Abstract
The rehabilitation outcomes following lower limb amputation depend on decision-making in the surgery room and in optimal fitting of the prosthetic components. Presently, the surgical and rehabilitation processes are performed according to general guidelines and on the experience of the surgeon/prosthetist. Patient-specific models of the residual limb and its interaction with the prosthetic socket have been created for the last two decades for research purposes. However, no modeling technique has yet to be integrated with the clinical community, as a tool for surgical and rehabilitative decision-making. In this chapter, we will review the main advancements in patient-specific modeling of the lower limb residuum over the last decades and discuss its potential use as both a tool for clinicians and as a patient-specific monitor aimed to prevent injury to the residuum.
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References
Beil, T.L., Street, G.M., Covey, S.J.: Interface pressures during ambulation using suction and vacuum-assisted prosthetic sockets. J. Rehabil. Res. Dev. 39(6), 693–700 (2000)
Boone, D., Burgess, E.: Automated fabrication of mobility aids: clinical demonstration of the UCL computer aided socket design system. J. Prosthet. Orthot. 1(3), 187–190 (1989)
Brånemark, R., Brånemark, P.I., Rydevik, B., Myers, R.R.: Osseointegration in skeletal reconstruction and rehabilitation: a review. J. Rehabil. Res. Dev. 38, 175–181 (2001)
Commean, P.K., Smith, K.E., Vannier, M.W.: Design of a 3-D surface scanner for lower limb prosthetics: a technical note. J. Rehabil. Res. Dev. 33(3), 267–278 (1996)
Dean, D., Saunders, C.G.: A software package for design and manufacture of prosthetic sockets for transtibial amputees. IEEE Trans. Biomed. Eng. 32(4), 257–262 (1985)
Dillingham, T.R., Pezzin, L.E.: Postacute care services use for dysvascular amputees: a population-based study of Massachusetts. Am. J. Phys. Med. Rehabil. 84, 147–152 (2005)
Dudek, N.L., Marks, M.B., Marshall, S.C.: Skin problems in an amputee clinic. Am. J. Phys. Med. Rehabil. 85, 424–429 (2006)
Esquenazi, A.: Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration. Disabil. Rehabil. 26(14–15), 831–836 (2004)
Facoetti, G., Gabbiadini, S., Colombo, G., Rizzi, C.: Knowledge-based system for guided modeling of sockets for lower limb prostheses. Comput. Aided Design Appl. 7(5), 723–737 (2010)
Gailey, R.S., Wenger, M.A., Raya, M., Kirk, N., Erbs, K., Spyropoulos, P., Nash, M.S.: Energy expenditure of trans-tibial amputees during ambulation at self-selected pace. Prosthet. Orthot. Int. 18(2), 84–91 (1994)
Gefen, A.: Deep tissue injury from a bioengineering point of view. Ostomy Wound Manage. 55(4), 26–36 (2009)
Gefen, A.: How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. Ostomy Wound Manage. 54, 26–35 (2008)
Gefen, A., Gefen, N., Linder-Ganz, E., Margulies, S.S.: In vivo muscle stiffening under bone compression promotes deep pressure sores. J. Biomech. Eng. 127, 512–524 (2005)
Geil, M.D.: Consistency, precision, and accuracy of optical and electromagnetic shape-capturing systems for digital measurement of residual-limb anthropometrics of persons with transtibial amputation. J. Rehabil. Res. Dev. 44(4), 515–524 (2007)
Hagberg, K., Brånemark, R.: One hundred patients treated with osseointegrated transfemoral amputation prostheses–rehabilitation perspective. J. Rehabil. Res. Dev. 46(3), 331–344 (2009)
Herbert, N., Simpson, D., Spence, W.D., Ion, W.: A preliminary investigation into the development of 3-D printing of prosthetic sockets. J. Rehabil. Res. Dev. 42(2), 141–146 (2005)
Houston, V.L., Burgess, E.M., Childress, D.S., Lehneis, H.R., Mason, C.P., Garbarini, M.A., LaBlanc, K.P., Boone, D.A., Chan, R.B., Harlan, J.H., Brncick, M.D.: Automated fabrication of mobility aids (AFMA): below-knee CASD/CAM testing and evaluation program results. J. Rehabil. Res. Dev. 29(4), 78–124 (1992)
