Prosthesis Research Articles

Nanotechnology and Prosthetic Devices: Integrating Biomedicine and Materials Science for Enhanced Performance and Adaptability

Nanomaterials are revolutionizing prosthetic device development. Nanotechnology has made prosthetic devices that replicate natural limb behavior and respond to users’ intentions possible. Nanomaterials improve prosthetic functionality, comfort, and lifespan. Nanocomposites, smart sensors, and medication delivery systems have addressed mechanical strength, control, and biocompatibility, resulting in enhanced prosthetic devices that improve user freedom, mobility, and quality of life. Biomedicine and materials science have helped nanomaterials reach their full potential, enabling their seamless integration into prosthetic devices and fostering interdisciplinary collaborations that advance prosthetics. The literature study shows substantial advances in nanomaterials for prosthetic devices; however, various gaps in present research and possible future research areas are indicated. First, long-term biocompatibility studies are needed to understand nanomaterials’ long-term effects on humans. Nanomaterial-based prosthetic devices must be tested and researched to assure safety and efficacy in real-world situations. Second, nanocomposites and nanoscale components must be standardized and quality-controlled to enable consistency and scalability in prosthetic devices. Third, nanoscale sensor and neural interface ethics must address privacy, security, and user consent issues. The nanomaterial-based prosthetic devices must be made more inexpensive and accessible to more disabled people. The study design was carried out to incorporate significant literature on the application of nanotechnology related to prosthetic devices. The literature was filtered from the Scopus database. The selected literature belongs to the original articles in which experimental work was carried out. Future research could combine nanotechnology with other developing technologies like artificial intelligence and robotics to produce more advanced and adaptable prosthetic devices.

A Multi-State Analysis of the Fiscal Impact of Commercial Insurance Coverage for General-Use & Activity-Specific Prosthetic & Orthotic Devices in the United States

Prosthetic and orthotic devices are assistive devices utilized by individuals with limb loss, limb difference, and mobility impairment. Research has shown these devices improve mobility and functionality, independence, and overall quality of life for individuals with disabilities who depend on them. This report focuses on two use types of prosthetic and orthotic devices: general-use and activity-specific. General-use prostheses and orthoses are designed to achieve the basic needs of ambulation and upper-limb functionality. In contrast, activity-specific devices are designed to support higher-intensity physical activities and recreation. Currently, 29 states do not require insurance coverage for general-use prosthetic and orthotic devices, and 45 states do not require insurance coverage for activity-specific devices, hindering individuals with limb loss, limb difference, and mobility impairment from essential life functions, including regular exercise required to prevent chronic illnesses. This study analyzes proposed legislation in 11 states, aiming to expand state-regulated coverage for prosthetic and orthotic devices for the purpose of improving quality of life and longevity of health, including chronic illness prevention. The methodology includes estimating the per member per month (PMPM) and net cost variations per state based on U.S. Census populations, Center of Medicare and Medicaid Services (CMS) Public Use Data Files and state-specific Medicaid fee schedules. The authors hypothesize that expanded insurance coverage could yield long-term social and fiscal benefits to the patient and healthcare systems. Results show PMPM estimates for states pursuing various levels of coverage, encompassing both general-use and activity-specific devices. The analysis conservatively estimates small PMPM increases based on assumptions related to device coverage costs and utilization. The results further emphasize potential overall healthcare savings from insurance coverage for these devices with the implementation of the 11 legislative initiatives, from improved health outcomes, with minimal fiscal impact.

On the Polymeric Coating Deposition Techniques to Increase Body Acceptance and Allow Drug Delivery in Smart Bio-devices

Currently, prosthetic devices have been significantly improved thanks to highly biocompatible metallic alloys, such as titanium alloys, and owing to the use of antibiotic treatments to allow higher acceptance of the implant. However, risks of infection or implants collapse are always possible since the human body recognizes prosthetic devices as foreign bodies and reacts to them accordingly. The surface of a prosthetic device guides the first interactions with the surrounding environment, and thus the necessity to act on the prosthesis surface with a local approach arises. Indeed, the creation of surface coatings that can potentially be loaded to perform local drug delivery represents a way to reduce systemic antibiotic delivery while improving body tolerance to the implanted devices. Within this framework, the current study aims to investigate the influence of different techniques applied to produce polymer-based coatings upon titanium alloy bio-devices, with the purpose of optimizing their durability. Specifically, the experimental campaign examined three different coating techniques (electrophoretic deposition, dip coating, and spray coating), to compare the results in terms of coating uniformity and mechanical adhesion to the titanium alloy.

