Prosthesis Fitting Research Articles

Evaluation of fit feasibility of stock total joint replacement in temporomandibular joint ankylosis patients

Long standing adult temporomandibular joint ankylosis (TMJA) results in smaller ramal height, and warped and undulated ramus. Despite the efforts made to standardise the sizes available in stock joint (Zimmer Biomet®), the system causes fit challenges in TMJA patients. The aim of the study was to evaluate the virtual feasibility of stock prostheses in TMJA patients. The data included amount of bone contouring for fossa placement, available ramal length, length discrepancy if placed straight, angulation of mandibular component required to adapt to the bone, and mediolateral fit discrepancy. CT data of 50 TMJA patients (71 joints; unilateral, n=29; bilateral, n=21; male, n=33; female, n=17) with mean age of 24.26±8.88 years were included. 53 joints required more than 3mm lateral bone reduction for fossa placement. The ramal length were categorised into ranges 35–40mm (n=15), 41–45mm (n=14), 46–50mm (n=28) and >50mm (n=14). Correlation between the age of occurrence of ankylosis and ramal length using the Pearson correlation coefficient revealed a positive correlation (r=0.38, p=0.001). Length discrepancy, angulation of mandibular component, and mediolateral fit discrepancy decreases as the ramal length increases. Only 14 joints had appropriate fit of stock prostheses while the remaining 57 joints warranted compromised placement. Even the smallest available stock mandibular component (45mm) had a compromised fit in terms of length and adaptability on the lateral aspect of ramus. The study concludes that a short ramus is mostly limiting factor in using stock prosthesis in TMJA patients. There is a need for still smaller size stock prostheses.

Clinical evaluation of the fit of lithium disilicate crowns fabricated with three different CAD-CAM systems

Statement of problemThe fit and performance of prostheses fabricated using various computer-aided design and computer-aided manufacturing (CAD-CAM) systems have been evaluated. However, most studies were conducted in vitro, and relatively few have addressed gingival parameters and prosthesis fit under clinical conditions. PurposeThis clinical study aimed to compare the fit of lithium disilicate crowns produced using 3 CAD-CAM systems and evaluate clinical results up to 6 months after delivery. Material and methodsForty participants requiring a single crown were recruited. Three monolithic lithium disilicate crowns were fabricated per participant by using 3 different CAD-CAM systems (intraoral scanners, CAD software, and milling machines): CEREC group (CEREC Bluecam, CEREC AC, CEREC MC); EZIS group (EZIS PO, EZIS VR, EZIS HM); and TRIOS group (TRIOS 3, EXO-CAD, ARUM-4X). The fit of the prostheses was assessed via a silicone replica technique, and the most acceptable crown was delivered; 12 were selected from the CEREC group, 16 from the EZIS group, and 12 from the TRIOS group. Follow-up clinical examinations were performed at 1, 3, and 6 months after delivery. The Kruskal-Wallis test with the post hoc Mann-Whitney U test was conducted to analyze significant differences in crown fit and periodontal conditions among the groups (α=.05). ResultsThe marginal gap of the CEREC group was significantly higher than that of the EZIS group, and the occlusal gap of the EZIS group was significantly lower than those of the CEREC and TRIOS groups (P<.05). Probing depth, bleeding index, and plaque index showed no intergroup differences at 6 months (P>.05). ConclusionsThe lithium disilicate crowns of all groups showed clinically acceptable fit. No significant differences were found among the groups in terms of periodontal conditions after 6 months.

The necessity for treatment paths for lower limb prosthetics : All that glitters is not gold!

Frequently occurring problems in the fitting of leg prostheses are either, for aprosthetic fitting, insufficiently resilient leg stumps or insufficiently adapted prostheses. For this reason, there has been ademand at the political level to establish treatment pathways and aquality standard for the care of people after leg amputations. How can ajoint, interdisciplinary approach to the provision of aids be developed? Does interdisciplinary care of amputees lead to an improvement in the quality of care? Acompendium "Quality standard in the field of lower extremity prostheses" was compiled and presented at the OT World in Leipzig in 2018. The basic principle is treatment pathways for the interdisciplinary care of all amputation levels of the lower extremities. The result is acompendium that represents the current "gold standard" in orthopaedic care after lower limb amputations. The compendium not only describes the treatment paths in detail but also makes demands on the quality of the result of the surgical amputation, as well as the goals of residual limb conditioning and the demands on the quality of the fitting of the prosthesis. Atraffic light system is used to make recommendations, restrictions and rejections, thus defining the gold standard. If all the professions involved (doctors, CPOs, physiotherapists) do not work separately but rather together with the necessary expertise and routine, the quality of care for amputees will improve, and at the same time, the health care system will become more cost efficient.

