Prostheses play a vital role in restoring function and mobility to individuals with physical disabilities. This study focuses on the procedure to create customized prostheses using semirigid molds obtained from additive technologies. This innovative methodology aims to improve the fit and comfort of prostheses.The manufacturing process of prostheses using semirigid molds combined with additive technologies involves several key phases. These include the use of computed tomography (CT) of the affected area, computer-aided design, and the production of custom mold models.This study introduces the main production phases of customized prostheses, based on the strategy that involves the manufacturing of semirigid molds, by additive manufacturing (AM). This approach improves fit, comfort, and integration of prostheses into patients\' daily lives. In particular, prostheses for cranioplasty are described in this study.

People with unilateral transtibial amputation (TTA) using a passive-elastic prosthesis exhibit lower positive affected leg trailing work (ALtrail Wpos) and a greater magnitude of negative unaffected leg leading work (ULlead Wneg) during walking than non-amputees, which may increase joint pain and osteoarthritis risk in the unaffected leg. People with TTA using a stance-phase powered prosthesis (e.g., BiOM, Ottobock, Duderstadt, Germany) walk with increased ALtrail Wpos and potentially decreased magnitude of ULlead Wneg compared to a passive-elastic prosthesis. The BiOM includes a passive-elastic prosthesis with a manufacturer-recommended stiffness category and can be tuned to different power settings, which may change ALtrail Wpos, ULlead Wneg, and the prosthesis effective foot length ratio (EFLR). Thirteen people with TTA walked using 16 different prosthetic stiffness category and power settings on a level treadmill at 0.75-1.75 m/s. We constructed linear mixed effects models to determine the effects of stiffness category and power settings on ALtrail Wpos, ULlead Wneg, and EFLR and hypothesized that decreased stiffness and increased power would increase ALtrail Wpos, not change and decrease ULlead Wneg magnitude, and decrease and not change prosthesis EFLR, respectively. We found there was no significant effect of stiffness category on ALtrail Wpos but increased stiffness reduced ULlead Wneg magnitude, perhaps due to a 0.02 increase in prosthesis EFLR compared to the least stiff category. Furthermore, we found that use of the BiOM with 10% and 20% greater than recommended power increased ALtrail Wpos and decreased ULlead Wneg magnitude at 0.75-1.00 m/s. However, prosthetic power setting depended on walking speed so that use of the BiOM increased ULlead Wneg magnitude at 1.50-1.75 m/s compared to a passive-elastic prosthesis. Ultimately, our results suggest that at 0.75-1.00 m/s, prosthetists should utilize the BiOM attached to a passive-elastic prosthesis with an increased stiffness category and power settings up to 20% greater than recommended based on biological ankle values. This prosthetic configuration can allow people with unilateral transtibial amputation to increase ALtrail Wpos and minimize ULlead Wneg magnitude, which could reduce joint pain and osteoarthritis risk in the unaffected leg and potentially lower the metabolic cost of walking.

UNASSIGNED: Although mechanical properties of running specific prostheses (RSPs) can affect running performance, manufacturers do not consistently report them. This study aimed to review existing literature on RSP mechanical and structural properties and their relationship with running performance.
UNASSIGNED: A comprehensive search was conducted using keywords related to mechanical properties of RSPs and running performance. Search terms included stiffness and hysteresis, as well as performance outcomes including metabolic cost and running speed. Non-peer-reviewed and non-English publications were excluded.
UNASSIGNED: Twenty articles were included in the review. Sixteen studies used a material testing machine to measure RSP material properties, and four articles used other techniques including 2D/3D video capture and force platforms. Both measurement techniques and reporting of outcomes were inconsistent, which limits the ability to draw broad conclusions. Additionally, several studies did not report the numerical data for material properties despite measuring them. Relatively few articles measured both material properties and running performance and assessed correlations.
UNASSIGNED: Several articles connected prosthesis properties to running performance. However, inconsistent measurement and reporting of mechanical properties, along with the multifactorial nature of the athlete-prosthesis system, limit the ability to draw broad conclusions regarding the relationship between material and structural properties and athlete performance. Current evidence may be useful for clinicians seeking ways to optimize RSP stiffness in a case-by-case basis; however, clinicians would benefit from more consistent and systematic comparisons of the attributes of different RSPs and their role in performance.

