Fully Implanted Prostheses for Musculoskeletal Limb Reconstruction After Amputation: An In Vivo Feasibility Study
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Annals of Biomedical Engineering ( 2020) https://doi.org/10.1007/s10439-020-02645-3
Original Article
Fully Implanted Prostheses for Musculoskeletal Limb Reconstruction After Amputation: An In Vivo Feasibility Study PATRICK T. HALL ,1 SAMANTHA Z. BRATCHER,1 CALEB STUBBS,1 REBECCA E. RIFKIN,2 REMI M. GRZESKOWIAK,2 BRYCE J. BURTON,3 CHERYL B. GREENACRE,4 STACY M. STEPHENSON,5 DAVID E. ANDERSON,2 and DUSTIN L. CROUCH1 1 Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, 1512 Middle Dr, Knoxville, TN 37966, USA; 2Department of Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA; 3Office of Laboratory Animal Care, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA; 4Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA; and 5University of Tennessee Medical Center, Knoxville, TN, USA
(Received 6 February 2020; accepted 30 September 2020) Associate Editor Jane Grande-Allen oversaw the review of this article.
Abstract—Previous prostheses for replacing a missing limb following amputation must be worn externally on the body. This limits the extent to which prostheses could physically interface with biological tissues, such as muscles, to enhance functional recovery. The objectives of our study were to (1) test the feasibility of implanting a limb prosthesis, or endoprosthesis, entirely within living skin at the distal end of a residual limb, and (2) identify effective surgical and postsurgical care approaches for implanting endoprostheses in a rabbit model of hindlimb amputation. We iteratively designed, fabricated, and implanted unjointed endoprosthesis prototypes in six New Zealand White rabbits following amputation. In the first three rabbits, the skin failed to heal due to ishemia and dehiscence along the sutured incision. The skin of the final three subsequent rabbits successfully healed over the endoprotheses. Factors that contributed to successful outcomes included modifying the surgical incision to preserve vasculature; increasing the radii size on the endoprostheses to reduce skin stress; collecting radiographs presurgery to match the bone pin size to the medullary canal size; and ensuring post-operative bandage integrity. These results will support future work to test jointed endoprostheses that can be attached to muscles. Keywords—Orthopedic, Vascularization, Subdermal, Endoprosthesis, Osseointegration, Animal model.
Address correspondence to Patrick T. Hall, Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, 1512 Middle Dr, Knoxville, TN 37966, USA. Electronic mail: [email protected]
INTRODUCTION A major goal of limb prostheses is to return intuitive control and realistic sensation of movements associated with the lost limb following amputation. Such sensorimotor function is especially important for upper18,29,39 limb amputees since it enables the closedloop motor co
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