Direct biomechanical manipulation of human gait stability: A systematic review.

People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.

A Data-Driven Design Framework for Structural Optimization to Enhance Wearing Adaptability of Prosthetic Hands.

Prosthetic hands have significant potential to restore the manipulative capabilities and self-confidence of amputees and enhance their quality of life. However, incompatibility between prosthetic devices and residual limbs can lead to secondary injuries such as skin pressure ulcers and restricted joint motion, contributing to a high prosthesis abandonment rate. To address these challenges, this study introduces a data-driven design framework (D3Frame) utilizing a multi-index optimization method. By incorporating motion/ pressure data, as well as clinical criteria such as pain threshold/ tolerance, from various anatomical sites on the residual limbs of amputees, this framework aims to optimize the structural design of the prosthetic socket, including the Antecubital Channel (AC), Lateral Epicondylar Region Contour (LC), Medial Epicondylar Region Contour (MC), Olecranon Region Contour (OC), Lateral Flexor/ Extensor Region (LR), and Medial Flexor/ Extensor Region (MR). Experiments on five forearm amputees verified the improved adaptability of the optimized socket compared to traditional sockets under three load conditions. The experimental results revealed a modest score enhancement on standard clinical scales and reduced muscle fatigue levels. Specifically, the percent effort of muscles and slope value of mean/ median frequency decreased by 19%, 70%, and 99% on average, respectively, and the average values of mean/ median frequency in the motion cycle both increased by approximately 5%. The proposed D3Frame in this study was applied to optimize the structural aspects of designated regions of the prosthetic socket, offering the potential to aid prosthetists in prosthesis design and, consequently, augmenting the adaptability of prosthetic devices.

Prevalencija lezija oralne mukoze kod institucionalizovanih starijih osoba

Background: The presence of mucosal changes and variations is quite high among institutionalized adults. Aim: The present study aimed to determine the prevalence of oral mucosal changes among the institutionalized elderly. Material and method: The presented data originate from research done in the period from May-July 2018 in "Mother Teresa" nursing home in Skopje, Republic of North Macedonia. The investigation included a total number of 70 subjects older than 65 years and it was focused on the presence of mucosal changes. In describing the changes in oral mucosa we have used two differentiated termslesion or pathological change and variation from normal. Results: During the examination of the prevalence of oral mucosal lesions we have found that all the subjects have at least one oral change in their oral cavity. The average number of oral changes among the examined institutionalized elderly is 2,24 ± 0,69. Total number of diagnosed changes on oral mucosa among all 70 subjects was 157. In the group of normal mucosa, variations dominate status fordyce (35.71 %) and coated tongue (28,57%). In the group of pathological changes, there is a domination of the lesions associated with the wearing of prosthetic devices-ulcerous changes caused by the prosthetic devices (15.71%) and stomatitis protetica (10%). Conclusion: In the investigated population, there is a one hundred percent presence of oral changes. Most of them are variations of the oral mucosa. But more important pathological lesions are those associated with wearing prosthetic devices. Also, it is very important to stress that pathological lesions require constant monitoring.

РОЛЬ И ВЛИЯНИЕ РАЗВИТИЯ ПРОТЕЗОСТРОЕНИЯ ВЕРХНИХ И НИЖНИХ КОНЕЧНОСТЕЙ НА ПОЛНОМАСШТАБНУЮ СОЦИАЛЬНУЮ ИНТЕГРАЦИЮ ТРУДОСПОСОБНЫХ ИНВАЛИДОВ

