, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Hempstead, NY (United States)

2012-05-15

Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort

Prosthetic joint infections: radionuclide state-of-the-art imaging

International Nuclear Information System (INIS)

Gemmel, Filip; Wyngaert, Hans van den; Love, Charito; Welling, M.M.; Gemmel, Paul; Palestro, Christopher J.

2012-01-01

Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort

Development and marketing of a prosthetic urinary control valve system

Science.gov (United States)

Tenney, J. B., Jr.; Rabinowitz, R.; Rogers, D. W.; Harrison, H. N.

1983-01-01

An implantable prosthetic for the control of urinary incontinence was developed and marketed. Three phases are presented: bench development studies, animal trials, and human clinical trials. This work was performed under the direction of a Research Team at Rochester General Hospital (RGH). Bench trials were completed on prototype hardware and provided early verification of the device's ability to withstand repeated cyclic testing. Configurational variants were evaluated and a preferred design concept was established. Silicone rubber (medical grade) was selected as the preferred material for the prosthesis.

The Ninapro database: A resource for sEMG naturally controlled robotic hand prosthetics.

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Atzori, Manfredo; Muller, Henning

2015-01-01

The dexterous natural control of robotic prosthetic hands with non-invasive techniques is still a challenge: surface electromyography gives some control capabilities but these are limited, often not natural and require long training times; the application of pattern recognition techniques recently started to be applied in practice. While results in the scientific literature are promising they have to be improved to reach the real needs. The Ninapro database aims to improve the field of naturally controlled robotic hand prosthetics by permitting to worldwide research groups to develop and test movement recognition and force control algorithms on a benchmark database. Currently, the Ninapro database includes data from 67 intact subjects and 11 amputated subject performing approximately 50 different movements. The data are aimed at permitting the study of the relationships between surface electromyography, kinematics and dynamics. The Ninapro acquisition protocol was created in order to be easy to be reproduced. Currently, the number of datasets included in the database is increasing thanks to the collaboration of several research groups.

Development of nylon-based artificial muscles for the usage in robotic prosthetic limb

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Atikah, Nurul Anis; Weng, Leong Yeng; Anuar, Adzly; Fat, Chau Chien; Abidin, Izham Zainal; Sahari, Khairul Salleh Mohamed

2017-09-01

This paper describes the development of nylon-based artificial muscles that is intended to be used in prosthetic limb for young amputees. Prosthetic limbs are very expensive and this situation is further compounded for young amputees who are very quickly out-grow their prosthesis. The proposed artificial muscles are made of nylon fishing strings from various size such as 0.45mm, 0.55mm, 0.65mm and 1.00mm. These fishing strings were twisted into coils to create Super Coiled Polymers (SCP) and tested using hot air blower. These artificial muscles react counterintuitively, where when it is exposed to heat, contracts, and when cooled, expands. Peltier devices, when switched-on acts as heat pump, where one side is hot and the other is cold. This phenomenon, when affixed in between 2 SCP's, creates tandem motion similar to triceps and biceps. As initial study, the hot side of the Peltier module was tested using these artificial muscles. The string was measured for both its force production, length contraction, the initial results were promising.

An experimental apparatus to simulate body-powered prosthetic usage: Development and preliminary evaluation.

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Gao, Fan; Rodriguez, Johanan; Kapp, Susan

2016-06-01

Harness fitting in the body-powered prosthesis remains more art than science due to a lack of consistent and quantitative evaluation. The aim of this study was to develop a mechanical, human-body-shaped apparatus to simulate body-powered upper limb prosthetic usage and evaluate its capability of quantitative examination of harness configuration. The apparatus was built upon a torso of a wooden mannequin and integrated major mechanical joints to simulate terminal device operation. Sensors were used to register cable tension, cable excursion, and grip force simultaneously. The apparatus allowed the scapula to move up to 127 mm laterally and the load cell can measure the cable tension up to 445 N. Our preliminary evaluation highlighted the needs and importance of investigating harness configurations in a systematic and controllable manner. The apparatus allows objective, systematic, and quantitative evaluation of effects of realistic harness configurations and will provide insightful and working knowledge on harness fitting in upper limb amputees using body-powered prosthesis. © The International Society for Prosthetics and Orthotics 2015.

3D reconstruction of the structure of a residual limb for customising the design of a prosthetic socket.

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Shuxian, Zheng; Wanhua, Zhao; Bingheng, Lu

2005-01-01

Aiming at overcoming the limitations of the plaster-casting method in traditional prosthetic socket fabrication, the idea of reconstructing the 3D models for bones and skin of the residual limb is proposed. Given the two-dimensional obtained image through CT scanning, using image processing and reverse engineering techniques, the 3D solid model of the residual limb can be successfully reconstructed. The new approach can reproduce both the internal and the external structure of the residual limb. It can moreover avoid making a positive mould by the way of manual modifications. In addition to this, it can provide a scientific basis for the individualization of prosthetic socket design.

Facial identification in very low-resolution images simulating prosthetic vision.

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Chang, M H; Kim, H S; Shin, J H; Park, K S

2012-08-01

Familiar facial identification is important to blind or visually impaired patients and can be achieved using a retinal prosthesis. Nevertheless, there are limitations in delivering the facial images with a resolution sufficient to distinguish facial features, such as eyes and nose, through multichannel electrode arrays used in current visual prostheses. This study verifies the feasibility of familiar facial identification under low-resolution prosthetic vision and proposes an edge-enhancement method to deliver more visual information that is of higher quality. We first generated a contrast-enhanced image and an edge image by applying the Sobel edge detector and blocked each of them by averaging. Then, we subtracted the blocked edge image from the blocked contrast-enhanced image and produced a pixelized image imitating an array of phosphenes. Before subtraction, every gray value of the edge images was weighted as 50% (mode 2), 75% (mode 3) and 100% (mode 4). In mode 1, the facial image was blocked and pixelized with no further processing. The most successful identification was achieved with mode 3 at every resolution in terms of identification index, which covers both accuracy and correct response time. We also found that the subjects recognized a distinctive face especially more accurately and faster than the other given facial images even under low-resolution prosthetic vision. Every subject could identify familiar faces even in very low-resolution images. And the proposed edge-enhancement method seemed to contribute to intermediate-stage visual prostheses.

Consumer satisfaction with the services of prosthetics and orthotics facilities.

