Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases

Background and purpose — Osseointegrated implants are an alternative for prosthetic attachment in individuals with amputation who are unable to wear a socket. However, the load transmitted through the osseointegrated fixation to the residual tibia and knee joint can be unbearable for those with transtibial amputation and knee arthritis. We report on the feasibility of combining total knee replacement (TKR) with an osseointegrated implant for prosthetic attachment. Patients and methods — We retrospectively reviewed all 4 cases (aged 38–77 years) of transtibial amputations managed with osseointegration and TKR in 2012–2014. The below-the-knee prosthesis was connected to the tibial base plate of a TKR, enabling the tibial residuum and knee joint to act as weight-sharing structures. A 2-stage procedure involved connecting a standard hinged TKR to custom-made implants and creation of a skin-implant interface. Clinical outcomes were assessed at baseline and after 1–3 years of follow-up using standard measures of health-related quality of life, ambulation, and activity level including the questionnaire for transfemoral amputees (Q-TFA) and the 6-minute walk test. Results — There were no major complications, and there was 1 case of superficial infection. All patients showed improved clinical outcomes, with a Q-TFA improvement range of 29–52 and a 6-minute walk test improvement range of 37–84 meters. Interpretation — It is possible to combine TKR with osseointegrated implants.

Can the direct measurement of the load applied on the residuum of individuals with transfemoral amputation fitted with bone-anchored prosthesis help to improve the rehabilitation program?

To strive to improve the rehabilitation program of individuals with transfemoral amputation fitted with bone-anchored prosthesis based on data from direct measurements of the load applied on the residuum we first of all need to understand the load applied on the fixation. Therefore the load applied on the residuum was first directly measured during standardized activities of daily living such as straight line level walking, ascending and descending stairs and a ramp and walking around a circle. From measuring the load in standardized activities of daily living the load was also measured during different phases of the rehabilitation program such as during walking with walking aids and during load bearing exercises.[1-15] The rehabilitation program for individuals with a transfemoral amputation fitted with an OPRA implant relies on a combination of dynamic and static load bearing exercises.[16-20] This presentation will focus on the study of a set of experimental static load bearing exercises. [1] A group of eleven individuals with unilateral transfemoral amputation fitted with an OPRA implant participated in this study. The load on the implant during the static load bearing exercises was measured using a portable system including a commercial transducer embedded in a short pylon, a laptop and a customized software package. This apparatus was previously shown effective in a proof-of-concept study published by Prof. Frossard. [1-9] The analysis of the static load bearing exercises included an analysis of the reliability as well as the loading compliance. The analysis of the loading reliability showed a high reliability between the loading sessions indicating a correct repetition of the LBE by the participants. [1, 5] The analysis of the loading compliance showed a significant lack of axial compliance leading to a systematic underloading of the long axis of the implant during the proposed experimental static LBE.

Direct measurement of inner prosthesis loading during activities of daily living: Proposal for classification of functional outcome

Background The purpose of this presentation is to outline the relevance of the categorization of the load regime data to assess the functional output and usage of the prosthesis of lower limb amputees. The objectives are • To highlight the need for categorisation of activities of daily living • To present a categorization of load regime applied on residuum, • To present some descriptors of the four types of activity that could be detected, • To provide an example the results for a case. Methods The load applied on the osseointegrated fixation of one transfemoral amputee was recorded using a portable kinetic system for 5 hours. The load applied on the residuum was divided in four types of activities corresponding to inactivity, stationary loading, localized locomotion and directional locomotion as detailed in previously publications. Results The periods of directional locomotion, localized locomotion, and stationary loading occurred 44%, 34%, and 22% of recording time and each accounted for 51%, 38%, and 12% of the duration of the periods of activity, respectively. The absolute maximum force during directional locomotion, localized locomotion, and stationary loading was 19%, 15%, and 8% of the body weight on the anteroposterior axis, 20%, 19%, and 12% on the mediolateral axis, and 121%, 106%, and 99% on the long axis. A total of 2,783 gait cycles were recorded. Discussion Approximately 10% more gait cycles and 50% more of the total impulse than conventional analyses were identified. The proposed categorization and apparatus have the potential to complement conventional instruments, particularly for difficult cases.

