-
Experimental Biology and Medicine... Apr 2017Over the past 20 years, the field of antimicrobial medical device coatings has expanded nearly 30-fold with technologies shifting their focus from diffusion-only based... (Review)
Review
Over the past 20 years, the field of antimicrobial medical device coatings has expanded nearly 30-fold with technologies shifting their focus from diffusion-only based (short-term antimicrobial eluting) coatings to long-term antimicrobial eluting and intrinsically antimicrobial functioning materials. A variety of emergent coatings have been developed with the goal of achieving long-term antimicrobial activity in order to mitigate the risk of implanted device failure. Specifically, the coatings can be grouped into two categories: those that use antibiotics in conjunction with a polymer coating and those that rely on the intrinsic properties of the material to kill or repel bacteria that come into contact with the surface. This review covers both long-term drug-eluting and non-eluting coatings and evaluates the inherent advantages and disadvantages of each type while providing an overview of variety applications that the coatings have been utilized in. Impact statement This work provides an overview, with advantages and limitations of the most recently developed antibacterial coating technologies, enabling other researchers in the field to more easily determine which technology is most advantageous for them to further develop and pursue.
Topics: Anti-Infective Agents; Biofouling; Biomedical Technology; Copper; Metal Nanoparticles; Polymers; Prostheses and Implants; Prosthesis-Related Infections; Silver; Time Factors
PubMed: 28110543
DOI: 10.1177/1535370216688572 -
Der Unfallchirurg Apr 2017The direct attachment of osseointegrated (OI) prostheses to the skeleton avoids the inherent problems of socket suspension. It also provides physiological weight... (Review)
Review
The direct attachment of osseointegrated (OI) prostheses to the skeleton avoids the inherent problems of socket suspension. It also provides physiological weight bearing, improved range of motion in the proximal joint, as well as osseoperceptive sensory feedback, enabling better control of the artificial limbs by amputees. The present article briefly reviews the pioneering efforts on extremity osseointegration surgeries in Sweden and the development of the OPRA (Osseointegrated Prostheses for the Rehabilitation of Amputees) program. The standard implant design of the OPRA system and surgical techniques are described as well as the special rehabilitation protocols based on surgical sites. The results of long-term follow-up for transradial, transhumeral, and thumb amputee operations are briefly reported including the prospective study of transfemoral amputees according to OPRA protocol. The importance of refinement on implant designs and surgical techniques based on the biomechanical analysis and early clinical trials is emphasized. Future aspects on osseointegration surgery are briefly described, including novel treatment options using implanted electrodes.
Topics: Amputation, Surgical; Amputation Stumps; Artificial Limbs; Evidence-Based Medicine; Exoskeleton Device; Humans; Osseointegration; Prosthesis Design; Prosthesis Implantation; Sweden; Treatment Outcome
PubMed: 28229193
DOI: 10.1007/s00113-017-0331-4 -
PloS One 2022Press-fitted implants are implanted by impaction to ensure adequate seating, but without overloading the components, the surgeon, or the patient. To understand this...
Press-fitted implants are implanted by impaction to ensure adequate seating, but without overloading the components, the surgeon, or the patient. To understand this interrelationship a uniaxial discretised model of the hammer/introducer/implant/bone/soft-tissues was developed. A parametric analysis of applied energy, component materials and geometry, and interactions between implant and bone and between bone and soft-tissues was performed, with implant seating and component stresses as outcome variables. To reduce the impaction effort (energy) required by the surgeon for implant seating and also reduce stresses in the hardware the following outcomes were observed: Reduce energy per hit with more hits / Increase hammer mass / Decrease introducer mass / Increase implant-bone resistance (eg stem roughness). Hardware stiffness and patient mechanics were found to be less important and soft tissue forces, due to inertial protection by the bone mass, were so low that their damage would be unlikely. This simple model provides a basic understanding of how stress waves travel through the impacted system, and an understanding of their relevance to implantation technique and component design.
Topics: Bone Density; Bone and Bones; Femur; Hip Prosthesis; Humans; Lower Extremity; Prostheses and Implants
PubMed: 35594265
DOI: 10.1371/journal.pone.0268561 -
Current Opinion in Rheumatology May 2010Surgeons have long been striving to develop new surgical procedures to improve functional outcomes for a variety of hand and wrist deformities resulting from rheumatoid... (Review)
Review
PURPOSE OF REVIEW
Surgeons have long been striving to develop new surgical procedures to improve functional outcomes for a variety of hand and wrist deformities resulting from rheumatoid arthritis (RA). The purpose of this review is to assess the latest surgical outcomes related to hand and wrist surgery in the patient with RA.