Science.gov (United States)

Bosmans, Joline; Geertzen, Jan; Dijkstra, Pieter U

2009-03-01

Consumer satisfaction with the services provided in a prosthetics and orthotics (P&O) facility has seldom been studied. The aim of this study was to analyze consumer satisfaction regarding the services provided by 15 P&O facilities in The Netherlands. Consumers (n = 1,364) of these P&O facilities who were fitted with a prosthesis, orthopaedic shoes, an orthosis, or another device, were asked to rate the overall services provided and whether they were satisfied with the device provided and its delivery time. Additionally, they filled in a modified SERVQUAL questionnaire (see Appendix). Consumers gave the service provided by P&O facilities a mean overall rating of 8.1. The highest ratings were given by consumers fitted with a prosthesis (mean overall rating of services: 8.4). In total, 78% of the consumers were satisfied with the device provided and 93% with the delivery time. The results of our study showed that, on the SERVQUAL, 50% of the statements fulfilled the criteria for a satisfactory quality of the services. The overall consumer rating of the service provided by P&O facilities is high and depends on the device provided. The outcomes on the SERVQUAL were moderate. In future, it is important to study consumer satisfaction more extensively in order to improve the quality of P&O services in daily practice. Additionally, specific questionnaires need to be developed to measure all aspects of prosthetic and orthotic care, with the aim to improve the services.

Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

Science.gov (United States)

Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

2013-01-01

Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

Accuracy of FDG-PET-CT in the Diagnostic Work-up of Vascular Prosthetic Graft Infection

NARCIS (Netherlands)

Bruggink, J. L. M.; Glaudemans, A. W. J. M.; Saleem, B. R.; Meerwaldt, R.; Alkefaji, H.; Prins, T. R.; Start, R. H. J. A.; Zeebregts, C. J.

Objectives: To investigate the diagnostic accuracy of fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) compared with computed tomography (CT) scanning and added value of fused FDG-PET CT in diagnosing vascular prosthetic graft infection. Design: Prospective cohort study with

Prosthetic rehabilitation of a preschooler with induced anodontia - A clinical report

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Shivayogi M Hugar

2011-01-01

Full Text Available A case of prosthetic rehabilitation with complete dentures for a three year nine months old child is presented. Dental prosthesis are frequently used to avoid psychologic, speech, or swallowing problems in preschooler children. The case was followed up for a period of three years. These prosthesis were modified as the child grew and as the permanent teeth erupted into the oral cavity the dentures were trimmed from the areas of erupting teeth to facilitate their eruption.

Prosthetic valve endocarditis 7 months after transcatheter aortic valve implantation diagnosed with 3D TEE

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Cenk Sarı

2016-03-01

Full Text Available Transcatheter aortic valve implantation (TAVI was introduced as an alternative treatment for patients with severe symptomatic aortic stenosis for whom surgery would be high-risk. Prosthetic aortic valve endocarditis is a serious complication of surgical AVR (SAVR with high morbidity and mortality. According to recent cases, post-TAVI prosthetic valve endocarditis (PVE seems to occur very rarely. We present the case of a 75-year-old woman who underwent TAVI (Edwards Saphien XT with an uneventful postoperative stay. She was diagnosed with endocarditis using three dimensional (3D echocardiography on the TAVI device 7 months later and she subsequently underwent surgical aortic valve replacement. Little experience of the interpretation of transoesophageal echocardiography (TEE and the clinical course and effectiveness of treatment strategies in post-TAVI endocarditis exists. We report a case of PVE in a TAVI patient which was diagnosed with three-dimensional transoesophageal echocardiography (3DTEE.

Acute failure of a St. Jude's prosthetic aortic valve: large pannus formation masked by a small thrombus.

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Hurwitz, Seth Eric; Waxman, Daniel; Hecht, Susan

2009-09-01

Pannus formation and valve thrombus can cause prosthetic valve failure. The authors report the case of a 50-year-old woman who presented to the emergency room with decompensated heart failure secondary to mechanical valve dysfunction. On two-dimensional and transesophageal echocardiography, the patient had severe aortic stenosis and regurgitation. A thrombus seen on the valve was felt to be the etiology of her prosthetic valve failure. She underwent emergent cardiac surgery for aortic valve replacement. Pathology revealed that although a small thrombus was present, extensive pannus was the underlying mechanism of valve dysfunction. Differentiation between pannus and thrombus may have important clinical implications, but this case illustrates that distinguishing between these entities by echocardiographic and clinical criteria may not be possible.

Neisseria meningitidis Infecting a Prosthetic Knee Joint: A New Case of an Unusual Disease

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Berta Becerril Carral

2017-01-01

Full Text Available Primary meningococcal meningitis is an infrequent but known disease. However, the infection of a prosthetic joint with Neisseria meningitidis is rare. We hereby describe the second case of an arthroplasty infected with Neisseria meningitidis that responded favourably to prosthesis retention with surgical debridement, in combination with antibiotics treatment.

Prosthetic joint infection: state-of-the-art

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Boris Sergeyevich Belov

2013-01-01

Full Text Available In current clinical practice, joint replacement is one of the progressive and permanently developed surgical treatments in patients with locomotor injury of any genesis. However, the upward trend in the number of replacements is inevitably accompanied by the rising number of patients with periprosthetic joint infection. The polymorphism of its clinical picture and the nonspecificity of diagnostic tests lead to a frequent delay in the diagnosis of prosthetic joint infection (PJI and thus late treatment. This paper gives an update on the etiology, epidemiology, clinical presentation, and diagnosis of PJI. Emphasis is laid on the value of a multimodal approach to PJI treatment Р a combination of surgery and etiotropic antibiotic therapy. The choice of a treatment modality is determined by patient status, comorbidity, and the magnitude and duration of the infectious process.

Prosthetic rehabilitation of edentulous patient with limited oral access: A clinical report

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Sandeep Kumar

2012-01-01

Full Text Available Microstomia may result from surgical treatment of orofacial neoplasms, cleft lips, maxillofacial trauma, burns, radiotherapy or scleroderma. A maximal oral opening that is smaller than the size of a complete denture can make prosthetic treatment challenging. This clinical report presents the prosthodontic management of a total edentulous patient with microstomia. Sectional mandibular and maxillary trays and foldable mandibular and maxillary denture were fabricated for the total edentulous patient.