The research touches upon the issues of legal and financial accessibility of upper and lower limb prostheses (hereinafter - ULP) provided at the expense of budgetary funds to disabled people of working age, their functional capabilities for domestic and labor activities, as well as the introduction of innovative technologies in the production of ULP and the impact of the market of assistive products on increasing the motivation of disabled people to be involved in labor inclusion, including by expanding the range of employment opportunities. The aim of the research is to highlight the importance of the development of domestic scientific and technologically innovative production of technical rehabilitation devices and prosthetic and orthopedic products (TSR and prosthetic devices), as well as a wide market for their provision, including as mandatory and compensatory tools to increase the participation of disabled people in the creation of products and services in the actively developing labor market. The object of the research is scientific and technological achievements, industries, and clusters involved in the development and creation of technologically advanced rehabilitation aids to increase the inclusion of disabled people. The subject of the study is the impact of assistive technologies on the reintegration of disabled people into society. The scientific hypothesis is an attempt to prove that with the development of domestic scientific and technical production of assistive technologies, including prosthetics, the level of inclusion of persons with disabilities in society and the labor market should increase, and the financial accessibility of their suspension should be ensured. In the process of the research, the method of analysis and structuring of domestic and foreign experience in the development and creation of multifunctional rehabilitation devices as an instrument of inclusive mechanism that helps persons with disabilities to socialize and realize their labor potential in the labor market was used. The following conclusions were made based on the results of the research: state guarantees of accessibility and quality of rehabilitation equipment products, and their constant innovative modernization are essential for the disabled, which has a positive impact on the reintegration of persons with disabilities into the actively developing society and labor market; authorities at all levels need immediately begin to create a labor market for the disabled in connection with the actively advancing robotization and digitalization, and the use of artificial intelligence.

Deep Learning for Enhanced Prosthetic Control: Real-Time Motor Intent Decoding for Simultaneous Control of Artificial Limbs.

The development of advanced prosthetic devices that can be seamlessly used during an individual's daily life remains a significant challenge in the field of rehabilitation engineering. This study compares the performance of deep learning architectures to shallow networks in decoding motor intent for prosthetic control using electromyography (EMG) signals. Four neural network architectures, including a feedforward neural network with one hidden layer, a feedforward neural network with multiple hidden layers, a temporal convolutional network, and a convolutional neural network with squeeze-and-excitation operations were evaluated in real-time, human-in-the-loop experiments with able-bodied participants and an individual with an amputation. Our results demonstrate that deep learning architectures outperform shallow networks in decoding motor intent, with representation learning effectively extracting underlying motor control information from EMG signals. Furthermore, the observed performance improvements by using deep neural networks were consistent across both able-bodied and amputee participants. By employing deep neural networks instead of a shallow network, more reliable and precise control of a prosthesis can be achieved, which has the potential to significantly enhance prosthetic functionality and improve the quality of life for individuals with amputations.

Soft Wearable Body-Powered Hydraulic Actuation System for a Prosthetic Finger Design.

Finger and fingertip loss is the most common form of upper-limb amputation. With a focus on amputations involving the loss of distal and/or partial middle finger segments, this paper outlines the design and development of a novel soft body-powered hydraulically-driven actuation system for a prosthetic finger, while offering an in-depth examination of its subsystems. The proposed device utilises a soft wearable hydraulic mechanism to transfer pressure from the proximal interphalangeal (PIP) joint of the human finger to the distal interphalangeal (DIP) joint of the prosthetic finger, enabling movement of the soft prosthetic DIP joint. The design parameters of the soft actuator, such as its configuration, constituent material, and volume were analysed through experiments with able-bodied participants. Each participant tried 42 different actuators while flexing their index finger, repeating the task four times, yielding 168 trials per participant. The human and prosthetic finger flexion angles and resultant pressures were measured using an Aurora electromagnetic sensor and a fluid pressure transducer. All data was segmented and analysed. Soft actuator designs were selected through statistical analysis of the material (Agilus 30 and Dragon Skin 30), configuration (chambers located underside or around the PIP joint), and volume. The study demonstrated that the selected soft wearable hydraulic mechanism transferred generated pressure from the participant's PIP joint effectively, enabling movement of the prosthetic digit. Our research contributes to current developments in versatile body-powered prosthetic devices, laying the foundations for broad applications in affordable healthcare devices.

Intuitive and versatile bionic legs: a perspective on volitional control.