RECENT FINDINGS
There is a lack of outcome studies in RA hand and wrist surgery to justify many of the surgical procedures proposed for the treatment of the rheumatoid hand. However, advances made by the silicone metacarpophalangeal arthroplasty (SMPA) group regarding hand reconstruction for RA patients have improved patient care for this widely used procedure. Prophylactic versus therapeutic procedures are also discussed.
SUMMARY
Rheumatoid hand is one of the earliest presentations of RA, and the progression of rheumatoid hand disease can be unpredictable. There are a number of surgical treatments for the rheumatoid hand and careful sequential planning of the surgical procedures can maintain patients' hand function and in many cases should enhance outcomes of the rheumatoid hand by correcting existing deformities. An early introduction to a hand surgeon can inform patients of available options and allow longitudinal assessment of structural and functional changes that could be treatable by future surgical interventions.
Topics: Arthritis, Rheumatoid; Arthroplasty, Replacement, Finger; Early Diagnosis; Hand; Humans; Metacarpophalangeal Joint; Orthopedic Procedures; Outcome Assessment, Health Care; Prostheses and Implants; Prosthesis Implantation; Radiography; Treatment Outcome
PubMed: 20061956
DOI: 10.1097/BOR.0b013e3283369c9d -
BMJ Open Sep 2017The regulation of surgical implants is vital to patient safety, and there is an international drive to establish registries for all implants. Hearing loss is an area of... (Review)
Review
OBJECTIVE
The regulation of surgical implants is vital to patient safety, and there is an international drive to establish registries for all implants. Hearing loss is an area of unmet need, and industry is targeting this field with a growing range of surgically implanted hearing devices. Currently, there is no comprehensive UK registry capturing data on these devices; in its absence, it is difficult to monitor safety, practices and effectiveness. A solution is developing a national registry of all auditory implants. However, developing and maintaining a registry faces considerable challenges. In this systematic review, we aimed to identify the essential features of a successful surgical registry.
METHODS
A systematic literature review was performed adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis recommendations. A comprehensive search of the Medline and Embase databases was conducted in November 2016 using the Ovid Portal. Inclusion criteria were: publications describing the design, development, critical analysis or current status of a national surgical registry. All registry names identified in the screening process were noted and searched in the grey literature. Available national registry reports were reviewed from registry websites. Data were extracted using a data extraction table developed by thematic analysis. Extracted data were synthesised into a structured narrative.
RESULTS
Sixty-nine publications were included. The fundamentals to successful registry development include: steering committee to lead and oversee the registry; clear registry objectives; planning for initial and long-term funding; strategic national collaborations among key stakeholders; dedicated registry management team; consensus meetings to agree registry dataset; established data processing systems; anticipating challenges; and implementing strategies to increase data completion. Patient involvement and awareness of legal factors should occur throughout the development process.
CONCLUSIONS
This systematic review provides robust knowledge that can be used to inform the successful development of any UK surgical registry. It also provides a methodological framework for international surgical registry development.
Topics: Cooperative Behavior; Equipment and Supplies; Humans; Patient Safety; Prostheses and Implants; Quality Control; Registries
PubMed: 28947457
DOI: 10.1136/bmjopen-2017-017373 -
Current Opinion in Biotechnology Aug 2016Elastomers are popular in vascular engineering applications, as they offer the ability to design implants that match the compliance of native tissue. By mimicking the... (Review)
Review
Elastomers are popular in vascular engineering applications, as they offer the ability to design implants that match the compliance of native tissue. By mimicking the natural tissue environment, elastic materials are able to integrate within the body to promote repair and avoid the adverse physiological responses seen in rigid alternatives that often disrupt tissue function. The design of elastomers has continued to evolve, moving from a focus on long term implants to temporary resorbable implants that support tissue regeneration. This has been achieved through designing chemistries and processing methodologies that control material behavior and bioactivity, while maintaining biocompatibility in vivo. Here we review the latest developments in synthetic and natural elastomers and their application in cardiovascular treatments.
Topics: Animals; Biocompatible Materials; Blood Vessel Prosthesis; Blood Vessels; Elastomers; Humans; Prostheses and Implants; Tissue Engineering
PubMed: 27149017
DOI: 10.1016/j.copbio.2016.04.008 -
Nature Nov 2009Biomaterials, traditionally defined as materials used in medical devices, have been used since antiquity, but recently their degree of sophistication has increased... (Review)
Review
Biomaterials, traditionally defined as materials used in medical devices, have been used since antiquity, but recently their degree of sophistication has increased significantly. Biomaterials made today are routinely information rich and incorporate biologically active components derived from nature. In the future, biomaterials will assume an even greater role in medicine and will find use in a wide variety of non-medical applications through biologically inspired design and incorporation of dynamic behaviour.
