Advanced techniques in amputation surgery and prosthetic technology in the lower extremity

Abstract

Bone-anchored implants give patients with unmanageable stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates.Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons.Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines.Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist-antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints.As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price.Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter-individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ankles (A-MPK/As) might succeed in uneven ground-walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way.Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor-controlled prosthetic components. Cite this article: EFORT Open Rev 2020;5:724-741. DOI: 10.1302/2058-5241.5.190070.

Keywords: RPNI; TMR; amputation surgery; bone-anchored prosthesis; prosthetic technology bionics.

Fig. 1

Numbers of publications split by journal impact factor in presented five categories.

Fig. 2

Number of publications split by journal ranking (JCR) in presented five categories.

Fig. 3.

Flow diagram showing the selection process of this review’s articles.

Fig. 4.

Illustration of the principle of targeted muscle reinnervation (TMR). (A) Muscle before amputation with motor nerve and by-passing mixed nerve. (B) Muscle and by-passing nerve are cut during amputation. (C) Muscle is denervated. (D) Mixed nerve re-innervates the muscle. (based on BodyParts3D, [http://lifesciencedb.jp/bp3d/] © The DatabaseCenter for Life Science licensed under CC Attribution-ShareAlike 2.1 Japan)

Fig. 5.

Illustration of the principle of regenerative peripheral nerve interface (RPNI). (A) Muscle before amputation with motor nerve and by-passing mixed nerve. (B) Muscle and by-passing nerve are cut during amputation. (C) Two free muscle grafts are harvested from a nearby muscle. (D) Two RPNIs are designed by wrapping the nerve ends with the free muscle flaps. (based on BodyParts3D, [http://lifesciencedb.jp/bp3d/] © The DatabaseCenter for Life Science licensed under CC Attribution-ShareAlike 2.1 Japan)

Fig. 6.

Numbers of publications split by countries of origin in category ‘prosthetic technology’.