Smart Sensing and Dynamic Fitting for Enhanced Comfort and Performance of Prosthetics

Science.gov (United States)

2015-10-01

conductive foam: the antenna radiation patch, the ground plane, and the reflectors can be cut from the conductive foams using laser machining. The patch...Detailed structure of “limb-socket” test setup; (c) Internal pressure sensor array with associated solenoid valves Accomplishment #7: Built an...motion; Linear stage Load cell “Limb-socket” (a) Prosthetic liner Bubble actuator patch “Limb” “Socket” (b) Internal pressure sensors Solenoid valves

The additional value of three-dimensional transesophageal echocardiography in complex aortic prosthetic heart valve endocarditis

NARCIS (Netherlands)

Tanis, Wilco; Teske, Arco J.; Van Herwerden, Lex A.; Chamuleau, Steven; Meijboom, Folkert; Budde, Ricardo P J; Cramer, MJ

2015-01-01

Background Two-dimensional transthoracic and transesophageal echocardiography (2DTTE and 2DTEE) may fail to detect signs of prosthetic heart valve (PHV) endocarditis due to acoustic shadowing. Three-dimensional (3D) TEE may have additional value; however, data are scarce. This study was performed to

Cetacean Swimming with Prosthetic Limbs

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Bode-Oke, Ayodeji; Ren, Yan; Dong, Haibo; Fish, Frank

2016-11-01

During entanglement in fishing gear, dolphins can suffer abrasions and amputations of flukes and fins. As a result, if the dolphin survives the ordeal, swimming performance is altered. Current rehabilitation technques is the use of prosthesis to regain swimming ability. In this work, analyses are focused on two dolphins with locomotive impairment; Winter (currently living in Clearwater Marine Aquarium in Florida) and Fuji (lived in Okinawa Churaumi Aquarium in Japan). Fuji lost about 75% of its fluke surface to necrosis (death of cells) and Winter lost its tail due to amputation. Both dolphins are aided by prosthetic tails that mimic the shape of a real dolphin tail. Using 3D surface reconstruction techniques and a high fidelity Computational Fluid Dynamics (CFD) flow solver, we were able to elucidate the kinematics and hydrodynamics and fluke deformation of these swimmers to clarify the effectiveness of prostheses in helping the dolphins regain their swimming ability. Associated with the performance, we identified distinct features in the wake structures that can explain this gap in the performance compared to a healthy dolphin. This work was supported by ONR MURI Grant Number N00014-14-1-0533.

Patient satisfaction and prosthetic aspects with mini-implants retained mandibular overdentures. A 5-year prospective study.

Science.gov (United States)

Elsyad, Moustafa Abdou

2016-07-01

This study aimed to evaluate patient satisfaction and prosthetic aspects during a 5-year prospective clinical study of mini dental implants (MDIs) retaining mandibular overdentures. This observational prospective clinical study was conducted on a group of completely edentulous patients (n = 28) with retention problems of conventional mandibular dentures. All patients received new maxillary and mandibular conventional dentures. A total of 112 MDIs (four per patient) were inserted using the flapless surgical approach and immediately loaded by the new mandibular dentures (overdentures). Patients indicated satisfaction with their prosthesis using a questionnaire and a visual analogue scale (VAS). Patient satisfaction and prosthetic complications were recorded 6 months (T6 m ), 1 (T1), 3 (T3), and 5 (T5) years after overdenture insertion. The patient satisfaction with eating (hard/soft) food (P teeth (n = 10), overdentures relines (n = 10), detachment of the metal housings (n = 9), and fracture of mandibular overdentures (n = 8). Mucositis, soreness, and decubitis ulcer under overdenture occurred most often at T6 m and decreased significantly with time (P = 0.002, 0.005, and 0.024, respectively). Within the limitations of this clinical study, patient satisfaction with mini-implant retained mandibular overdentures increased significantly with time. However, this treatment required a considerable amount of prosthetic maintenance and repair after 5 years of service. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Christ Siemens Touraine syndrome: Two case reports and felicitous approaches to prosthetic management

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Navanith Renahan

2015-01-01

Full Text Available Ectodermal dysplasia is a heterogeneous group of inherited disorders, which exhibit a classic triad of hypohydrosis, hypotrichosis, and hypodontia. Hypohidrotic or anhidrotic ectodermal dysplasia or Christ Siemens Touraine syndrome is the most common condition among ectodermal dysplasia patients. This is a case report on two Christ Siemens Touraine syndrome cases and two different approaches to prosthetic management.

Prosthetic Need between Different Age and Gender ‎With Patient Attending College of Dentistry,Tikrit ‎University

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Reem Ahmed Shihab‎

2017-12-01

Full Text Available Background: the most important factor that affects speak, mastication and aesthetics is tooth loss which in turn imitated on the quality of life. The goal of our research was to evaluate the prosthetic need in sample attending prosthetic department and compare between age and gender. Material and methods: A sample of 244 patients was randomly chosen for questionnaire in the (Removable Prosthodontics Clinic into College of Dentistry-Tikrit University. All subjects were divided in six groups according to their age and also divided according to gender. Intraoral examinations were performed and reasons for extraction were recorded. All statistic calculations were performed using SPSS 23 (Statistical Package for Social Sciences. Results: The total number of 244 patients was involved in this study: 165 (67.6% males and 79 (32.4% females. We found that the higher percentage of patients were in the age group of (20-29 for males which was (23%, 56 patient, while the higher female percentage was found in the age group of (40-49 which was 11.5% . Reasons for extraction recorded the higher percentage due to Caries for both males (75.2% & females (81 % as suspected. Conclusion:The number of patient attending prosthetic department male more than female. Dental caries were the principal cause for extractions in younger patients followed by periodontitis. Society needs more motivation about dental health and care.

Does integrating research into the prosthetics and orthotics undergraduate curriculum enhance students' clinical practice? An interview study on students' perception.

