Musculoskeletal model of osseointegrated transfemoral amputees in OpenSim.
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ABSTRACT:
SUBMITTER: Raveendranathan V
PROVIDER: S-EPMC10538745 | biostudies-literature | 2023
REPOSITORIES: biostudies-literature
Publications
Musculoskeletal model of osseointegrated transfemoral amputees in OpenSim.
Raveendranathan Vishal V Kooiman Vera G M VGM Carloni Raffaella R
PloS one 20230928 9
This study presents a generic OpenSim musculoskeletal model of people with an osseointegrated unilateral transfemoral amputation wearing a generic prosthesis. The model, which consists of seventy-six musculotendon units and two ideal actuators at the knee and ankle joints of the prosthesis, is tested by designing an optimal control strategy that guarantees the tracking of experimental amputee data during level-ground walking while finding the actuators' torques and minimizing the muscle forces. ...[more]
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Project description:BackgroundCommercially available osseointegrated devices for transfemoral amputees are limited in size and thus fail to meet the significant anatomical variability in the femoral medullary canal. This study aimed to develop a customized osseointegrated stem to better accommodate a variety of femoral anatomies in transfemoral amputees than off-the-shelf stems. Customization is expected to enhance cortical bone preservation and increase the stem-bone contact area, which are critical for the long-term stability and success of implants.MethodsA customized stem (OsteoCustom) was designed based on the statistical shape variability of the medullary canal. The implantability of the OsteoCustom stem was tested via 70 computed tomography (CT) images of human femurs and compared to that of a commercial device (OFI-C) for two different resection levels. The evaluations included the volume of cortical bone removed and the percentage of stem-bone contact area for both resection levels. Statistical significance was analyzed using paired and unpaired t tests.ResultsThe OsteoCustom stem could be virtually implanted in all 70 femurs, while the OFI-C was unsuitable in 19 cases due to insufficient cortical thickness after implantation, further emphasizing its adaptability to varying anatomical conditions. The OsteoCustom stem preserved a greater volume of cortical bone than did the OFI-C. In fact, 42% less bone was removed at the proximal resection level (3.15 cm³ vs. 5.42 cm³, p ≤ 0.0001), and 33% less at the distal resection level (2.25 cm³ vs. 3.39 cm³, p = 0.003). The stem-bone contact area was also greater for the OsteoCustom stem, particularly at the distal resection level, showing a 20% increase in contact area (52.3% vs. 32.2%, p = 0.002) compared to that of the OFI-C.ConclusionsThe OsteoCustom stem performed better than the commercial stem by preserving more cortical bone and achieving a greater stem-bone contact area, especially at distal resection levels where the shape of the medullary canal exhibits more inter-subject variability. Optimal fit in the distal region is of paramount importance for ensuring the stability of osseointegrated implants. This study highlights the potential benefits of customized osseointegrated stems in accommodating a broader range of femoral anatomies, with enhanced fit in the medullary canal.
| S-EPMC11360735 | biostudies-literature
Project description:Musculoskeletal simulations are used in many different applications, ranging from the design of wearable robots that interact with humans to the analysis of patients with impaired movement. Here, we introduce OpenSim Moco, a software toolkit for optimizing the motion and control of musculoskeletal models built in the OpenSim modeling and simulation package. OpenSim Moco uses the direct collocation method, which is often faster and can handle more diverse problems than other methods for musculoskeletal simulation. Moco frees researchers from implementing direct collocation themselves-which typically requires extensive technical expertise-and allows them to focus on their scientific questions. The software can handle a wide range of problems that interest biomechanists, including motion tracking, motion prediction, parameter optimization, model fitting, electromyography-driven simulation, and device design. Moco is the first musculoskeletal direct collocation tool to handle kinematic constraints, which enable modeling of kinematic loops (e.g., cycling models) and complex anatomy (e.g., patellar motion). To show the abilities of Moco, we first solved for muscle activity that produced an observed walking motion while minimizing squared muscle excitations and knee joint loading. Next, we predicted how muscle weakness may cause deviations from a normal walking motion. Lastly, we predicted a squat-to-stand motion and optimized the stiffness of an assistive device placed at the knee. We designed Moco to be easy to use, customizable, and extensible, thereby accelerating the use of simulations to understand the movement of humans and other animals.
| S-EPMC7793308 | biostudies-literature
Project description:This study constitutes the first attempt to systematically quantify residual limb volume fluctuations in transfemoral amputees. The study was carried out on 24 amputees to investigate variations due to prosthesis doffing, physical activity, and testing time. A proper experimental set-up was designed, including a 3D optical scanner to improve precision and acceptability by amputees. The first test session aimed at measuring residual limb volume at 7 time-points, with 10 min intervals, after prosthesis doffing. This allowed for evaluating the time required for volume stabilization after prosthesis removal, for each amputee. In subsequent sessions, 16 residual limb scans in a day for each amputee were captured to evaluate volume fluctuations due to prosthesis removal and physical activity, in two times per day (morning and afternoon). These measurements were repeated in three different days, a week apart from each other, for a total of 48 scans for each amputee. Volume fluctuations over time after prosthesis doffing showed a two-term decay exponential trend (R2 = 0.97), with the highest variation in the initial 10 min and an average stabilization time of 30 min. A statistically significant increase in residual limb volume following both prosthesis removal and physical activity was verified. No differences were observed between measures collected in the morning and in the afternoon.Clinical Trials.gov ID: NCT04709367.