Innovative technique to enhance the art of ocularistry: A case report

Loss of any organ of a body is a traumatising event as it creates functional, esthetics and psychological disharmony in an individual’s life. An ocular defect can be a congenital anomaly or an acquired defect. Rehabilitation of such defect with customized well fitting prosthesis that restores the shape of associated anatomical structures and volume of the socket, not only require an artistic skill but also technical knowledge as every case is unique on its own. The main objective of this article is to describe innovative yet simple technique using NAES ruler for iris selection and fixation of gaze yielding results with utmost patient satisfaction and acceptance. Keywords: Custom ocular prosthesis, Gaze fixation, Iris selection, NAES ruler,

&lt;p&gt;Primary Dermis Fat Grafting for Socket Reconstruction: Retrospective Comparison of Electrocoagulation versus Scalpel Dissection for Epidermis Removal&lt;/p&gt;

PurposeTo evaluate outcomes of the use of electrocoagulation for epidermis removal in dermis fat grafting (DFG) compared to the conventional scalpel dissection in patients who underwent primary anophthalmic socket reconstruction.DesignRetrospective, observational, and comparative study.MethodsA retrospective review was performed on patients who underwent primary DFG for socket reconstruction between 2017 and 2019 at tertiary teaching hospitals. Patients with previous orbital surgery, previous radiotherapy to the periocular region, any medical condition that affects healing, cicatrizing ocular surface disease or heavy smokers were excluded. Patients with complete documentation of preoperative and postoperative data only were included. Patients were divided into two groups; group A: epidermis removal by the traditional scalpel dissection and group B: epidermis removal using low power setting electrocoagulation. The main outcome was the timing of complete epithelialization of the dermis layer. Other outcomes included implant motility, prosthesis fitting, patient’s satisfaction, and any complications.ResultsA total of 27 patients met the study criteria, and the mean follow-up period was 24.81 months. There were no differences between both groups regarding preoperative characteristics. The mean duration of complete epithelialization of the DFG implant was 9.15 ± 2.94 weeks in group A compared to 22.29 ± 4.43 weeks in group B (p value <0.001). Dermal ulceration was noticed in 9 patients (64.3%) in group B compared to none in group A (p value =0.001). Dermal ulceration was significantly associated with long conjunctival healing period (p value <0.001). Volume loss was more common in group B while graft hirsutism and granuloma were more evident in group A. Final prosthesis fitting was possible in all included patients.ConclusionEpidermis removal using the electrocoagulation is related to much more delayed epithelialization of the dermis with a higher rate of dermal ulceration compared to the scalpel dissection technique. However, there was no significant difference between both groups regarding the final prosthesis fitting or the overall patient satisfaction.

Natural History After Below-knee Amputation: Analysis of Survival and Prosthetic Fitting Over 2 Decades

IntroductionThis study sought to evaluate the natural history of patients undergoing below-knee amputation (BKA) and compare their evolution over 2 decades, as well as survival predictors, prosthetic fitting, and contralateral amputation. MethodsRetrospective study of 209 consecutive patients (mean age 72.9 years; 68% males) who underwent BKA in 2 periods: 1996–2005 and 2006–2015. The fitting of prostheses, risk of contralateral amputation and survival, as well as their predictive factors, were assessed by survival analysis. Results133 BKA were performed from 1996 to 2005 and 106 from 2006 to 2015. The etiology that motivated the BKA was acute ischemia (4.3%), chronic ischemia (34.0%), infection (9.1%) or mixed (chronic+infection, 52.6%), with no differences found between periods. Survival: mortality within one month=9.2%, one year=31.9%, 2 years=43.8% and 5 years=63.9%, with no significant differences between the 2 periods. Prosthetic: the fitting rate was 44.5% throughout the follow-up, with no significant differences between the two periods. 41.1% patients managed to walk. Contralateral amputation: 20.1% of the patients later required a major contralateral amputation, with no significant differences between the two periods. ConclusionsIn the last decade, fewer BKA have been performed probably, due to higher previous interventional revascularization. Despite this, the results of fitting, contralateral amputation or survival was not modified. In any case, the number of patients who are able to achieve ambulation is modest, so it emphasizes the need for an optimal selection of patients with BKA with the goal of prosthetic fitting.

