title: Developing a quantitative measurement system for assessing heterotopic ossification and monitoring the bioelectric metrics from electrically induced osseointegration in the residual limb of service members.
abstract: Poor prosthetic fit is often the result of heterotopic ossification (HO), a frequent problem following blast injuries for returning service members. Osseointegration technology offers an advantage for individuals with significant HO and poor socket tolerance by using direct skeletal attachment of a prosthesis to the distal residual limb, but remains limited due to prolonged post-operative rehabilitation regimens. Therefore, electrical stimulation has been proposed as a catalyst for expediting skeletal attachment and the bioelectric effects of HO were evaluated using finite element analysis in 11 servicemen with transfemoral amputations. Retrospective computed tomography (CT) scans provided accurate reconstructions, and volume conductor models demonstrated the variability in residual limb anatomy and necessity for patient-specific modeling to characterize electrical field variance if patients were to undergo a theoretical osseointegration of a prosthesis. In this investigation, the volume of HO was statistically significant when selecting the optimal potential difference for enhanced skeletal fixation, since higher HO volumes required increased voltages at the periprosthetic bone (p = 0.024, r = 0.670). Results from Spearman's rho correlations also indicated that the age of the subject and volume of HO were statistically significant and inversely proportional, in which younger service members had a higher frequency of HO (p = 0.041, r = -0.622). This study demonstrates that the volume of HO and age may affect the voltage threshold necessary to improve current osseointegration procedures.
authors.affiliation: Department of Veterans Affairs, Salt Lake City, UT 84148, USA.
authors.forename: Brad M
authors.initials: BM
authors.lastname: Isaacson
authors.forename: Jeroen G
authors.initials: JG
authors.lastname: Stinstra
authors.forename: Rob S
authors.initials: RS
authors.lastname: MacLeod
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pasquina
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloebaum
mesh_terms: D000328:Adult; D000672:Amputation Stumps / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D004599:Electric Stimulation Therapy / Q000379:methods*; D020342:Finite Element Analysis; D006801:Humans; D008297:Male; D008889:Military Personnel; D016348:Osseointegration / Q000502:physiology*; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017755:Prosthesis Fitting; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
references.citation: Clin Orthop Relat Res. 1977 May;(124):124-7
references.pmid: 304401
references.citation: Clin Orthop Relat Res. 1975 Oct;(112):165-9
references.pmid: 811418
references.citation: Int J Radiat Oncol Biol Phys. 1997 Dec 1;39(5):961-6
references.pmid: 9392532
references.citation: J Am Acad Orthop Surg. 2006;14(10 Spec No.):S188-90
references.pmid: 17003197
references.citation: J Bone Joint Surg Am. 1974 Jul;56(5):1001-22
references.pmid: 4603167
references.citation: J Rehabil Res Dev. 2004 May;41(3B):vii-xii
references.pmid: 15543454
references.citation: Orthopedics. 2008 Oct;31(10):
references.pmid: 19226009
references.citation: J Bone Joint Surg Am. 1975 Apr;57(3):368-77
references.pmid: 1079028
references.citation: J Vis Exp. 2009 Jul 15;(29):1-6
references.pmid: 19609251
references.citation: J Am Acad Orthop Surg. 2006;14(10 Spec No.):S191-7
references.pmid: 17003198
references.citation: J Med Assoc Thai. 2004 Nov;87(11):1315-20
references.pmid: 15825706
references.citation: J Altern Complement Med. 2007 Jun;13(5):485-90
references.pmid: 17604552
references.citation: J Anat. 2006 Jul;209(1):59-67
references.pmid: 16822270
references.citation: J Bone Joint Surg Am. 2007 Mar;89(3):476-86
references.pmid: 17332095
references.citation: J Bone Joint Surg Am. 2003 Aug;85(8):1538-43
references.pmid: 12925635
references.citation: Physiotherapy. 1980 Jul;66(7):219-20
references.pmid: 6779299
references.citation: J Bone Joint Surg Am. 1990 Aug;72(7):1067-73
references.pmid: 2117012
references.citation: BMJ. 2009 Feb 27;338:b11
references.pmid: 19251750
references.citation: Am J Phys Med Rehabil. 2003 Nov;82(11):897-900
references.pmid: 14566159
references.citation: J Cell Physiol. 1986 Dec;129(3):283-8
references.pmid: 3782308
references.citation: J Bone Miner Metab. 2007;25(1):6-11
references.pmid: 17187188
references.citation: Orthopedics. 1993 Jul;16(7):793-7
references.pmid: 8361918
references.citation: J Arthroplasty. 1993 Apr;8(2):157-66
references.pmid: 8386746
references.citation: J Bone Joint Surg Am. 1970 Sep;52(6):1131-7
references.pmid: 4989460
references.citation: J Bone Joint Surg Am. 1980 Oct;62(7):1143-6
references.pmid: 6776126
references.citation: Clin Orthop Relat Res. 1976 Jun;(117):209-16
references.pmid: 1277668
references.citation: Am J Physiol. 1980 Nov;239(5):R424-7
references.pmid: 7435656
references.citation: Invest Ophthalmol Vis Sci. 1990 Nov;31(11):2278-82
references.pmid: 2242993
references.citation: Clin Orthop Relat Res. 1984 Nov;(190):138-41
references.pmid: 6435920
references.citation: Bioelectromagnetics. 2002 Feb;23(2):132-43
references.pmid: 11835260
references.citation: J Bone Joint Surg Am. 1974 Jul;56(5):1023-30
references.pmid: 4847224
references.citation: Clin Orthop Relat Res. 1968 Mar-Apr;57:303-9
references.pmid: 5669863
references.citation: Eur Spine J. 2001 Oct;10 Suppl 2:S96-101
references.pmid: 11716023
references.citation: J Bone Joint Surg Am. 1985 Oct;67(8):1261-9
references.pmid: 3932363
references.citation: Calcif Tissue Int. 1995 Feb;56(2):123-9
references.pmid: 7736320
references.citation: J Rehabil Res Dev. 2009;46(9):1109-20
references.pmid: 20437317
references.citation: Clin Orthop Relat Res. 1984 Jun;(186):249-71
references.pmid: 6373088
references.citation: Acta Orthop Scand. 1987 Oct;58(5):567-77
references.pmid: 3321881
references.citation: Clin Orthop Relat Res. 1975 Oct;(112):142-9
references.pmid: 811416
references.citation: Radiat Prot Dosimetry. 2007;124(2):124-9
references.pmid: 17494982
references.citation: Prosthet Orthot Int. 2008 Mar;32(1):29-41
references.pmid: 18330803
references.citation: Mech Ageing Dev. 2009 Jan-Feb;130(1-2):54-7
references.pmid: 18502471
references.citation: Prosthet Orthot Int. 2006 Dec;30(3):279-85
references.pmid: 17162518
references.citation: Clin Orthop Relat Res. 1984 Jun;(186):154-8
references.pmid: 6426837
references.citation: J Orthop Res. 2009 Dec;27(12):1645-51
references.pmid: 19517576
references.citation: Arthroscopy. 2007 Dec;23(12):1359.e1-3
references.pmid: 18063185
references.citation: Clin Orthop Relat Res. 1975 Jan-Feb;(106):330-5
references.pmid: 1079175
references.citation: Clin Orthop Relat Res. 1991 Feb;(263):49-58
references.pmid: 1899637
references.citation: Acta Orthop Scand. 1983 Oct;54(5):698-702
references.pmid: 6422696