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Project description:This paper presents the design and validation of a control system for a pair of powered knee and ankle prostheses to be used as a prosthetic intervention for bilateral transfemoral amputees. The control system leverages communication between the prostheses for enhanced awareness and stability, along with power generation at the knee and ankle joints to better restore biomechanical functionality in level ground walking. The control methodology employed is a combination of an impedance-based framework for weight-bearing portions of gait and a trajectory-based approach for the nonweight-bearing portions. The control system was implemented on a pair of self-contained powered knee and ankle prostheses, and the ability of the prostheses and control approach to provide walking functionality was assessed in a set of experimental trials with a bilateral transfemoral amputee subject. Specifically, experimental data from these trials indicate that the powered prostheses and bilateral control architecture provide gait kinematics that reproduce healthy gait kinematics to a greater extent than the subject's daily-use passive prostheses.
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Project description:BackgroundPercutaneous osseointegrated (OI) docking of prosthetic limbs returns loading directly to the residual bone of individuals with amputations. Lower limb diaphyseal biomechanics have not been studied during the wide range of daily activities performed by individuals with lower extremity amputations; therefore, little is known about the loads experienced at the bone-endoprosthetic interface of a percutaneous OI device.Research questionDoes residual limb length and/or gender influence loading magnitudes in the diaphysis of the femur or tibia during daily activities?MethodsThis observational study used motion capture data from 40 non-amputee volunteers performing nine activities ranging from low to high demand, to virtually simulate residual limbs of amputees. To simulate diaphyseal bone loading in individuals with lower limb amputations, virtual joints were defined during post-processing at 25, 50, and 75 % of residual limb length of both the femur and the tibia, representing six clinically relevant residual limb lengths for OI device placement. Peak axial distractive and compressive forces, torsional moments, and bending moments were calculated for each activity. Comparisons were made between genders and between different levels of the simulated residual limb.ResultsFor simulated above and below knee amputations, short residual limbs showed the highest average bending, torsion, and axial distractive loads, while axial compressive loads were highest for long residual limbs. Absolute maxima for all subjects showed this same trend, except in below knee torsion, where 75 % residual tibia length showed the maximum. The highest demand activities yielding peaks in all directions were cutting with right leg planted, jump, run, and fall.SignificanceOverall, individuals with shorter residual limbs experienced higher diaphyseal forces. This should be taken into consideration during surgical implantation of percutaneous OI devices where residual limb length can potentially be shortened, and during rehabilitation of percutaneous OI patients.
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Project description:BackgroundPercutaneous osseointegrated devices for skeletal fixation of prosthetic limbs have the potential to improve clinical outcomes in the transhumeral amputee population. Initial endoprosthesis stability is paramount for long-term osseointegration and safe clinical introduction of this technology. We evaluated an endoprosthetic design featuring a distally porous coated titanium stem with proximal slots for placement of bicortical interlocking screws.MethodsYield load, ultimate failure load, and construct stiffness were measured in 18 pairs of fresh-frozen and thawed cadaver humeri, at distal and proximal amputation levels, without and with screws, under axial pull-out, torsion, and bending loads. Paired statistical comparisons were performed without screws at the two resection levels, and at distal and proximal levels with and without screws.FindingsWithout screws, the location of the amputation influenced the stability only in torsional yield (p = 0.032) and torsional ultimate failure (p = 0.033). Proximally, the torsional yield and the torsional ultimate failure were 44% and 47% of that distally. Screws improved stability. In axial pull-out, screws increased the distal ultimate failure 3.2 times (p = 0.003). In torsion, screws increased the yield at the proximal level 1.9 times (p = 0.035), distal ultimate failure load 3.3 times (p = 0.016) and proximal ultimate failure 6.4 times (p = 0.013). In bending, screws increased ultimate failure at the proximal level 1.6 times (p = 0.026).InterpretationProximal slots and bicortical interlocking screws may find application in percutaneous osseointegrated devices for patients with amputations, especially in the less stable proximal bone of a short residual limb.