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Al Qaroot, Bashar S; Sobuh, Mohammad

2016-06-01

Problem-based learning (where rather than feeding students the knowledge, they look for it themselves) has long been thought of as an ideal approach in teaching because it would encourage students to acquire knowledge from an undetermined medium of wrong and right answers. However, the effect of such approach in the learning experience of prosthetics and orthotics students has never been investigated. This study explores the implications of integrating problem-based learning into teaching on the students' learning experience via implementing a research-informed clinical practice module into the curriculum of last year prosthetics and orthotics undergraduate students at the University of Jordan (Amman, Jordan). Qualitative research pilot study. Grounded theory approach was used based on the data collected from interviewing a focus group of four students. Students have identified a number of arguments from their experience in the research-informed clinical practice where, generally speaking, students described research-informed clinical practice as a very good method of education. Integrating problem-based learning into teaching has many positive implications. In particular, students pointed out that their learning experience and clinical practice have much improved after the research-informed clinical practice. Findings from this investigation demonstrate that embedding problem-based learning into prosthetics and orthotics students' curriculum has the potential to enhance students' learning experience, particularly students' evidence-based practice. This may lead to graduates who are more knowledgeable and thus who can offer the optimal patient care (i.e. clinical practice). © The International Society for Prosthetics and Orthotics 2014.

Limitations of multimodality imaging in the diagnosis of pannus formation in prosthetic aortic valve and review of the literature.

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Soumoulou, Juan Bautista; Cianciulli, Tomás Francisco; Zappi, Andrea; Cozzarin, Alberto; Saccheri, María Cristina; Lax, Jorge Alberto; Guidoin, Robert; Zhang, Ze

2015-04-26

Pannus formation is a rare complication and occurs almost exclusively in mechanical prosthetic valves. It consists of fibrous tissue that covers the surface of the prosthesis either concentrically or eccentrically, resulting in valve dysfunction. The pathophysiology seems to be associated to a chronic inflammatory process that explains the late and insidious clinical presentation. This diagnosis should be considered in patients with high transvalvular gradients on transthoracic echo, and workup should be completed with fluoroscopy and transesophageal echocardiography. Treatment is always surgical and recurrence is rare. We present a case of pannus formation in a prosthetic aortic valve and a review of the literature regarding this disorder.

A funnel shaped pannus formation above the mitral prosthetic valve diagnosed with real time three-dimensional echocardiography

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Ezgi Polat Ocaklı

2017-09-01

Full Text Available Prosthetic valve obstruction due to pannus formation can be a life-threatening complication. We showed that real time three dimensional echocardiography has incremental value in diagnosing pannus localization and extent.

Amniotic membranes as prosthetic material: experimental utilization data of a rat model.

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Zachariou, Z

1997-10-01

Prosthetic materials are applied for closing big tissue defects, the repair of traumatized organs, or hernias. Because nonabsorbable synthetic materials are rigid, possess a defined and unchangeable size, and foreign body reaction (FBR) may occur, biological materials may be an alternative. In experimental studies in rats the authors implanted the fetal parts of the human amniotic membranes and examined the utilization and FBR induced in a standardized model. In addition amnion (AM) was combined with vicryl-net (VN) for higher implant stability. Fifteen, 30 and 90 days after implantation, macroscopic appearance was examined, and light microscopy and immunohistology testing of the specimens were performed. Adhesions to parenchymal organs and omentum were present irrespective of the side facing the abdominal cavity. AM induced a rapid FBR, which diminished with time. Chorion (CH) and parts of the AM were resorbed within the examined period after infiltration with recipient cells and neovascularisation. The combined implant, AM, and VN showed best results because disadvantages of one material could be compensated for by the advantages of the other. The studies show that AM, in its anatomic definition, combined with VN proves to be a safe and reliable prosthetic material for the use in tissue defects.

QT Prolongation Complicated with Torsades de Pointes in Prosthetic Mitral Valve Endocarditis: A Case Report

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A. Tounsi

2012-01-01

Full Text Available We present the case of a 49-year-old male patient with prosthetic mitral valve endocarditis associated with QT prolongation and torsades de pointes. He was asymptomatic until the end of January 2012, when he was admitted to our hospital emergency unit because of syncope, fever, and suspicion of endocarditis. Cardiologic evaluation was requested and the transthoracic (TTE and transesophageal (TEE echocardiograms revealed vegetations on the prosthetic mitral valve. All cultures were positive for methicillin-sensitive Staphylococcus aureus. The corrected QT (QTc interval was markedly prolonged upon admission (QTc 540 ms. He experienced torsades de pointes (TdP several times and he was recovered after bystander cardiopulmonary resuscitation. The clinical course and the long QTc interval with deep inverted T wave were completely normalized 4 weeks after. He continued on triple antibiotic therapy for 45 days with a good revolution. The clinical features and the possible mechanisms of QT prolongation (inflammation, infection of this patient are discussed.

Virtual Constraint Control of a Powered Prosthetic Leg: From Simulation to Experiments with Transfemoral Amputees.

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Gregg, Robert D; Lenzi, Tommaso; Hargrove, Levi J; Sensinger, Jonathon W

2014-12-01

Recent powered (or robotic) prosthetic legs independently control different joints and time periods of the gait cycle, resulting in control parameters and switching rules that can be difficult to tune by clinicians. This challenge might be addressed by a unifying control model used by recent bipedal robots, in which virtual constraints define joint patterns as functions of a monotonic variable that continuously represents the gait cycle phase. In the first application of virtual constraints to amputee locomotion, this paper derives exact and approximate control laws for a partial feedback linearization to enforce virtual constraints on a prosthetic leg. We then encode a human-inspired invariance property called effective shape into virtual constraints for the stance period. After simulating the robustness of the partial feedback linearization to clinically meaningful conditions, we experimentally implement this control strategy on a powered transfemoral leg. We report the results of three amputee subjects walking overground and at variable cadences on a treadmill, demonstrating the clinical viability of this novel control approach.

Prosthetic valve endocarditis 7 months after transcatheter aortic valve implantation diagnosed with 3D TEE.