Misfit detection in implant-supported prostheses of different compositions by periapical radiography and cone beam computed tomography: An in vitro study

Statement of problemMisfits at the implant-abutment joint (IAJ) can cause the biological and mechanical failure of implant therapy. Standard parallel periapical radiography (PERI) is the method of choice for assessing the fitting of implant-supported prostheses. Although current guidelines do not support the use of cone beam computed tomography (CBCT) solely for misfit detection, CBCT scans can also register misfits as imaging findings. Whether the material used for prostheses manufacturing influences misfit appearance in PERI and CBCT images is unknown. PurposeThe purpose of this in vitro study was to assess the influence of the type of prosthesis material on misfit detection at the IAJ by using PERI and CBCT. Material and methodsThirty-two implants with an external hexagon connection were placed in dried human mandibles. Implant-supported crowns were manufactured with different materials and allocated to 3 experimental groups: metal-ceramic (MC), titanium abutment veneered with acrylic resin (TIT), and zirconia abutment veneered with glass-ceramic (ZIR). All crowns were installed both with and without a simulated 200-μm-thick gap at the IAJ (n=64) and were assessed by PERI and CBCT scans. Four dentists evaluated the images for the presence or absence of misfit. Statistical analysis included the Kappa test and areas under the receiver operating characteristics curve (Az values) comparisons (α=.05). ResultsKappa values indicated almost perfect intraevaluator and interevaluator reproducibility for PERI and ranged from fair to almost perfect for CBCT. For PERI, Az values were not significantly different among the MC (0.995), TIT (0.997), and ZIR groups (1.000) (P>.05). Regarding CBCT, the Az values found for TIT (0.941) and MC (0.890) were significantly higher than for ZIR (0.762) (P<.05). Az values for PERI were significantly higher than for CBCT (P<.05). ConclusionsThe type of prosthesis material did not influence misfit detection at the IAJ with PERI; however, ZIR had lower diagnostic accuracy than TIT and MC implant-supported crowns with CBCT.

Automated Noncontact Facial Topography Mapping, 3-Dimensional Printing, and Silicone Casting of Orbital Prosthesis

A proof-of-concept workflow study for the fabrication of custom orbital exenteration prostheses via automated noncontact scanning, 3D printing, and silicone casting. Noncomparative, interventional case series. Setting: Single-center institutional study. StudyPopulation: Three patients who have discontinued wearing of the ocularist-made exenteration prosthesis due to altered fit, discoloration, or material degradation. InterventionProcedure: A digital representation of the exenteration socket and contralateral periocular region was captured through noncontact facial topography mapping. Digital construction of the anterior prosthesis surface was based on the mirrored image of the contralateral side, and the posterior surface contour was based on orbital cavity geometry. The anterior and posterior surface details were digitally merged. A 2-piece mold was designed and produced in a 3D printer. Colorimetry was used to create a custom blend of pigments for incorporation into the Shore 40 silicone elastomer to generate a prosthesis that approximates the patient's skin tone. MainOutcomeMeasures: Prosthesis symmetry, skin tone match, comfort of wear, and appearance. The first copy of every 3D-printed orbital prosthesis using this fabrication workflow produced good symmetry, color match, and prosthesis fit. In one case, the recontoured second copy with improved prosthesis edge-to-skin interface was made without the patient present. A noncontact 3D scanning, computer-aided design, 3D printing, and silicone casting for fabrication of orbital prosthesis was developed and validated. This production workflow has the potential to provide an efficient, standardized, reproducible exenteration prosthesis and to overcome the principal barriers to an affordable custom prosthesis worldwide: access and cost.