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Project description:Patients with a lower limb amputation rely more on visual feedback to maintain balance than able-bodied individuals. Altering this sensory modality in amputees thus results in a disrupted postural control. However, little is known about how lower limb amputees cope with augmented visual information during balance tasks. In this study, we investigated how unilateral transfemoral amputees incorporate visual feedback of their center of pressure (CoP) position during quiet standing. Ten transfemoral amputees and ten age-matched able-bodied participants were provided with real-time visual feedback of the position of their CoP while standing on a pressure platform. Their task was to keep their CoP within a small circle in the center of a computer screen placed at eye level, which could be achieved by minimizing their postural sway. The visual feedback was then delayed by 250 and 500 ms and was combined with a two- and five-fold amplification of the CoP displacements. Trials with eyes open without augmented visual feedback as well as with eyes closed were further performed. The overall performance was measured by computing the sway area. We further quantified the dynamics of the CoP adjustments using the entropic half-life (EnHL) to study possible physiological mechanisms behind postural control. Amputees showed an increased sway area compared to the control group. The EnHL values of the amputated leg were significantly higher than those of the intact leg and the dominant and non-dominant leg of controls. This indicates lower dynamics in the CoP adjustments of the amputated leg, which was compensated by increasing the dynamics of the CoP adjustments of the intact leg. Receiving real-time visual feedback of the CoP position did not significantly reduce the sway area neither in amputees nor in controls when comparing with the eyes open condition without visual feedback of the CoP position. Further, with increasing delay and amplification, both groups were able to compensate for small visual perturbations, yet their dynamics were significantly lower when additional information was not received in a physiologically relevant time frame. These findings may be used for future design of neurorehabilitation programs to restore sensory feedback in lower limb amputees.
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Project description:Knowledge of joint moments will provide greater insight into the manner in which lower-extremity amputees wearing running-specific prostheses regain running capacity and compensate for replacement of an active leg with a passive prosthetic implement. Thus, the purpose of this study was to investigate three-dimensional joint moments during sprinting for unilateral transfemoral amputees wearing running-specific prostheses. Ten sprinters with unilateral transfemoral amputation performed maximal sprinting at the 22 m mark while wearing running-specific prostheses. Joint moments were calculated through an inverse dynamics approach. All peak flexion and extension moments in the prosthetic leg were found to be lower than those of the intact leg, except for the peak plantar flexion moment. In the frontal plane, the peak adduction and abduction moments in the prosthetic leg were generally lower than those of the intact leg. The peak internal rotation moments differed significantly between the legs, but the peak external rotation moments did not. The results of the present study suggest that asymmetric joint moment adaptations occur for unilateral transfemoral amputees to compensate for replacement of the biological leg with a passive prosthetic knee joint and running-specific prosthesis.
| S-EPMC6398468 | biostudies-literature
Project description:Machines and humans become mechanically coupled when lower limb amputees walk with powered prostheses, but these two control systems differ in adaptability. We know little about how they interact when faced with real-world physical demands (e.g. carrying loads). Here, we investigated how each system (i.e. amputee and powered prosthesis) responds to changes in the prosthesis mechanics and gravitational load. Five transfemoral amputees walked with and without load (i.e. weighted backpack) and a powered knee prosthesis with two pre-programmed controller settings (i.e. for load and no load). We recorded subjects' kinematics, kinetics, and perceived exertion. Compared to the no load setting, the load setting reduced subjects' perceived exertion and intact-limb stance time when they carried load. When subjects did not carry load, their perceived exertion and gait performance did not significantly change with controller settings. Our results suggest transfemoral amputees could benefit from load-adaptive powered knee controllers, and controller adjustments affect amputees more when they walk with (versus without) load. Further understanding of the interaction between powered prostheses, amputee users, and various environments may allow researchers to expand the utility of prostheses beyond simple environments (e.g. firm level ground without load) that represent only a subset of real-world environments.
| S-EPMC5670174 | biostudies-literature
Project description:Spring-like leg behavior is a general feature of mammalian bouncing gaits, such as running and hopping. Although increases in step frequency at a given running speed are known to increase the stiffness of the leg spring (kleg) in non-amputees, little is known about stiffness regulation in unilateral transfemoral amputees. In this study, we investigated stiffness regulation at different step frequencies at a given running speed in unilateral transfemoral amputees. We recruited nine unilateral transfemoral amputees wearing running-specific prostheses. They were asked to perform the action of running across a range of step frequencies (±20, ±15, ±10, ±5, and 0% of their preferred step frequency) at a given speed on an instrumented treadmill. The kleg values were calculated using ground reaction force data in both the affected and unaffected limbs. It was found that kleg increased with increasing step frequency for the unaffected limb, but not for the affected limb. Consequently, the unilateral transfemoral amputees attained the desired step frequency in the unaffected limb, but were unable to match the three highest step frequencies using their affected limbs. These results suggest that the stiffness regulation strategy during running differs between the affected and unaffected limbs.
| S-EPMC7136227 | biostudies-literature