Isaacson, B.M., Stinstra, J.G., MacLeod, R.S., Pasquina, P.F., Bloebaum, R.D.: Developing a quantitative measurement system for assessing heterotopic ossification and monitoring the bioelectric metrics from electrically induced osseointegration in the residual limb of service members. Ann. Biomed. Eng. 38(9), 2968–2978 (2010)
Kosasih, J.B., Silver-Thorn, M.B.: Sensory changes in adults with unilateral transtibial amputation. J. Rehabil. Res. Dev. 35, 85–90 (1998)
Krouskop, T.A., Muilenberg, A.L., Doughtery, D.R., Winningham, D.J.: Computer-aided design of a prosthetic socket for an above-knee amputee. J. Rehabil. Res. Dev. 24(2), 31–38 (1987)
Lin, C.C., Chang, C.H., Wu, C.L., Chung, K.C., Liao, I.C.: Effects of liner stiffness for trans-tibial prosthesis: a finite element contact model. Med. Eng. Phys. 26, 1–9 (2004)
Linder-Ganz, E., Engelberg, S., Scheinowitz, M., Gefen, A.: Pressure-time cell death threshold for albino rat skeletal muscles as related to pressure sore biomechanics. J. Biomech. 39, 2725–2732 (2005)
Linder-Ganz, E., Gefen, A.: Stress analyses coupled with damage laws to determine biomechanical risk factors for deep tissue injury during sitting. J. Biomech. Eng. 131, 011033-1–011033-13 (2009)
Lyon, C.C., Kulkarni, J., Zimerson, E., VanRoss, E., Beck, M.H.: Skin disorders in amputees. J. Am. Acad. Dermatol. 42, 501–507 (2000)
Mak, A.F.T., Zhang, M., Boone, D.A.: State-of-the-art research in lower-limb prosthetic biomechanics-socket interface: a review. J. Rehabil. Res. Dev. 38, 161–174 (2001)
Mak, A.F., Zhang, M., Tam, E.W.: Biomechanics of pressure ulcer in body tissues interacting with external forces during locomotion. Annu. Rev. Biomed. Eng. 12, 29–53 (2010)
Oberg, K., Kofman, J., Karisson, A., Lindstrom, B., Sigblad, G.: The CAPOD system-A scandinavian CAD/CAM system for prosthetic sockets. J. Prosthet. Orthot. 1(3), 139–148 (1989)
Panagiotopoulou, O.: Finite element analysis (FEA): applying an engineering method to functional morphology in anthropology and human biology. Ann. Hum. Biol. 36(5), 609–623 (2009)
Pinzur, M.S., Beck, J., Himes, R., Callaci, J.: Distal tibiofibular bone-bridging in transtibial amputation. J. Bone Joint Surg. Am. 90(12), 2682–2687 (2008)
Portnoy, S., Siev-Ner, I., Shabshin, N., Gefen, A.: Effects of sitting postures on risks for deep tissue injury in the residuum of a transtibial prosthetic-user: a biomechanical case study. Comput. Methods Biomech. Biomed. Eng. 5, 1 (2010)
Portnoy, S., Siev-Ner, I., Shabshin, N., Kristal, A., Yizhar, Z., Gefen, A.: Patient-specific analyses of deep tissue loads post transtibial amputation in residual limbs of multiple prosthetic users. J. Biomech. 42, 2686–2693 (2009)
Portnoy, S., Siev-Ner, I., Yizhar, Z., Kristal, A., Shabshin, N., Gefen, A.: Surgical and morphological factors that affect internal mechanical loads in soft tissues of the transtibial residuum. Ann. Biomed. Eng. 37, 2583–2605 (2009)
Portnoy, S., van Haare, J., Geers, R.P.J., Kristal, A., Siev-Ner, I., Seelen, H.A.M., Oomens, C.W.J., Gefen, A.: Real-time subject-specific analyses of dynamic internal tissue loads in the residual limb of transtibial amputees. Med. Eng. Phys. 32, 312–323 (2010)
Reihsner, R., Melling, M., Pfeiler, W., Menzel, E.J.: Alterations of biochemical and two-dimensional biomechanical properties of human skin in diabetes mellitus as compared to effects of in vitro non-enzymatic glycation. Clin. Biomech. (Bristol, Avon) 15(5), 379–386 (2000)
Reynolds, D.P.: Shape design and interface load analysis for below-knee prosthetic sockets. Ph.D. Dissertation, University College, University of London (1998)
Reynolds, D.P., Lord, M.: Interface load analysis for computer-aided design of below-knee prosthetic sockets. Med. Biol. Eng. Comput. 30(4), 419–426 (1992)
Rogers, B., Bosker, G.W., Crawford, R.H., Faustini, M.C., Neptune, R.R., Walden, G., Gitter, A.J.: Advanced trans-tibial socket fabrication using selective laser sintering. Prosthet. Orthot. Int. 31(1), 88–100 (2009)
Rogers, B., Bosker, G., Faustini, M., Walden, G., Neptune, R.R., Crawford, R.: Case report: variably compliant transtibial prosthetic socket fabricated using solid freeform fabrication. J. Prosthet. Orthot. 20(1), 1–7 (2008)