Effect of position on precision within the recording field of a markerless motion capture system

Introduction Markerless motion capture systems are relatively new devices that can significantly speed up capturing full body motion. A precision of the assessment of the finger’s position with this type of equipment was evaluated at 17.30 ± 9.56 mm when compare to an active marker system [1]. The Microsoft Kinect was proposed to standardized and enhanced clinical evaluation of patients with hemiplegic cerebral palsy [2]. Markerless motion capture systems have the potential to be used in a clinical setting for movement analysis, as well as for large cohort research. However, the precision of such system needs to be characterized. Global objectives • To assess the precision within the recording field of the markerless motion capture system Openstage 2 (Organic Motion, NY). • To compare the markerless motion capture system with an optoelectric motion capture system with active markers. Specific objectives • To assess the noise of a static body at 13 different location within the recording field of the markerless motion capture system. • To assess the smallest oscillation detected by the markerless motion capture system. • To assess the difference between both systems regarding the body joint angle measurement. Methods Equipment • OpenStage® 2 (Organic Motion, NY) o Markerless motion capture system o 16 video cameras (acquisition rate : 60Hz) o Recording zone : 4m * 5m * 2.4m (depth * width * height) o Provide position and angle of 23 different body segments • VisualeyezTM VZ4000 (PhoeniX Technologies Incorporated, BC) o Optoelectric motion capture system with active markers o 4 trackers system (total of 12 cameras) o Accuracy : 0.5~0.7mm Protocol & Analysis • Static noise: o Motion recording of an humanoid mannequin was done in 13 different locations o RMSE was calculated for each segment in each location • Smallest oscillation detected: o Small oscillations were induced to the humanoid mannequin and motion was recorded until it stopped. o Correlation between the displacement of the head recorded by both systems was measured. A corresponding magnitude was also measured. • Body joints angle: o Body motion was recorded simultaneously with both systems (left side only). o 6 participants (3 females; 32.7 ± 9.4 years old) • Tasks: Walk, Squat, Shoulder flexion & abduction, Elbow flexion, Wrist extension, Pronation / supination (not in results), Head flexion & rotation (not in results), Leg rotation (not in results), Trunk rotation (not in results) o Several body joint angles were measured with both systems. o RMSE was calculated between signals of both systems. Results Conclusion Results show that the Organic Motion markerless system has the potential to be used for assessment of clinical motor symptoms or motor performances However, the following points should be considered: • Precision of the Openstage system varied within the recording field. • Precision is not constant between limb segments. • The error seems to be higher close to the range of motion extremities.

A cryptographic system based on finite field transforms

In this paper, we develop a cipher system based on finite field transforms. In this system, blocks of the input character-string are enciphered using congruence or modular transformations with respect to either primes or irreducible polynomials over a finite field. The polynomial system is shown to be clearly superior to the prime system for conventional cryptographic work.

The machinability of a cast aluminium alloy-graphite particle composite

The microstructure of a cast Al---Si alloy-graphite particle composite is examined using optical and analytical scanning electron microscopy. Specimens containing different percentages of graphite were machined by orthogonal planning with 25° and 45° rake angle tools at both 6.5 and 13.2 m min−1. The machining forces are reported and the chip-rake-face friction coefficients and shear flow stresses are calculated. It is shown that the reduction in machining forces with increasing graphite content is due mostly to a decrease in the shear flow stress rather than to lower chip-rake-face friction. Both the polished and the machined surfaces of the composite are rougher than those of the simple alloy, apparently owing to the greater porosity, the tearing out of graphite particles, or the opening of cracks at the graphite particles in the wake of the tool.

Finite element analysis of laminated anisotropic thin-walled open-section beams

A finite element analysis of thin-walled open-section laminated anisotropic beams is presented herein. A two-noded, 8 degrees of freedom per node thin-walled open-section laminated anisotropic beam finite element has been developed and used. The displacements of the element reference axes are expressed in terms of one-dimensional first order Hermite interpolation polynomials and line member assumptions are invoked in the formulation of the stiffness matrix. The problems of: 1. (a) an isotropic material Z section straight cantilever beam, and 2. (b) a single-layer (0°) composite Z section straight cantilever beam, for which continuum solutions (exact/approximate) are possible, have been solved in order to evaluate the performance of the finite element. Its applicability has been shown by solving the following problems: 3. (c) a two-layer (45°/−45°) composite Z section straight cantilever beam, 4. (d) a three-layer (0°/45°/0°) composite Z section straight cantilever beam.

A laminated anisotropic curved beam and shell stiffening finite element

The details of development of the stiffness matrix of a laminated anisotropic curved beam finite element are reported. It is a 16 dof element which makes use of 1-D first order Hermite interpolation polynomials for expressing it's assumed displacement state. The performance of the element is evaluated considering various examples for which analytical or other solutions are available.