Active lower limb prostheses show large potential to offer energetic, balance, and versatility improvements to users when compared to passive and semi-active devices. Still, their control remains a major development challenge, with many different approaches existing. This perspective aims at illustrating a future leg prosthesis control approach to improve the everyday life of prosthesis users, while providing a research road map for getting there. Reviewing research on the needs and challenges faced by prosthesis users, we argue for the development of versatile control architectures for lower limb prosthetic devices that grant the wearer full volitional control at all times. To this end, existing control approaches for active lower limb prostheses are divided based on their consideration of volitional user input. The presented methods are discussed in regard to their suitability for universal everyday control involving user volition. Novel combinations of established methods are proposed. This involves the combination of feed-forward motor control signals with simulated feedback loops in prosthesis control, as well as online optimization techniques to individualize the system parameters. To provide more context, developments related to volitional control design are touched on.

Hand Gesture Classification through Time Frequency Images with One-to-One, All-to-One, and Cross-Validation Approaches.

Surface electromyographic (sEMG) signals are a non-invasive method for acquiring signals that play a fundamental role in the monitoring of prosthetic devices by providing information about human motor functions. This leads to the need for accurate classification of sEMG signals, despite variations in signal stationarity, the presence of sensor noise, differences between the muscles involved, and the peculiarities of each patient. This study focuses on the classification of hand grip postures using sEMG signals acquired from amputee patients. Special emphasis is placed on the use of the time-frequency domain for feature extraction, using the spectral analysis of the reduced-time Fourier transform (STFT).To carry out this task, a classification model based on a convolutional neural network (CNN) is used. The classification method is adjusted, trained, and evaluated through three experiments. The first, called "One to One", yields accuracy percentages of 90.84%, 91.05%, and 91.13% for spectrograms of 32x32, 64x64, and 128x128 in size, respectively. In the second validation, called "All by One", an accuracy of 62.28% is achieved for spectrograms of 32x32 pixels. Finally, in the last K-fold cross-validation validation, an average accuracy of 86.73%, 86.77%, and 87.97% is obtained for spectrograms of 32x32, 64x64, and 128x128 in size, respectively.

Безопасность субуретральной петлевой пластики трансобтураторным доступом у пациенток младше 45 лет

Introduction. Symptoms of stress urinary incontinence develop with age in every third woman. To date, suburethral sling surgery is the «gold standard» treatment for stress urinary incontinence. Sling operation is possible by various approaches, each of them has its own advantages and disadvantages. It is believed that transobturator access is combined with the risks of damage of the obturator vessels, tendons of the adductor muscles of the thigh, branches of the genital and anterior labial nerves. In connection with the above, most authors do not recommend the transobturator access for younger patients. The purpose of the study. To evaluate the efficacy and safety of suburethral sling surgery by transobturator access in patients under 45 years of age suffering from stress and mixed forms of urinary incontinence. Materials and methods. A single-center, retrospective observational study was conducted. The anamnestic data of the patients, efficacy (according to the examination in the chair, questionnaires ICIQ-SF, IIQ-7) and safety (the presence of erosions of the synthetic prosthesis, dyspareunia and chronic pain by examination, survey and questionnaires VAS, ODI) were evaluated. The analysis of the obtained data was carried out using the Microsoft Excel data array processing program. Results. After applying the inclusion and exclusion criteria, 61 patients participated in the study. The subjective effectiveness of the operation was 98.3%, the objective effectiveness was 95%. No erosion of the synthetic prosthetic device was observed in any patient. Chronic pain persisting for more than 1 month was noted in 1 patient (1.7%). Complaints of dyspareunia were also noted in only 1 patient (1.7%). Conclusion. The obtained results indicate the high efficiency and safety of transobturator access, and allow us to conclude that the use of transobturator access as a technique for primary implantation of a suburethral sling in young patients is justified.

A review of carbon fiber-reinforced polymer composite used to solve stress shielding in total hip replacement

<abstract> <p>Arthroplasty is generally used to treat advanced osteoarthritis or other degenerative joint diseases. However, it can also be considered in younger patients with severe joint damage that seriously limits their function and quality of life. Young patients are at risk of aseptic mobilization and bone resorption due to the uneven distribution of stress on the contact surface between the prosthesis and the femur that generates the stress-shielding phenomenon. To overcome this occurrence, it is necessary to use biocompatible materials with a stiffness that is similar to bone. Composite hip prostheses, consisting of continuous fiber-reinforced polymers, play a progressively key role in the development of prosthetic devices. Composite materials can be designed more carefully than monolithic stems (single-phase materials such as metals), allowing for the development of more effective tissue substitutes. Our purpose of this review was to analyze the state of the art in the use of carbon femoral prostheses. In particular, the major mechanical properties of reinforcement (fiber) and matrix were outlined with their applications in the prosthetic field.</p> </abstract>

What do users and their aiding professionals want from future devices in upper limb prosthetics? A focus group study.