Prosthetic Rehabilitation in Bilateral High Above Elbow Amputation

Rehabilitation in patients with bilateral high above elbow amputation presents a considerable prosthetic problem. A patient with high upper arm amputations after a high-voltage injury is presented. He was successfully fitted with multifunctional myoelectric hand prostheses. The problems in rehabilitation of adult bilateral arm amputees are discussed and the value of fitting these patients with electrically powered prostheses is assessed. The balance between technical and clinical aspects is discussed in relation to patient acceptance. In our case good acceptance and functional benefit was noted. The fact is stressed that the bilateral upper extremity amputee can regain considerable physical function with the fitting of suitable prostheses, even if the limb remnants are short and provide little or no function. An extensive team approach at specialized centres will favour the results.

Abstract A119: PR16 Access to breast cancer survivorship care in a medically underserved region: Examining the role of non-medical providers

Abstract Background: The increasing number, and longevity, of breast cancer survivors in the US creates new challenges for survivorship care. Survivorship research has focused on medical and insurance providers but paid little attention to other actors integral to service delivery for breast cancer survivors, particularly in community settings outside of academic hospitals or comprehensive cancer centers. This study examined where, and how, breast cancer survivors accessed survivorship services in a medically underserved region of Southern California, and who were the providers of these services. Methods: Extensive recruitment efforts across California’s two-county Inland Empire (Riverside and San Bernardino counties) enabled inclusion of a diverse group of breast cancer survivors (49% non-white, 12% monolingual Spanish speakers) from metropolitan areas, small towns, and desert communities. Open-ended, semi-structured interviews were audio-recorded with 82 survivors. These interviews focused on survivors’ service needs, how connections with services were made, and where services were obtained. Interviews were also conducted with 84 service providers from 71 organizations, including legal services, financial assistance, patient navigation, prosthesis fitting, lymphedema care, nipple tattooing, nutrition counseling, medical interpreting, transportation, and psychosocial support. Detailed interview transcriptions were coded line-by-line, then analyzed inductively through an iterative process of testing and retesting interpretations against the empirical data, a practice derived from grounded theory. Results: In the Inland Empire community-based nonprofits enabled access for low-income, undocumented, un- and underinsured survivors who might not otherwise have obtained services such as patient navigation, lymphedema garments, mastectomy bras/prostheses, or psychosocial support. These same survivorship services were also provided in medical facilities. But in community-based nonprofits the services were free and typically provided by lay staff/volunteers, while in medical facilities the services were mostly fee-based and provided by licensed healthcare professionals. Conclusion: This qualitative study makes visible the contributions of non-medical providers that remain largely unacknowledged within discussions of survivorship care. It also raises concerns about survivor disparities that warrant further investigation. While quality of care has become a significant concern in oncology, there are no measures for comparing quality across the medical and non-medical settings where survivors obtain services. Filling service delivery gaps with non-medical providers enables access without guaranteeing comparable quality of services and may therefore perpetuate, or even exacerbate, disparities for the most vulnerable survivors. Funding: Research was supported by the National Cancer Institute of the National Institutes of Health under Award #F31CA192478. Citation Format: Deborah Lefkowitz. PR16 Access to breast cancer survivorship care in a medically underserved region: Examining the role of non-medical providers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A119.

Ранняя протезно-ортопедическая помощь как основа медицинской реабилитации детей с врождёнными и ампутационными дефектами нижних конечностей

Introduction The quality of medical rehabilitation and habilitation of children with lower limb defects depends on early prosthetic and orthopedic care. Purpose Analysis of the provision of prosthetic and orthopedic care for children with orthopedic pathology of the lower extremities at the Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht. Methods The results of rehabilitation and habilitation of 261 children with orthopedic pathology of the lower extremities were studied. Methods of clinical examination, radiography, physiological and biomechanical study were applied. Statistical analysis was carried out. Results In 261 cases studied, the causes of defects were congenital anomalies (82 %) and amputation defects (18 %). Surgical preparation for prosthesis application was performed in 85 cases (33 %). More than half of the patients who sustained interventions had a defect at the hip level. The anatomical and functional features of stumps in children with abnormal development of the lower extremities were studied and the principles of prosthesis and orthosis application were developed. Discussion Delay in prosthesis application leads to negative effects on the child's body. The supply of children with technical means of rehabilitation is not regulated in due manner by the current legislation, which leads to the complexity of the purpose of the product and the delay in the timing of prosthesis and orthosis fitting. Early prosthetic and orthopedic care for children with orthopedic pathology of the lower limb is a prerequisite for normal development of their growing body. Due to subjectivity of child's assessment of the results of prosthetic fitting, there is high risk of secondary deformities of the child's musculoskeletal system; for children using limb prostheses and orthoses, it is necessary to use an objective instrumental assessment of the results of prosthesis application; dispensary observation; monitoring of motor loads and the technical condition of the prosthesis. Early prosthetic and orthopaedic assistance to children should be conducted not only according to the rules of registration of the individual program for rehabilitation and habilitation (IPRH), but also followed to disability with the aim of preventing the development of complications, injuries, diseases of the musculoskeletal system, and impairment of functional disorders.