Sanders, J.E., Daly, C.H.: Normal and shear stresses on a residual limb in a prosthetic socket during ambulation: comparison of finite element results with experimental measurements. J. Rehabil. Res. Dev. 30(2), 191–204 (1993)
Saunders, C.G., Bannon, M., Sabiston, R.M., Panych, L., Jenks, S.L., Wood, I.R., Raschke, S.: The CANFIT system: shape management technology for prosthetic and orthotic applications. J. Prosthet. Orthot. 1(3), 122–130 (1989)
Selles, R.W., Janssens, P.J., Jongenengel, C.D., Bussmann, J.B.: A randomized controlled trial comparing functional outcome and cost efficiency of a total surface-bearing socket versus a conventional patellar tendon-bearing socket in trans-tibial amputees. Arch. Phys. Med. Rehab. 86, 154–161 (2005)
Silver-Thorn, M.B.: Investigation of lower limb tissue perfusion during loading. J. Rehab. Res. Develop. 39, 597–608 (2002)
Silver-Thorn, M.B., Steege, J.W., Childress, D.S.: A review of prosthetic interface stress investigations. J. Rehab. Res. Develop. 33, 253–266 (1996)
Sinha, R., van den Heuvel, W.J., Arokiasamy, P.: Factors affecting quality of life in lower limb amputees. Prosthet. Orthot. Int. 35(1), 90–96 (2011)
Slocum, D.B.: An Atlas of Amputation. The C.V. Mosby Company, St Louis (1949)
Smith, D.G., Burgess, E.M.: The use of CAD/CAM technology in prosthetics and orthotics–current clinical models and a view to the future. J. Rehabil. Res. Dev. 38(3), 327–334 (2001)
Smith, E., Ryall, N.: Residual limb osteomyelitis: a case series from a national prosthetic centre. Disabil. Rehabil. 31, 1785–1789 (2009)
Steege, J.W., Schnur. D.S., Vorhis, R.L., Rovick, J.S.: Finite element analysis as a method of pressure prediction at the below-knee socket interface. In: Proceedings of RESNA 10th Annual Conference, California, pp. 814–816 (1987)
Van-Schie, C.H.M.: A review of the biomechanics of the diabetic foot. Lower Extrem. Wounds 4, 160–170 (2005)
Walsh, N.E., Lancaster, J.L., Faulkner, V.W., Rogers, W.E.: A computerized system to manufacture prostheses for amputees in developing countries. J. Prosthet. Orthot. 1(3), 165–181 (1989)
Weinans, H., Sumner, D.R., Igloria, R., Natarajan, R.N.: Sensitivity of periprosthetic stress-shielding to load and the bone density–modulus relationship in subject-specific finite element models. J. Biomech. 33(7), 809–817 (2000)
Wik, T.S., Foss, O.A., Havik, S., Persen, L., Aamodt, A., Witsø, E.: Periprosthetic fracture caused by stress shielding after implantation of a femoral condyle endoprosthesis in a transfemoral amputee-a case report. Acta Orthop. 81(6), 765–767 (2010)
Xu, W., Xu, D.H., Crocombe, A.D.: Three-dimensional finite element stress and strain analysis of a transfemoral osseointegration implant. Proc. Inst. Mech. Eng. H 220(6), 661–670 (2006)
Yang, F.: Asymptotic solution to axisymmetric indentation of a compressible elastic thin film. Thin Solid Films 515, 2274–2283 (2006)
Zhang, M., Mak, A.F., Roberts, V.C.: Finite element modeling of a residual lower-limb in a prosthetic socket: a survey of the development in the first decade. Med. Eng. Phys. 20(5), 360–373 (1998)
Zhang, M., Roberts, C.: Comparison of computational analysis with clinical measurement of stresses on below-knee residual limb in a prosthetic socket. Med. Eng. Phys. 22(9), 607–612 (2000)
Ziegler-Graham, K., MacKenzie, E.J., Ephraim, P.L., Travison, T.G., Brookmeyer, R.: Estimating the prevalence of limb loss in the United States 2005–2050. Arch. Phys. Med. Rehabil. 89(3), 422–429 (2008)
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Portnoy, S., Gefen, A. (2011). Patient-Specific Modeling of Subjects with a Lower Limb Amputation. In: Gefen, A. (eds) Patient-Specific Modeling in Tomorrow's Medicine. Studies in Mechanobiology, Tissue Engineering and Biomaterials, vol 09. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8415_2011_99
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DOI: https://doi.org/10.1007/8415_2011_99
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