High rejection rates of upper limb prosthetics indicate that current prosthetic devices only partially meet user demands. This study therefore investigated the benefits and challenges with current prostheses, associated services and potential areas for improvement from the perspective of upper limb prosthesis users and various professionals working in the field of upper limb and hand prosthetics. Seven different focus group discussions were conducted with 32 participants. Participants were grouped by prosthesis type, if they were prosthesis users, or professionals. All focus group discussions were transcribed verbatim, and a summarizing content analysis was performed. Three main topic areas to be addressed emerged from the interviews: 1. a properly functioning prosthesis, 2. the infrastructure, and 3. users' psychological and physical prerequisites. The interaction between a well-functioning prosthesis and a well-developed infrastructure was shown to be important for successful use. Our study raises many of the same issues that have been reported in previous qualitative studies, dating back over several decades. This study underlines the need to include users and professionals in the future development of prosthetic devices.

Multimodality Imaging Diagnosis in Infective Endocarditis.

Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices. New advanced non-invasive imaging tests are increasingly used in the diagnosis of IE. Nuclear medicine imaging techniques have demonstrated their superiority over TEE for the diagnosis of PVE and cardiac implantable electronic device infective endocarditis (CIED-IE). Cardiac computed tomography angiography imaging is useful in PVE cases with inconclusive TTE and TEE investigations and for the evaluation of paravalvular complications. In the present review, imaging tools are described with their values and limitations for improving diagnosis in NVE, PVE and CIED-IE. Current knowledge about multimodality imaging approaches in IE and imaging methods to assess the local and distant complications of IE is also reviewed. Furthermore, a potential diagnostic work-up for different clinical scenarios is described. However, further studies are essential for refining diagnostic and management approaches in infective endocarditis, addressing limitations and optimizing advanced imaging techniques across different clinical scenarios.

Systematic Review of Carbapenem Resistant Gram-negative Infective Endocarditis, Treatment Options and Outcomes

Background: Gram negative infective endocarditis is rare and usually associated with intravenous drug use or significant healthcare exposure and prosthetic cardiac valves or devices. Carbapenem resistance is a growing concern worldwide with limited drug options for these infections especially serious high inoculum infections such as endocarditis.
 Methods: A systematic review examining treatment options and outcomes was conducted with identification of 12 cases in the literature.
 Results: Pseudomonas aeruginosa was the most common organism with left sided valvular involvement being most common. 18 different antibiotic regimens were used with surgery occurring in 5 cases (42%). In hospital mortality was 33% which increased at 6 months post episode. Increased age (p= 0.056) and CCI (p=0.006) appeared to be associated with death. Microbiological cure was more common in patients who received combination therapy with 2 active agents (75% successful) and combination therapy including an active beta-lactam agent (100% successful) but these did not meet statistical significance.
 Conclusions: Recommendations for management of this rare condition based on this systematic review and other available evidence are summarised in this review. Management should generally involve multidisciplinary teams, combination therapy with at least 2 active agents including a beta-lactam agent where possible with consideration of surgery in all cases. Evidence is however limited with need for ongoing publication of cases and further research to guide therapy in the future.

Forensic Odontology and Its Ineluctable Slice: Prosthodontics - A Review

The branch of forensic science that deals with dental evidence is called forensic odontology. It is a very recent science that makes use of dentists' expertise to benefit the legal system. The importance of forensic identification based on examination of prosthetic appliances is growing since labelling on dentures and other prosthetic devices may offer crucial hints for patient identification. This article reviews the relevant research and emphasises how a prosthodontist can be crucial in the identification of a deceased person. Keywords: Denture marking, embossing, forensic odontology, inclusion, denture marking medium

Characterizing cardiac contractile motion for noninvasive radioablation of ventricular tachycardia