Anthropometric Measurement of Caucasian and Asian Knees, Mismatch with Knee Systems?

Background:Positioning and fit of the knee prostheses in patients determines functional outcome. For that matter anthropometric differences between knee joints of patients, will affect function. Since most total knees implant systems are designed for caucasians, discrepancies in matching to Asian patients might exist, with consequently less optimal fit of the implant. The aim of this study was to evaluate differences in anthropometric dimensions between Caucasian and Asian knees of patients eligible for total knee arthroplasty.Materials and Methods:134 patients were included for radiographic anthropometric measurements on distal femurs, proximal tibia and patellar dimension were measured of 67 Caucasian and 67 Asian patients. Patient groups were age and gender matched. All radiographs were obtained preoperatively prior to total knee arthroplasty at two different centers, Jakarta and Leiden. The radiographic measurements were widest anteroposterior (AP) and widest mediolateral (ML) dimensions, aspect ratio (ML/AP), patellar length and patellar tendon length, patellar tendon/patella ratio. Sizes of eight knee implant designs (Vanguard, Genesis II, Persona -standard and narrow-, GK Sphere, Gemini, Attune and Sigma PFC) were collected from manufactures brochures and compared to the anthropometric measurements. Chi-Square test, student t-test and Bayesian statistics were used to compare differences between the two populations.Results:The mean age of the Caucasian group was 68 ± 7.1 years and the Asian patients were 67 ± 7.8 years. Both groups included 14.9% males and 85.1% females. The Dutch patients had a height of 166cm (sd 8.1 cm) the Indonesian patients 156 cm (sd 8.0 cm), the Dutch being 6.4% taller. Preoperative deformities in the Asians was predominantly into varus, while the Dutch patients had a slight valgus alignment; 90% of the KL scores were grade 3 and 4, comparable in both groups. In AP and ML the Caucasian femur is larger than the Asian femur (male-AP 12%, female-AP 15%, male-ML 6%, female-ML 9%). The Caucasian tibia is larger in AP and ML dimensions compared to the Asian patient’s tibia. The ML/AP aspect ratios were significantly different (p<0.0001) between Asian and Caucasian patients, with the ML/AP aspect ratio of both the femur and the tibia being larger in Asian patients 1.4 (sd 0.10) compared to Caucasians 1.3 (sd 0.10) for the femur. As for the tibia the aspect ratio in Asian patients is 1.5 (sd 0.11); Caucasians 1.3 (0.11). The Asian patients have a relative patella baja compared to the Caucasians. Good matching to the tibial aspect ratios (ML/AP) of Dutch and Indonesian patients appeared to present to the eight knee systems but to only three knee systems matched well to the femoral aspect ratios (ML/AP).Conclusion:Absolute and relative differences of knee dimensions exist between Caucasian and Asian knees. Caucasian has larger AP and ML for both tibial and femoral but smaller in aspect ratio for both tibia and femur compared to Asian patients. With respect to the fit of the implant to the natural knee, total knee arthroplasty remains a compromise to nature

Simulation of tissue-prosthesis margin interface by using surface scanning and digital design for auricular prostheses