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Sarı, Cenk; Durmaz, Tahir; Karaduman, Bilge Duran; Keleş, Telat; Bayram, Hüseyin; Baştuğ, Serdal; Özen, Mehmet Burak; Bayram, Nihal Akar; Bilen, Emine; Ayhan, Hüseyin; Kasapkara, Hacı Ahmet; Bozkurt, Engin

2016-01-01

Transcatheter aortic valve implantation (TAVI) was introduced as an alternative treatment for patients with severe symptomatic aortic stenosis for whom surgery would be high-risk. Prosthetic aortic valve endocarditis is a serious complication of surgical AVR (SAVR) with high morbidity and mortality. According to recent cases, post-TAVI prosthetic valve endocarditis (PVE) seems to occur very rarely. We present the case of a 75-year-old woman who underwent TAVI (Edwards Saphien XT) with an uneventful postoperative stay. She was diagnosed with endocarditis using three dimensional (3D) echocardiography on the TAVI device 7 months later and she subsequently underwent surgical aortic valve replacement. Little experience of the interpretation of transoesophageal echocardiography (TEE) and the clinical course and effectiveness of treatment strategies in post-TAVI endocarditis exists. We report a case of PVE in a TAVI patient which was diagnosed with three-dimensional transoesophageal echocardiography (3DTEE). Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

Clinical Effectiveness of Using Aesthetic Fixed Prosthetic Appliances with Combined Occlusal Surface

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Andrii Biben

2017-06-01

Conclusions. Aesthetic fixed prosthetic appliances with combined occlusal surface demonstrated high functional and aesthetic characteristics. The use of the USHPS system showed a decisive advantage of milled frameworks and combined occlusal surface over traditional cast ceramic frameworks.The combination of high mechanical, strength and tribological properties of zirconium dioxide and high biological as well as aesthetic properties of ceramic materials helped reveal high clinical characteristics of aesthetic appliances with combined occlusal surface.

An evaluation of advanced digital colour technology for colour matching maxillofacial prosthetics.

OpenAIRE

Nacher-Garcia, C.

2016-01-01

Aim: To evaluate the reliability and reproducibility of the Spectromatch-Pro digital colour system (Spectromatch Ltd. UK) in the reproduction of simulated skin-silicone colour samples; and to determine threshold Delta E (∆E) (CIE L*a*b*) of perceptible and acceptable colour differences for maxillofacial prosthetics. Method: A two phase quantitative research design. Phase 1: tested; (i) the reproducibility of the spectrophotometer for eight subjects (n=48) scans; from four ethnic groups...

Energy storage and release of prosthetic feet. Part 1: biomechanical analysis related to user benefits

NARCIS (Netherlands)

Postema, K.; Hermens, Hermanus J.; de Vries, J.; de Vries, J.; Koopman, Hubertus F.J.M.; Eisma, W.H.

1997-01-01

The energy storing and releasing behaviour of 2 energy storing feet (ESF) and 2 conventional prosthetic feet (CF) were compared (ESF: Otto Bock Dynamic Pro and Hanger Quantum; CF: Otto Bock Multi Axial and Otto Bock Lager). Ten trans-tibial amputees were selected. The study was designed as a

Evaluation of a Musculoskeletal Model with Prosthetic Knee through Six Experimental Gait Trials

OpenAIRE

Kia, Mohammad; Stylianou, Antonis P.; Guess, Trent M.

2014-01-01

Knowledge of the forces acting on musculoskeletal joint tissues during movement benefits tissue engineering, artificial joint replacement, and our understanding of ligament and cartilage injury. Computational models can be used to predict these internal forces, but musculoskeletal models that simultaneously calculate muscle force and the resulting loading on joint structures are rare. This study used publicly available gait, skeletal geometry, and instrumented prosthetic knee loading data [1]...

Fabrication, sensation and control of fluidic elastomer actuators and their application towards hand orthotics and prosthetics

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Zhao, Huichan

Due to their continuous and natural motion, fluidic elastomer actuators (FEAs) have shown potential in a range of robotic applications including prosthetics and orthotics. Despite their advantages and rapid developments, robots using these actuators still have several challenging issues to be addressed. First, the reliable production of low cost and complex actuators that can apply high forces is necessary, yet none of existing fabrication methods are both easy to implement and of high force output. Next, compliant or stretchable sensors that can be embedded into their bodies for sophisticated functions are required, however, many of these sensors suffer from hysteresis, fabrication complexity, chemical safety and environmental instability, and material incompatibility with soft actuators. Finally, feedback control for FEAs is necessary to achieve better performance, but most soft robots are still "open-loop". In this dissertation, I intend to help solve the above issues and drive the applications of soft robotics towards hand orthotics and prosthetics. First, I adapt rotational casting as a new manufacturing method for soft actuators. I present a cuboid soft actuator that can generate a force of >25 N at its tip, a near ten-fold increase over similar actuators previously reported. Next, I propose a soft orthotic finger with position control enabled via embedded optical fiber. I monitor both the static and dynamic states via the optical sensor and achieve the prescribed curvatures accurately and with stability by a gain-scheduled proportional-integral-derivative controller. Then I develop the soft orthotic fingers into a low-cost, closed-loop controlled, soft orthotic glove that can be worn by a typical human hand and helpful for grasping light objects, while also providing finger position control. I achieve motion control with inexpensive, binary pneumatic switches controlled by a simple finite-state-machine. Finally, I report the first use of stretchable optical

A new three-dimensional, print-on-demand temporomandibular prosthetic total joint replacement system: Preliminary outcomes.

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Dimitroulis, George; Austin, Stephen; Sin Lee, Peter Vee; Ackland, David

2018-05-16

The aim of this study is to present the preliminary clinical data on the OMX Temporomandibular Joint (TMJ) Prosthetic total joint replacement system. A prospective, cohort, clinical study was undertaken of consecutive adult patients with Category 5 end-stage joint disease who were implanted with the OMX TMJ prosthesis between May 2015 and April 2017. A total of 50 devices were implanted in 38 patients, with 12 patients receiving bilateral prosthetic joints. There were 31 females and 7 males in this cohort, who ranged in age from 20 to 66 years, with a mean of 43.8 years (±14.0 years). Ten of the 50 prosthetic joints (20%) were fully customized, while the remaining were patient matched using virtual planning software. Based on a mean follow-up period of 15.3 months (range 12-24 months) following the TMJ total joint replacement, preliminary results suggest the OMX TMJ prosthesis has made a positive impact on clinical outcomes, with a mean 74.4% reduction in joint pain levels and significant improvements (p < 0.05) in jaw function as measured by the visual analogue scales for mouth opening (30.8%), diet (77.1%), and function (59.2%). No device failures were reported during the study period. This study suggests that the print-on-demand OMX TMJ prosthesis, designed for rapid delivery of both patient-matched and fully customize devices, represents a safe, reliable and versatile implantable joint replacement system for the treatment of category 5 end-stage TMJ disease. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report.