Topics: Animals; Biocompatible Materials; Biomedical Engineering; Biomedical Research; Biomimetic Materials; Equipment Design; History, 20th Century; History, 21st Century; History, Ancient; Humans; Prostheses and Implants
PubMed: 19940912
DOI: 10.1038/nature08601 -
Annals of Palliative Medicine Mar 2022Rhinoplasty is one of the most common operations in plastic and aesthetic surgery. Both solid silicone material and autologous cartilage (AC) tissue have their... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rhinoplasty is one of the most common operations in plastic and aesthetic surgery. Both solid silicone material and autologous cartilage (AC) tissue have their individual advantages and disadvantages. In this meta-analysis, the efficacy, complication rate of rhinoplasty with AC and silicone material were comprehensively analyzed and compared.
METHODS
The databases Medline, Embase, PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang were searched by rapid matching of keywords to obtain randomized controlled trials related to AC rhinoplasty or silicone filled rhinoplasty, which were analyzed using the software Stata 16.0 after screening and quality assessment.
RESULTS
A total of 1,233 patients undergoing rhinoplasty from 7 articles were included in the study. Meta-analysis showed that rhinoplasty with AC would gain more satisfaction [risk ratio (RR) =1.11; 95% confidence interval (CI): (1.02, 1.21); Z=2.413; P=0.016]. would reduce the complication rate [RR =0.34; 95% CI: (0.22, 0.52); Z=-5.010; P<0.0001], and resulting in less secondary surgery rate [RR =0.34; 95% CI: (0.18, 0.64); Z=-3.363; P=0.001] comparing to silicone prosthesis (SP) material.
DISCUSSION
In rhinoplasty, the use of AC material gains more satisfaction, has less total complication rate, and results in less secondary surgery rate than silicone material. But based on the heterogeneity and publication bias in the studies, this topic still needs to be further explored by including more high-quality studies.
Topics: Cartilage; Humans; Prostheses and Implants; Rhinoplasty; Silicones; Transplantation, Autologous
PubMed: 35365029
DOI: 10.21037/apm-22-111 -
Journal of Biomedicine & Biotechnology 2012Wear particle-induced periprosthetic osteolysis remains the principal cause of aseptic loosening of orthopaedic implants. Monocytes/macrophages phagocytose wear... (Review)
Review
Wear particle-induced periprosthetic osteolysis remains the principal cause of aseptic loosening of orthopaedic implants. Monocytes/macrophages phagocytose wear particles and release cytokines that induce inflammatory response. This response promotes osteoclast differentiation and osteolysis. The precise mechanisms by which wear particles are recognized and induce the accumulation of inflammatory cells in the periprosthetic tissue have not been fully elucidated. Recent studies have shown that toll-like receptors (TLRs) contribute to the cellular interaction with wear particles. Wear particles are recognized by monocytes/macrophages through TLRs coupled with the adaptor protein MyD88. After the initial interaction, wear particles induce both local and systemic migration of monocytes/macrophages to the periprosthetic region. The cellular migration is mediated through chemokines including interleukin-8, macrophage chemotactic protein-1, and macrophage inhibitory protein-1 in the periprosthetic tissues. Interfering with chemokine-receptor axis can inhibit cellular migration and inflammatory response. This paper highlights recent advances in TLR, and chemokine participated in the pathogenesis of aseptic loosening. A comprehensive understanding of the recognition and migration mechanism is critical to the development of measures that prevent wear particle-induced aseptic loosening of orthopaedic implants.
Topics: Animals; Cell Movement; Chemokines; Humans; Prostheses and Implants; Prosthesis Failure; Signal Transduction; Toll-Like Receptors
PubMed: 23193363
DOI: 10.1155/2012/596870 -
PloS One 2018Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated... (Review)
Review
BACKGROUND
Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis.
OBJECTIVE
The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions.
METHODS
Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis.
RESULTS
A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible.
CONCLUSIONS
At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness.
Topics: Costs and Cost Analysis; Humans; Orthotic Devices; Prostheses and Implants; Randomized Controlled Trials as Topic
PubMed: 29538382
DOI: 10.1371/journal.pone.0192094