Statement of problemOne of the most challenging aspects of auricular prosthesis design and fabrication is ensuring that the prosthesis fits the patient through a range of head and facial movements. Techniques used in conventional prosthetic treatment pathways account for issues of prosthesis fit, but this challenge has not been fully addressed in emerging treatment pathways that use digital technology. PurposeThe purpose of this clinical study was to develop and evaluate a digital workflow by using surface scan data and incorporating the simulation of tissue movement into the design of auricular prostheses that fit the participant through a range of facial movements. An iterative design process was used to develop a design workflow through a sequential case series of participants with auricular prostheses. Material and methodsScan data were acquired from a case series of 5 participants with existing implant-retained auricular prostheses. An iterative design process was used to digitally design auricular prostheses that fit the participants through a range of jaw and facial movements. The fit, shape, and retention of the digitally designed and conventionally made prostheses were assessed and compared. Design considerations were identified and documented through the iterative design process. ResultsA final design workflow was iteratively developed based on the 5 participants. The shapes of the digitally designed prostheses were well matched to nontreatment anatomy overall. Prosthesis fit was variable: Some digitally designed prostheses fit the participant intimately through a range of movements, and others experienced significant gaps between the margins and the tissues. ConclusionsAn iterative design process provided a method of working toward quality improvement. Although the final design workflow provides a generally successful method of manipulating scan data in the design of auricular prostheses, the prosthesis fit at the anterior margin during facial movements remains variable and requires further development to achieve a consistently acceptable solution.

SwedeAmp—the Swedish Amputation and Prosthetics Registry: 8-year data on 5762 patients with lower limb amputation show sex differences in amputation level and in patient-reported outcome

Background and purpose — For want of national guidelines for lower limb amputation (LLA) the quality registry SwedeAmp was started in 2011 to increase knowledge around LLA and prosthetic rehabilitation. We now present data from the first 8 years of registration.Patients and methods — We present descriptive data from the first 8 years (2011–2018) of registration. Patient-reported outcome was collected at baseline and at follow-up 12 and 24 months after surgery for patients with prosthetic supply and included generic (EQ-5D-5L) and amputee-specific (e.g., LCI-5L and Prosthetic Use Score) measures. Sex differences were investigated.Results — As at December 31, 2018, 5,762 patients, 7,776 amputations, 2,658 prosthetic supplies, 1,848 baselines, and 2,006 follow-ups were registered. 61% of the patients were male, and mean age by the time of the first registered amputation was 74 years (SD 14). Women were older, more frequently had vascular disease without diabetes and more often underwent amputation at a higher level compared with men (p < 0.001). Time from amputation to fitting of first individual prosthesis was median 69 days (6–500) after transtibial amputation (TTA) and 97 days (19–484) after transfemoral amputation (TFA). The outcomes were lower after TFA than after TTA.Interpretation — SwedeAmp shows sex differences concerning amputation level, diagnosis, and age, leading to the conclusion that women have worse preconditions for successful prosthetic mobility after LLA. With increasing coverage, SwedeAmp can provide deeper knowledge with regard to patients undergoing LLA in Sweden.

Primary orbital polymethylmethacrylate implant following primary enucleation for retinoblastoma: a study of 321 cases

ABSTRACT Purpose: To evaluate the outcome of primary orbital polymethylmethacrylate (PMMA) implant following the primary enucleation for retinoblastoma. Methods: Retrospective study of 321 retinoblastoma patients who underwent unilateral enucleation and PMMA implant for retinoblastoma by myoconjunctival technique. Outcome measures included implant centration and extrusion. Results: The mean age at the time of enucleation of patients with retinoblastoma was 35 months (median, 30 months; range, <1 to 449 months). After primary enucleation, primary orbital PMMA implant was used in all cases. The mean diameter of implant was 18 mm (median, 18 mm; range, 12–20 mm) and the mean horizontal diameter of the socket conformer was 24 mm (median, 24 mm; range, 18 mm–26 mm). Post-enucleation and implant, seven (2%) patients underwent orbital external beam radiotherapy owing to microscopic extrascleral tumor extension or tumor infiltration of optic nerve transection. Over a mean follow-up period of 40 months (median, 34 months; range, 4–129 months), implant migration was noted in 28 (9%) patients, implant extrusion in 9 (3%), and implant exposure in 5 (2%), and contracted socket in 5 (2%) patients including grade 1 contraction in 3 (1%), grade 2 in 1 (<1%), and grade 4 in 1 (<1%) patient. Implant exchange for an improved prosthesis fit was performed in 4 (1%) cases. Stable customized ocular prosthesis was achieved in all but one patient. Conclusion: Primary orbital PMMA implant following primary enucleation for retinoblastoma is associated with minimal complications and provides acceptable cosmetic outcomes.

Chopart Amputation: Questioning the Clinical Efficacy of a Long-standing Surgical Option for Diabetic Foot Infection.