BackgroundRespiratory motion management strategies are used to minimize the effects of breathing on the precision of stereotactic ablative radiotherapy for ventricular tachycardia, but the extent of cardiac contractile motion of the human heart has not been systematically explored. ObjectiveWe aim to assess the magnitude of cardiac contractile motion between different directions and locations in the heart. MethodsPatients with intracardiac leads or valves who underwent 4D cardiac computed tomography (4DCT) prior to a catheter ablation procedure for atrial or ventricular arrhythmias at 2 medical centers were studied retrospectively. The displacement of transvenous right atrial appendage (RA), right ventricle (RV) ICD, coronary sinus (CS) lead tips and prosthetic cardiac devices across the cardiac cycle were measured in orthogonal 3D views on a maximal-intensity projection CT reconstruction. ResultsA total of 31 pre-ablation cardiac 4DCTs were analyzed. The LV lead tip had significantly greater motion compared to the RV lead in the anterior-posterior direction (6.0±2.2mm vs 3.8±1.7mm; p=0.01) and superior-inferior direction (4.4±2.9mm vs 3.5±2.0mm; p=0.049). The prosthetic aortic valves had the least movement of all fiducials, specifically compared to the RV lead tip in the left-right direction (3.2±1.2mm vs 6.1±3.8mm, p=0.04) and the LV lead tip in the antero-posterior direction (3.8±1.7mm vs 6.0±2.2mm, p=0.03). ConclusionThe degree of cardiac contractile motion varies significantly (1mm to 15.2 mm) across different locations in the heart. The effect of contractile motion on the precision of radiotherapy should be assessed on a patient-specific basis.

Evidencing the effectiveness of upper limb prostheses: a multi-stakeholder perspective on study requirements.

The provision of upper limb prosthetic devices through the National Health Services (NHS) within the United Kingdom is driven by national policies. NHS England have recently published a new policy to provide multi-grip myoelectric hands. The policy highlighted that there was limited evidence to support its deployment and it will be reviewed should new information arise. The clear identification of the evidence gap provides an opportunity for the academic research community to conduct studies that will inform future iterations of this and other upper limb prosthetic related policies. This paper presents a summary of findings and recommendations based on two multi-stakeholder workshops held in June 2022 and July 2022, which explored the design requirements for policy-driven research studies. The workshops involved people from a broad range of stakeholder groups: policy, academia, NHS clinical and management, industry, and a person with upper limb absence. The workshop discussions focused on the research questions that NHS England identified in the policy evidence review: (1) Clinical Effectiveness; (2) Cost Effectiveness; (3) Safety; and (4) Patient Subgroups. The recommendations based on stakeholder discussions included the need to gather qualitative and quantitative research evidence, use goal-based outcome measures, and conduct longitudinal studies. Future research studies also need to address the complexities of conducting national and international policy-driven research, such as clinical resource capacity and participant involvement.

Smart Design of Hip Replacement Prostheses Using Additive Manufacturing and Machine Learning Techniques

The field of additive manufacturing, particularly 3D printing, has ushered in a significant transformation in the realm of joint arthritis treatment through prosthetic surgery. This innovative technology allows for the creation of bespoke prosthetic devices that are tailored to meet the specific needs of individual patients. These devices are constructed using high-performance materials, including titanium and cobalt-chrome alloys. Nevertheless, the routine physical activities of patients, such as walking, sitting, and running, can induce wear and tear on the materials comprising these prosthetic devices, subsequently diminishing their functionality and durability. In response to this challenge, this research has endeavored to leverage novel techniques. The primary focus of this study lies in the development of an algorithm designed to optimize hip replacement procedures via the mechanical design of the prosthesis. This optimization process exploits the capabilities of machine learning algorithms, multi-body dynamics, and finite element method (FEM) simulations. The paramount innovation in this methodology is the capacity to design a prosthetic system that intricately adapts to the distinctive characteristics of each patient (weight, height, gait cycle). The primary objective of this research is to enhance the performance and longevity of prosthetic devices by improving their fatigue strength. The evaluation of load distribution on the prosthetic device, facilitated by FEM simulations, anticipates a substantial augmentation in the useful life of the prosthetic system. This research holds promise as a notable advancement in prosthetic technology, offering a more efficacious treatment option for patients suffering from joint arthritis. The aim of this research is to make meaningful contributions to the enhancement of patient quality of life and the long-term performance of prosthetic devices.