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Fully Implanted Prostheses for Musculoskeletal Limb Reconstruction After Amputation: An In Vivo Feasibility Study

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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 post-surgical 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 pre-surgery 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.

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Acknowledgments

The authors thank Elizabeth Croy for her assistance with surgeries and radiography; Dr. Lori Cole and Chris Carter for veterinary care provided for the rabbits in this study; the Office of Laboratory Animal Care and Animal Housing Facility staffs at the University of Tennessee, Knoxville for animal care assistance; Dr. William Hamel for use of the stainless-steel 3-D printer; Dr. Brett Compton for providing silicone preparation equipment; and Danny Graham for his assistance in machining parts for the endoprostheses. Research reported in this publication was supported by (1) the Eunice Kennedy Shiver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number K12HD073945, (2) a seed grant from the University of Tennessee Office of Research and Engagement, and (3) the University of Tennessee Department of Mechanical, Aerospace and Biomedical Engineering start-up funds.

Conflict of interest

We have no financial or personal relationships with other people or organizations that could bias our work.

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Authors and Affiliations

  1. Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, 1512 Middle Dr, Knoxville, TN, 37966, USA

    Patrick T. Hall, Samantha Z. Bratcher, Caleb Stubbs & Dustin L. Crouch

  2. Department of Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA

    Rebecca E. Rifkin, Remi M. Grzeskowiak & David E. Anderson

  3. Office of Laboratory Animal Care, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA

    Bryce J. Burton

  4. Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA

    Cheryl B. Greenacre

  5. University of Tennessee Medical Center, Knoxville, TN, USA

    Stacy M. Stephenson

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  1. Patrick T. Hall
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Correspondence to Patrick T. Hall.

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Associate Editor Jane Grande-Allen oversaw the review of this article.

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Hall, P.T., Bratcher, S.Z., Stubbs, C. et al. Fully Implanted Prostheses for Musculoskeletal Limb Reconstruction After Amputation: An In Vivo Feasibility Study. Ann Biomed Eng 49, 1012–1021 (2021). https://doi.org/10.1007/s10439-020-02645-3

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