A study on the nature of the compound layer formed during the ion nitriding of En40B steel

Commercial-grade En40B steel has been ion nitrided in the temperature range 475–550°C in a 25%N2–75%H2 gas mixture. The nature of the compound layer formed was studied by the X-ray diffraction technique and optical metallography. It was observed that the structure of the compound layer gradually transforms from a predominantly epsilon (Porson) nitride to a predominantly γ′ nitride structure with increasing treatment time. Optical metallography studies on sections orthogonal to the nitrided surface showed that, after about 5 h of treatment, the thickness of the compound layer decreases with further increase in treatment time.

Reverse Channel Training For Reciprocal Mimo Systems With Spatial Multiplexing

This paper investigates the problem of designing reverse channel training sequences for a TDD-MIMO spatial-multiplexing system. Assuming perfect channel state information at the receiver and spatial multiplexing at the transmitter with equal power allocation to them dominant modes of the estimated channel, the pilot is designed to ensure an stimate of the channel which improves the forward link capacity. Using perturbation techniques, a lower bound on the forward link capacity is derived with respect to which the training sequence is optimized. Thus, the reverse channel training sequence makes use of the channel knowledge at the receiver. The performance of orthogonal training sequence with MMSE estimation at the transmitter and the proposed training sequence are compared. Simulation results show a significant improvement in performance.

Application of partition method to vibration problems of plates

The “partition method” or “sub-domain method” consists of expressing the solution of a governing differential equation, partial or ordinary, in terms of functions which satisfy the boundary conditions and setting to zero the error in the differential equation integrated over each of the sub-domains into which the given domain is partitioned. In this paper, the use of this method in eigenvalue problems with particular reference to vibration of plates is investigated. The deflection of the plate is expressed in terms of polynomials satisfying the boundary conditions completely. Setting the integrated error in each of the subdomains to zero results in a set of simultaneous, linear, homogeneous, algebraic equations in the undetermined coefficients of the deflection series. The algebraic eigenvalue problem is then solved for eigenvalues and eigenvectors. Convergence is examined in a few typical cases and is found to be satisfactory. The results obtained are compared with existing results based on other methods and are found to be in very good agreement.

The transient response of certain third-ordernon-linear systems

In this paper a method of solving certain third-order non-linear systems by using themethod of ultraspherical polynomial approximation is proposed. By using the method of variation of parameters the third-order equation is reduced to three partial differential equations. Instead of being averaged over a cycle, the non-linear functions are expanded in ultraspherical polynomials and with only the constant term retained, the equations are solved. The results of the procedure are compared with the numerical solutions obtained on a digital computer. A degenerate third-order system is also considered and results obtained for the above system are compared with numerical results obtained on the digital computer. There is good agreement between the results obtained by the proposed method and the numerical solution obtained on digital computer.

Microprocessor-based polynomial generator

A new method of generating polynomials using microprocessors is proposed. The polynomial is generated as a 16-bit digital word. The algorithm for generating a variety of basic 'building block' functions and its implementation is discussed. A technique for generating a generalized polynomial based on the proposed algorithm is indicated. The performance of the proposed generator is evaluated using a commercially available microprocessor kit.

Application of partition method to vibration problems of plates

The “partition method” or “sub-domain method” consists of expressing the solution of a governing differential equation, partial or ordinary, in terms of functions which satisfy the boundary conditions and setting to zero the error in the differential equation integrated over each of the sub-domains into which the given domain is partitioned. In this paper, the use of this method in eigenvalue problems with particular reference to vibration of plates is investigated. The deflection of the plate is expressed in terms of polynomials satisfying the boundary conditions completely. Setting the integrated error in each of the subdomains to zero results in a set of simultaneous, linear, homogeneous, algebraic equations in the undetermined coefficients of the deflection series. The algebraic eigenvalue problem is then solved for eigenvalues and eigenvectors. Convergence is examined in a few typical cases and is found to be satisfactory. The results obtained are compared with existing results based on other methods and are found to be in very good agreement.

Natural frequencies of polar orthotropic annular plates

The classical Rayleigh-Ritz method with simple polynomials as admissible functions has been used for obtaining natural frequencies of transversely vibrating polar orthotropic annular plates. The method in conjunction with transformations introduced in the analysis has been found to be quite effective, particularly for large hole sizes. Estimates of natural frequencies corresponding to modes with one as well as two nodal diameters are obtained for the nine combinations of clamped, simply supported and free edge conditions and for various values of rigidity ratio and hole sizes. Based on the variation of eigenvalue parameter with rigidity ratio, the frequencies of these modes as well as those of axisymmetric modes have been expressed by means of simple formulae in terms of rigidity ratio and the frequencies of corresponding modes in the isotropic case. These formulae have been used in determining the fundamental frequencies of orthotropic plates.