Diabetic foot ulcers with associated infection and osteomyelitis often lead to partial or complete limb loss. Determination of the appropriate level for amputation based on the patient's baseline physical function, extent of infection, vascular patency, and comorbidities can be challenging. Although Chopart amputation preserves greater limb length than more proximal alternatives such as Syme or below-the-knee amputations (BKA), challenges with wound healing and prosthesis fitting have been reported. We aimed to investigate the functional and clinical outcomes of Chopart amputation combined with tendon transfers. We identified patients who underwent Chopart amputations for diabetic foot infections by an academic orthopaedic group between August 2013 and September 2018. Subjects completed three Patient-Reported Outcomes Measurement Information Systems (PROMIS) instruments. Incidence of postoperative complications and change in patient-reported outcomes before and after surgery were recorded. Eighteen patients with an average age of 60.8 (range, 44 to 79) years were identified. The mean follow-up was 22.8 months (range, 6.7 to 51.0). Seventeen of the 18 total patients developed postoperative wound complications. These lead to revision amputations in 10 Chopart amputees, consisting of two Syme and eight BKAs. Half of the Chopart patients never received a prosthesis because of delayed wound healing and revision amputation. PROMIS physical function (PF) (31.1 pre-op and 28.6 post-op), pain interference (63.1 pre-op and 59.4 post-op), and depression (53.0 pre-op and 54.8 post-op) did not show significant change (P-values = 0.38, 0.29, 0.72, respectively). Pre- and post-op the PROMIS physical function scores were well below the US average. In our patient cohort, 94% of patients developed postoperative wound complication. Only 44% of patients ever successfully ambulated with a prosthesis after Chopart amputation, and the others (56%) required revision amputations such as a BKA. Even after wound healing, Chopart amputees may struggle with obtaining a prosthesis suitable for ambulation. Surgeons should exercise judicious patient selection before performing Chopart amputation. IV, Case Series.

3D CT scan-based study of glenoid morphology in Indian population: Clinical relevance in design of reverse total shoulder arthroplasty

BackgroundThe knowledge of normal anatomy of glenoid in a population has relevance in terms of comparison with other regional and national population. Furthermore, it could enable clinicians to judge whether the available sizes of reverse total shoulder arthroplasty (RTSA) prosthesis could provide optimal fit for the glenoid in Indian patients. MethodsWe evaluated consecutive 200 3-dimensional chest CT scans of 50 male and 50 female patients which included both shoulder joints and done for non-orthopaedic diseases at a tertiary care institute. The glenoid height, width, and version were measured using commercially available computer program. ResultsMean age of the patents was 38.6 ± 13.8 years (range, 19–59 years). The mean glenoid height was 33.9 ± 3.1 mm and maximum glenoid width was 24.2 ± 2.1 mm. Mean glenoid version in the study population was a retroversion of 3.47 ± 4.7°. The maximum glenoid width of 45% female and 15% male patients was less than 25 mm which is the diameter of smallest available glenoid baseplate among the commonly used RTSA systems. ConclusionsThe normal glenoid size of a large cohort of Indian population studied was smaller than that reported in cohorts from western countries. The glenoid width of substantial proportion of patients, especially female patients, was less than the diameter of smallest available glenoid baseplate. Clinical studies are needed in future in Indian patients undergoing RTSA to evaluate the glenoid bone-baseplate mismatch and ascertain the necessity of development of smaller size glenoid baseplate for optimal prosthesis fit in Indian patients.

Reconstruction of the Orbit and Anophthalmic Socket Using the Dermis Fat Graft: A Major Review.

To perform a comprehensive review of dermis fat graft (DFG) in socket reconstruction and illustrate the technical nuances and outcomes using a retrospective case review. A literature search of 143 texts was reviewed. A retrospective case series of 34 patients following primary or secondary DFG after enucleation at a single institution (2009-2019) was performed. Clinical outcomes were statistically analyzed. Variables investigated included age, sex, race, surgical indication, muscle reattachment, complications, motility, eyelid position, prosthesis fit, and need for additional surgery. The history of DFG, use in socket reconstruction, primary and secondary indications, and surgical techniques are described. Thirty-two adults and 2 pediatric cases of DFG were reviewed; 18.75% indications were primary and 81.25% were secondary. Good eyelid position was observed in 83.3% of patients with primary DFG versus 37.5% with secondary DFG (p = 0.07). Postoperative complications occurred in 58.8% of patients, were typically mild, and resolved with minimal or no intervention. No statistically significant differences were found between occurrence of any particular complication in primary versus secondary DFG placement (p = 0.36) or between primary and secondary DFG placement and the need for additional surgery (p = 1.0). Among the 67.7% patients who had implant exposure or extrusion as an indication for DFG, 39.1% required additional surgery within 2 years. Advanced age was not associated with higher complication rates (p = 0.12). DFG is an excellent option for socket reconstruction, particularly in cases involving pediatric patients, complicated orbits, history of multiple previous surgeries, and inflamed, contracted, or scarred sockets.