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Cobo, Fernando; Rodríguez-Granger, Javier; López, Enrique M; Jiménez, Gemma; Sampedro, Antonio; Aliaga-Martínez, Luis; Navarro-Marí, José María

2017-02-01

The clinical and microbiological characteristics of prosthetic joint infection (PJI) caused by Candida species is described, including 72 cases in the literature and a case of Candida glabrata infection handled at the present centre. We describe one patient and using the key words 'fungal prosthetic joint infection' and 'candida prosthetic joint infection' we searched MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science, CINAHL and Cochrane systematic review databases for case reports of this condition. Out of the 73 patients, 38 were female; mean age at diagnosis was 65.7 (± SD 18) yrs; 50 had risk factors for candidal infection such as systemic disease (e.g. rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus) and/or immunosuppressive therapy in 18 (24.6%) cases, diabetes mellitus in 14 (19.1%), immunosuppression due to malignant or chronic disease in 24 (32.8%) and long-term antibiotic use in four (5.4%) patients. Infection site was the knee in 36 patients and hip in 35; pain was present in 43 patients and swelling in 23 and the mean surgery-diagnosis interval was 32 months. The most frequent species was C. albicans, followed by C. parapsilosis. The diagnosis was obtained from joint fluid aspirate in 33 cases and intra-operative samples in 16. Susceptibility to antifungals was tested in only 21 isolates. The most frequently used antifungals were fluconazole and amphotericin B. Two-stage exchange arthroplasty was performed in 30 patients and resection arthroplasty in 31; 56 patients were cured with a combination of medical and surgical treatment; one patient died from the infection. PJI caused by Candida requires a high index of suspicion; surgery with long-term antifungal therapy is recommended.

Xeroderma Pigmentosum with Melanoma of Face and Its Prosthetic Management

International Nuclear Information System (INIS)

Sadaf, A.; Yazdanie, N.

2013-01-01

Xeroderma pigmentosum is a rare genetic disorder, characterized by cutaneous, ocular and neurological symptoms. Squamous cell carcinoma and melanoma are also its secondary characters. This case report is about maxillofacial prosthetic management of a 10 years old child presented with xeroderma pigmentosum. The nose of the patient was excised surgically due to melanoma. This case report elaborates the role of prosthodontist and the whole procedure of constructing the nasal prosthesis via conventional technique by using the patient's sibling nasal form as template. Regular follow up revealed marked improvement in esthetics, function and ultimately patient's quality of life. (author)

Design for a three-fingered hand. [robotic and prosthetic applications

Science.gov (United States)

Crossley, F. R. E.

1977-01-01

This paper describes the construction of a prototype mechanical hand or 'end effector' for use on a remotely controlled robot, but with possible application as a prosthetic device. An analysis of hand motions is reported, from which it is concluded that the two most important manipulations (apart from grasps) are to be able to pick up a tool and draw it into a nested grip against the palm, and to be able to hold a pistol-grip tool such as an electric drill and pull the trigger. One of our models was tested and found capable of both these operations.

Cinema and Prosthetic Memory: The Case of the Korean War

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Judith Keene

2010-04-01

Full Text Available This paper assesses the explanatory possibilities of the concept of prosthetic memory, with cinema as the enabler of popular understanding, when applied to the Korean War. The essay examines why it was that the conflict in Korea for many decades occupied a memory void and whether the explanations that have been offered for other similar “forgotten “wars are useful in relation to Korea. The analysis sugggests that cinema may be important in the formation of popular understanding but that there are serious analytical drawbacks in assuming that cinema can provide a window into popular mentalities.

Xeroderma pigmentosum with melanoma of face and its prosthetic management.

Science.gov (United States)

Sadaf, Ayesha; Yazdanie, Nazia

2013-10-01

Xeroderma pigmentosum is a rare genetic disorder, characterized by cutaneous, ocular and neurological symptoms. Squamous cell carcinoma and melanoma are also its secondary characters. This case report is about maxillofacial prosthetic management of a 10 years old child presented with xeroderma pigmentosum. The nose of the patient was excised surgically due to melanoma. This case report elaborates the role of prosthodontist and the whole procedure of constructing the nasal prosthesis via conventional technique by using the patient's sibling nasal form as template. Regular follow up revealed marked improvement in esthetics, function and ultimately patient's quality of life.

Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees: A Multicenter Cohort Study.

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Stefan Salminger

Full Text Available Hand-transplantation and improvements in the field of prostheses opened new frontiers in restoring hand function in below-elbow amputees. Both concepts aim at restoring reliable hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center cohort study comparing hand function and quality-of-life of people with transplanted versus prosthetic hands.Hand function in amputees with either transplant or prostheses was tested with Action Research Arm Test (ARAT, Southampton Hand Assessment Procedure (SHAP and the Disabilities of the Arm, Shoulder and Hand measure (DASH. Quality-of-life was compared with the Short-Form 36 (SF-36.Transplanted patients (n = 5 achieved a mean ARAT score of 40.86 ± 8.07 and an average SHAP score of 75.00 ± 11.06. Prosthetic patients (n = 7 achieved a mean ARAT score of 39.00 ± 3.61 and an average SHAP score of 75.43 ± 10.81. There was no significant difference between transplanted and prosthetic hands in ARAT, SHAP or DASH. While quality-of-life metrics were equivocal for four scales of the SF-36, transplanted patients reported significantly higher scores in "role-physical" (p = 0.006, "vitality" (p = 0.008, "role-emotional" (p = 0.035 and "mental-health" (p = 0.003.The indications for hand transplantation or prosthetic fitting in below-elbow amputees require careful consideration. As functional outcomes were not significantly different between groups, patient's best interests and the route of least harm should guide treatment. Due to the immunosuppressive side-effects, the indication for allotransplantation must still be restrictive, the best being bilateral amputees.

