Jason W. Stoneback, MD

BACKGROUND: Bone-anchored limbs (BALs) improve mobility, physical activity, multi-joint biomechanics, and static balance measures compared to when using a socket prosthesis. However, evidence surrounding how BAL use influences dynamic balance, and whether this is dependent on amputation level, remains unknown.

Walking swing limb advancement after transfemoral amputation relies on the hip for proper limb positioning. We compared hip mechanics and stride characteristics during swing before and after bone-anchored limb (BAL) implantation. We hypothesized swing limb advancement hip mechanics would be different and between-limb differences reduced after BAL implantation without compromising stride characteristics. Twenty participants were included in this retrospective observational investigation including...

CONCLUSIONS: The themes identified here can serve to guide clinicians in the selection of prosthetic components as further evidence is created to promote safety and functional outcomes for individuals with BALs. This consensus provides a basis for structuring future clinical practice guidelines and identifying knowledge gaps for future research studies.

CONCLUSIONS: The COLD-TUG test accurately measures prosthesis-donning burden in the context of functional mobility, thus providing valuable insights into functional abilities and quality of life. Use of a BAL was associated with a shorter donning time compared with use of a socket prosthesis.

People with unilateral transfemoral amputation commonly experience pain at the residual limb-socket interface and heightened risk of musculoskeletal overuse injuries. Compensatory movement patterns acutely alleviate pain but can contribute to chronic aberrant muscle function and joint loading. Bone-anchored limbs have been shown to normalize joint loading during walking compared to socket prostheses, but their effects on muscle forces are not well understood. In this study, we compared dynamic...

Osseointegration of a bone-anchored limb (BAL) is an emerging rehabilitation technique that offers significant advantages over traditional socket prostheses. By addressing functional limitations and recurrent cutaneous complications, BAL systems have shown an 82%-90% increase in daily prosthesis use among patients, who also report improvements in functional ability, balance, comfort, and overall quality of life. Despite these benefits, the process of patient selection for BAL remains...

BACKGROUND: Sit-to-stand transitions are demanding activities for people with unilateral transfemoral amputation. Movement asymmetries during sit-to-stand place greater stresses on the intact limb joints compared to the amputated limb joints, potentially contributing to musculoskeletal overuse injury and pain. Bone-anchored limbs address socket-related prosthesis issues, but their impact on cumulative joint moments during sit-to-stand is yet to be fully understood. The purpose of this study was...

CONCLUSIONS: The osseointegration of a bone-anchored limb improved patient-reported pain and quality of life in lower-extremity amputees.

Bone-anchored limbs (BALs) are a transformative alternative for patients with lower-limb amputation who suffer from debilitating socket problems by eliminating the need for skin-to-prosthetic contact. Despite its successes, some individuals continue to face challenges with BALs, experiencing a loss of implant integration resulting in prosthetic loosening. A thorough understanding of biomechanical behavior at the residual limb and bone-implant interface is necessary to fully understand mechanical...

CONCLUSION: The associations between residual femur length and hip loading symmetry in patients with transfemoral bone-anchored limbs suggest that those with shorter residual limbs will demonstrate more asymmetric joint loading when using a bone-anchored limb. Thus, these findings could potentially be used to better inform targeted interventions based on residual limb morphology, including continued gait training in rehabilitation to promote joint loading symmetry and surgical considerations...

PURPOSE: Implants in orthopedic trauma and arthroplasty surgery establish a milieu conducive to biofilm formation. Antimicrobial-loaded cements (ABCs) and beads have become popular in treating acute and chronic orthopedic surgery-related infections. The growing incidence of antimicrobial resistance has necessitated the exploration of alternative antibiotic medications. This review aims to demonstrate meaningful clinical decision-making guidance for orthopedic surgeons in approaching the...

CONCLUSIONS: Overall, this work provides key insights into the composition of equine synovial fluid and synovium in health and OA. The data generated in this study provides equine-specific cell type gene signatures which can be applied to future investigations. Furthermore, our analysis highlights the potential role of macrophages and IL23R^(+) γδ T cells in OA immunopathogenesis.

Bone-anchored limbs (BALs) are socket prosthesis alternatives, directly fixing to residual bone via osseointegrated implant. There is a need to quantify multi-level effects of rehabilitation for transfemoral BAL users (i.e. changes in joint loading and movement patterns). Our primary objective was determining feasibility of using optimal control to predict gait biomechanics compared to ground-truth experimental data from transfemoral BAL users. A secondary objective was examining biomechanical...

For some individuals with severe socket-related problems, prosthesis osseointegration directly connects a prosthesis to the residual limb creating a bone-anchored limb (BAL). We compared dynamic gait stability and between-limb stability symmetry, as measured by the Margin of Stability (MoS) and the Normalized Symmetry Index (NSI), for people with unilateral transfemoral amputation before and one-year after BAL implantation. The MoS provides a mechanical construct to assess dynamic gait stability...

BACKGROUND: A bone-anchored limb (BAL) is an alternative to a traditional socket-type prosthesis for people with transfemoral amputation. Early laboratory-based evidence suggests improvement in joint and limb loading mechanics during walking with a BAL compared to socket prosthesis use. However, changes in cumulative joint and limb loading measures, which may be predictive of degenerative joint disease progression, remain unknown.