Gaze, behavioral, and clinical data for phantom limbs after hand amputation from 15 amputees and 29 controls

Despite recent advances in prosthetics, many upper limb amputees still use prostheses with some reluctance. They often do not feel able to incorporate the artificial hand into their bodily self. Furthermore, prosthesis fitting is not usually tailored to accommodate the characteristics of an individual’s phantom limb sensations. These are experienced by almost all persons with an acquired amputation and comprise the motor and postural properties of the lost limb. This article presents and validates a multimodal dataset including an extensive qualitative and quantitative assessment of phantom limb sensations in 15 transradial amputees, surface electromyography and accelerometry data of the forearm, and measurements of gaze behavior during exercises requiring pointing or repositioning of the forearm and the phantom hand. The data also include acquisitions from 29 able-bodied participants, matched for gender and age. Special emphasis was given to tracking the visuo-motor coupling between eye-hand/eye-phantom during these exercises.

Finite element analysis of optimization on placement of medial fixed-bearing unicompartmental knee arthroplasty

Objective To investigate the influence of displacement of femoral and tibial components on the biomechanics of femoral or tibial bone in coronal view. Methods A series of CT and MRI of the left knee joint of a Han male volunteer was taken and a three-dimensional finite element model of the healthy knee joint was established. The femoral component and the tibial component were designed with varus 6°, varus 3°, 0°, valgus 3°, and valgus 6°, and were combined into 25 three-dimensional finite element model (FEM) of medial unicompartmental knee arthroplasty. A 1 000 N load was applied along the femoral mechanical axis. The von Mises cloud stress distribution was observed. Moreover, the lateral compartment load ratio, the high contact stress of cancellous bone and medial cortical bone below the tibial component, the upper surface of the polyethylene liner, and the femoral cartilage in the lateral compartment was measured. The statistically significant indicators compared with the neutral position (0° varus or valgus of the tibia and the femoral prosthesis, and 5° posterior slope of tibia prosthesis) were identified by scatter plots to find the dense and sparse areas of point items. The optimal position of the femoral component and the tibial component was determined by the number of items with statistical significance in the sparse area. Results When the femoral component was placed at 0° position, there was no significant difference in the high contact stress of cancellous bone below the tibial component in the five groups. When the femoral component was placed at 0° position, the tibial component was 6° varus or 6° valgus and the stress was increased by 9.21±3.38 MPa and 9.08±4.13 MPa (P<0.05), respectively. With the changes of femoral and tibial components from 6° varus to 6° valgus, the high contact stress of the medial cortical bone below the tibia was gradually decreased (P<0.05). When the femoral component was placed at 0°, the tibial component changes from 6° varus to 6° valgus without significant difference in the high contact stress on the upper surface of each group of polyethylene gasket. Compared with the neutral position group, the high contact stress of the 6° varus or 6° valgus group were increased by 2.88±2.53 MPa and 3.47±2.86 MPa, respective ly (P<0.05). The lateral compartment load ratio and the high contact stress of lateral compartment femoral cartilage was gradually decreased (P<0.05), when the femoral and tibial components changed from 6° varus to 6° valgus. The number (2.8%, 1/36) of indicators in the sparse area (the combination of all combinations of femur or tibia from 3° varus to 3° valgus) was less than that (57.8%, 37/64) in the dense area (set of all combinations except sparse area), and the difference was significant (χ2=29.61, P<0.001). Conclusion It is suggested that the position of the femoral component and the tibial component in fixed medial unicompartmental arthroplasty should not exceed 3° varus or valgus in patients with standard lower limb alignment. Key words: Osteoarthritis, knee; Arthroplasty, replacement, knee; Prosthesis fitting; Finite element analysis