Evaluation of 99mTc-UBI 29-41 scintigraphy for specific detection of experimental Staphylococcus aureus prosthetic joint infections

International Nuclear Information System (INIS)

Sarda-Mantel, Laure; Meulemans, Alain; Vrigneaud, Jean-Marc; Raguin, Olivier; Lebtahi, Rachida; Guludec, Dominique Le; Saleh-Mghir, Azzam; Welling, Mick M.; Hervatin, Florence; Martet, Genevieve; Chau, Francoise

2007-01-01

99m Tc-UBI 29-41 (UBI), an antimicrobial peptide, specifically targets bacteria. We tested the ability of UBI to discriminate between infected and uninfected prosthetic joints using a rabbit model previously validated. Left knee arthroplasty was performed on 20 New Zealand rabbits, then 10 7 cfu of S. aureus (n = 12) or sterile saline (n = 8) was injected into the joint. On days 9 and 20 after surgery, planar UBI scintigraphy was performed in six infected and four uninfected rabbits, 1 h and 4 h p.i. (150 MBq), on a gamma camera. Operated-to-normal knee activity ratio (ONKR) was calculated on each scintigram. Then, after sacrifice, tissue samples of both knees were counted in a gamma counter. One rabbit injected with sterile saline had cutaneous infection at sacrifice and was excluded from analysis. ONKR was higher in infected than in uninfected animals 4 h p.i. 20 days after surgery: 1.75 ± 0.48 vs 1.13 ± 0.11, p = 0.04. From 1 h to 4 h p.i., ONKR increased in 9/12 infected and 0/7 uninfected animals. According to UBI uptake intensity and kinetics, scintigraphy was truly positive in all infected cases on day 9 and in four of six infected cases on day 20. It was truly negative in two of three sterile inflamed prosthetic knees on day 9, and in all cases on day 20. Biodistribution studies revealed increased UBI uptake in periprosthetic tissues in all animals 9 days after surgery, and only in infected animals on day 20. In this experimental study, 99m Tc-UBI 29-41 scintigraphy permitted the early detection of acute prosthetic joint infection, and exclusion of infection in chronic sterile prosthetic joint inflammation. (orig.)

Analytical Study of Active Prosthetic Legs

Science.gov (United States)

Ono, Kyosuke; Katsumata, Mie

Walking with prosthesis has not been well analyzed mathematically and it seems that the design of powered prosthesis has been done empirically so far. This paper presents a dynamic simulation of a normal human walking and walking with an active prosthesis. We also studied the two controlling methods of a powered thigh prosthesis based on multi-body simulation of human walking. First we measured the normal human walking gait, then, we showed that a 3-DOF human walking model can walk on level ground by applying tracking control to the measured walking gait within a certain range of tuned walking period. Next, we applied the tracking control and self-excited control to the powered thigh prosthesis and compared the robustness and efficiency of the two control methods by numerical simulation. As a result, we found that the self-excited control can significantly decrease the hip joint torque and specific cost to 1/3 compared with the tracking control. Moreover, the self-excited control is superior to the tracking control because tuning for the walking period is not needed for the active prosthetic leg.

Surface EMG in advanced hand prosthetics.

Science.gov (United States)

Castellini, Claudio; van der Smagt, Patrick

2009-01-01

One of the major problems when dealing with highly dexterous, active hand prostheses is their control by the patient wearing them. With the advances in mechatronics, building prosthetic hands with multiple active degrees of freedom is realisable, but actively controlling the position and especially the exerted force of each finger cannot yet be done naturally. This paper deals with advanced robotic hand control via surface electromyography. Building upon recent results, we show that machine learning, together with a simple downsampling algorithm, can be effectively used to control on-line, in real time, finger position as well as finger force of a highly dexterous robotic hand. The system determines the type of grasp a human subject is willing to use, and the required amount of force involved, with a high degree of accuracy. This represents a remarkable improvement with respect to the state-of-the-art of feed-forward control of dexterous mechanical hands, and opens up a scenario in which amputees will be able to control hand prostheses in a much finer way than it has so far been possible.

A modified elastic foundation contact model for application in 3D models of the prosthetic knee.

Science.gov (United States)

Pérez-González, Antonio; Fenollosa-Esteve, Carlos; Sancho-Bru, Joaquín L; Sánchez-Marín, Francisco T; Vergara, Margarita; Rodríguez-Cervantes, Pablo J

2008-04-01

Different models have been used in the literature for the simulation of surface contact in biomechanical knee models. However, there is a lack of systematic comparisons of these models applied to the simulation of a common case, which will provide relevant information about their accuracy and suitability for application in models of the implanted knee. In this work a comparison of the Hertz model (HM), the elastic foundation model (EFM) and the finite element model (FEM) for the simulation of the elastic contact in a 3D model of the prosthetic knee is presented. From the results of this comparison it is found that although the nature of the EFM offers advantages when compared with that of the HM for its application to realistic prosthetic surfaces, and when compared with the FEM in CPU time, its predictions can differ from FEM in some circumstances. These differences are considerable if the comparison is performed for prescribed displacements, although they are less important for prescribed loads. To solve these problems a new modified elastic foundation model (mEFM) is proposed that maintains basically the simplicity of the original model while producing much more accurate results. In this paper it is shown that this new mEFM calculates pressure distribution and contact area with accuracy and short computation times for toroidal contacting surfaces. Although further work is needed to confirm its validity for more complex geometries the mEFM is envisaged as a good option for application in 3D knee models to predict prosthetic knee performance.

Effects of Salivary Oxidative Markers on Edentulous Patients' Satisfaction with Prosthetic Denture Treatments: A Pilot Study.

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Chia-Huang Chang

Full Text Available The purpose of this study was to assess relationships among periodontal conditions, salivary antioxidant levels, and patients' satisfaction with their prostheses.This study was conducted at the Division of Prosthodontics, Department of Dentistry, Taipei Medical University Hospital. The periodontal condition of patients was based on an assessment of the plaque index (PI and gingival index (GI. The pH value, flow rate, and buffer capacity of the saliva were estimated. The salivary total antioxidant status (TAS and superoxide dismutase (SOD level were also determined. Patients' satisfaction with prosthetic treatments was evaluated using the Chinese version of the short-form Oral Health Impact Profile (OHIP-14C. A multivariate regression model was used to determine whether patients' satisfaction with prosthetic treatment was affected by their oral health status.In total, 35 edentulous patients were recruited. In the Spearman correlation analysis, salivary pH (r = -0.36, p = 0.03 and the buffer ability (r = -0.48, p<0.01 were associated with OHIP-14C scores. In the multivariate analysis, patients who had a higher GI also had a higher score of physical disabilities (β = 1.38, p = 0.04. Levels of SOD increased with the scores of psychological discomfort (β = 0.33 U/g protein, p = 0.04.This study suggested that both the GI and SOD levels were associated with patients' satisfaction with prosthetic treatments. To the best of our knowledge, this is the first study to elucidate the relationship between OHIP scores and salivary oxidative markers in edentulous patients.

Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair

Energy Technology Data Exchange (ETDEWEB)

Hagelstein, Claudia; Weidner, Meike; Schoenberg, Stefan O.; Buesing, Karen A.; Neff, K.W. [University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim (Germany); Zahn, Katrin [University of Heidelberg, Department of Pediatric Surgery, University Medical Center Mannheim, Mannheim (Germany); Weiss, Christel [University of Heidelberg, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Mannheim (Germany); Schaible, Thomas [University of Heidelberg, Department of Pediatrics, University Medical Center Mannheim, Mannheim (Germany)

2015-01-15

To assess whether the need for postnatal prosthetic patch repair of the diaphragmatic defect in neonates with a congenital diaphragmatic hernia (CDH) is associated with the antenatal measured observed-to-expected magnetic resonance fetal lung volume (o/e MR-FLV). The o/e MR-FLV was calculated in 247 fetuses with isolated CDH. Logistic regression analysis was used to assess the prognostic value of the individual o/e MR-FLV for association with the need for postnatal patch repair. Seventy-seven percent (77 %) of patients with a CDH (190/247) required prosthetic patch repair and the defect was closed primarily in 23 % (57/247). Patients requiring a patch had a significantly lower o/e MR-FLV (27.7 ± 10.2 %) than patients with primary repair (40.8 ± 13.8 %, p < 0.001, AUC = 0.786). With an o/e MR-FLV of 20 %, 92 % of the patients required patch repair, compared to only 24 % with an o/e MR-FLV of 60 %. The need for a prosthetic patch was further influenced by the fetal liver position (herniation/no herniation) as determined by magnetic resonance imaging (MRI; p < 0.001). Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy (AUC = 0.827). Logistic regression analysis based on the o/e MR-FLV is useful for prenatal estimation of the prosthetic patch requirement in patients with a CDH. In addition to the o/e MR-FLV, the position of the liver as determined by fetal MRI helps improve prognostic accuracy. (orig.)

Prosthetic hand sensor placement: Analysis of touch perception during the grasp

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Mirković Bojana

2014-01-01

Full Text Available Humans rely on their hands to perform everyday tasks. The hand is used as a tool, but also as the interface to “sense” the world. Current prosthetic hands are based on sophisticated multi-fingered structures, and include many sensors which counterpart natural proprioceptors and exteroceptors. The sensory information is used for control, but not sent to the user of the hand (amputee. Grasping without sensing is not good enough. This research is part of the development of the sensing interface for amputees, specifically addressing the analysis of human perception while grasping. The goal is to determine the small number of preferred positions of sensors on the prosthetic hand. This task has previously been approached by trying to replicate a natural sensory system characteristic for healthy humans, resulting in a multitude of redundant sensors and basic inability to make the patient aware of the sensor readings on the subconscious level. We based our artificial perception system on the reported sensations of humans when grasping various objects without seeing the objects (obstructed visual feedback. Subjects, with no known sensory deficits, were asked to report on the touch sensation while grasping. The analysis included objects of various sizes, weights, textures and temperatures. Based on this data we formed a map of the preferred positions for the sensors that is appropriate for five finger human-like robotic hand. The final map was intentionally minimized in size (number of sensors.

Mitral valve-sparing procedures and prosthetic heart valve failure: A case report

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Khan, Nasir A; Butany, Jagdish; Leong, Shaun W; Rao, Vivek; Cusimano, Robert J; Ross, Heather J

2009-01-01

Prosthetic heart valve dysfunction due to thrombus or pannus formation can be a life-threatening complication. The present report describes a 47-year-old woman who developed valvular cardiomyopathy after chorda-sparing mitral valve replacement, and subsequently underwent heart transplantation for progressive heart failure. The explanted mitral valve prosthesis showed significant thrombus and pannus leading to reduced leaflet mobility and valvular stenosis. The present report illustrates the role of the subvalvular apparatus and pannus in prosthesis dysfunction. PMID:19279993

Contribution of a multiplex serological test for the preoperative diagnosis of prosthetic joint infection: a prospective study.

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de Seynes, Camille; de Barbeyrac, Bertille; Dutronc, Hervé; Ribes, Clément; Crémer, Paul; Dubois, Véronique; Fabre, Thierry; Dupon, Michel; Dauchy, Frédéric-Antoine

2018-03-22

Prosthetic joint infection (PJI) is a severe complication of orthopaedic surgery. Preoperative diagnosis, although sometimes difficult, is key to choose the relevant treatment. We conducted a prospective study aimed at evaluating the diagnostic performance of a multiplex serological test for the pre-operative diagnosis of PJI. Blood samples were collected between 1 July 2016 and 31 July 2017 among patients referred for suspected PJI that occurred at least six weeks prior. Infection diagnosis was confirmed using intraoperative bacteriological cultures during prosthetic exchange. Seventy-one patients were included, with a median age of 73 years (interquartile range [IQR]: 66-81) and 40 (56%) were male. Twenty-six patients had aseptic loosening and 45 patients had PJI. Among the latter, median time since the last surgery was 96 weeks (IQR: 20-324). Intraoperative cultures found Staphylococcus spp, Streptococcus spp or both in 39, 5 and 1 patients, respectively. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 81.8, 95.4, 97.3 and 72.4%, respectively, for all patients and 87.5, 93.5, 94.6 and 85.3%, respectively, for staphylococcal infections. Patients with false negative (FN) results had a significantly lower blood lymphocyte count (p = .045). Multiplex serological test performed well among patients with chronic staphylococcal prosthetic infection. This approach could contribute to PJI diagnosis especially in patients for whom the pre-operative analysis of joint fluid is not informative.

Zygoma Implant-Supported Prosthetic Rehabilitation of a Patient After Bilateral Maxillectomy.

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Celakil, Tamer; Ayvalioglu, Demet Cagil; Sancakli, Erkan; Atalay, Belir; Doganay, Ozge; Kayhan, Kivanc Bektas

2015-10-01

Maxillectomy defects may vary from localized to extensive soft and hard tissue loss. In addition to physical and psychologic damages, functional and aesthetic aspects must be restored. This clinical report describes the rehabilitation of a patient with a zygoma implant-supported obturator prosthesis caused by a subtotal bilateral maxillectomy due to a squamous oral cell carcinoma. Prosthetic rehabilitation of this patient was performed after zygoma implant surgery. A maxillary obturator prosthesis supported by 2 osseointegrated zygoma implants was fabricated. Despite limited mouth opening and anatomic deficiencies, the patient's aesthetic and functional demands were fulfilled.