UNASSIGNED: Suture anchor failures can lead to revision surgeries which are costly and burdensome for patients. The durability of musculoskeletal reconstructions is therefore partly affected by the design of the suture anchors.
UNASSIGNED: The purpose of the study was to quantify the strength of different suture anchors whose sizes are suitable for attaching artificial Achilles and tibialis cranialis tendons in a rabbit model, as well as determine the effect of cyclic loading on the anchoring strength.
UNASSIGNED: Four anchors (two with embedded eyelet and two with raised eyelet, n=5 per group) were tested with cyclical loading (1000 cycles and 4.5 mm/sec) and without cycling, to inform the failure loads and mode of failure of the suture anchors. An eyebolt screw with smooth eyelet was used as a control for the test groups.
UNASSIGNED: All samples in all groups completed 1000 cycles and failed via suture breakage in both test conditions. All anchors had failure loads exceeding the peak Achilles tendon force in rabbits during hopping gait. The data analysis showed an effect of anchor type on the maximum tensile force at failure (F max ) in all suture categories but not an effect of loading condition. Also, the Anika anchor had a significantly less adverse effect on suture strength compared to Arthrex anchor (p=0.015), IMEX anchor (p=0.004) and Jorvet anchor (p<0.001). We observed a greater percentage of failure at the mid-section for the anchors with the raised eyelets compared to the anchors with embedded eyelets, which all failed at the knot.
UNASSIGNED: Anchors with embedded eyelets had clinically preferred mode of failure with less adverse effects on suture and, may be more reliable than anchors with raised eyelets for attaching artificial Achilles and tibialis cranialis tendons in rabbits.

Polyetheretherketone (PEEK) is a polymer that has a comprehensive range of possible uses in dental treatment. The goal of this study was to compile research findings on the substance of dental claims and highlight the upcoming predictions of PEEK in clinical dentistry. PEEK is a novel polymeric material that is yet in its preliminary stage of evolution. Biomolecules are elastic materials with remarkable mechanical strength, barrier properties, and heat resistance compared to other matrix materials. The efficacy of PEEK in clinical dentistry has been acknowledged. Polyetherketone (PEKK) and PEEK are the most commonly mentioned members of the polyaryletherketone (PAEK) family. PEEK has also found significant use in dentistry, notably in prosthodontics and implant dentistry. It also offers exceptional mechanical qualities, including high strength and toughness, making it ideal for dental implants and prostheses. It can endure the stresses of chewing and grinding, resulting in long-lasting restorations. PEEK\'s tooth-colored look and ability to simulate natural tooth translucency make it suitable for use in dental prostheses such as crowns and bridges. This makes it a more esthetically acceptable alternative to standard metal-based repairs.

OBJECTIVE: This study aimed to characterize the processes of listing prostheses and medical devices in all insurance schemes.
METHODS: A literature review was performed, and in-depth interviews were conducted with the representatives of 6 insurance agencies. Civil Servant Medical Benefits Scheme (CSMBS), Social Security Scheme, Local Government Officer Scheme (LGOS), State Enterprise Scheme (SES), Universal Coverage Scheme (UCS), and Non-Thai Resident Scheme (NTRS).
RESULTS: The outcomes of interest were structure details and the body of the working groups, listing processes, and key assessment criteria. Each insurance scheme\'s process can be summarized in 5 steps: (1) receiving the proposed topics of health technologies, (2) screening, (3) selection, (4) consideration, and (5) approval and publicization. Notably, the organizational structures and working group compositions vary across schemes, leading to differences in process activities and assessment criteria. LGOS and SES are exceptions because they follow the application process of CSMBS. UCS demonstrates the most transparent process, providing specific working groups that are competent in undertaking each activity. The processes of listing prostheses and medical devices vary across health insurance in Thailand, leading to varying numbers of health technologies covered by insurance schemes.
CONCLUSIONS: This study characterizes prostheses and medical device listing processes in 6 Thai Universal Health Coverage insurance schemes (CSMBS, Social Security Scheme, UCS, LGOS, SES, and Non-Thai Resident Scheme). Variations in processes result in differing technology listings. It offers essential insights for healthcare professionals and policy makers.

Prostheses or implantable medical devices (IMDs) are parts made of natural or artificial materials intended to replace a body structure and therefore must be well tolerated by living tissues. The types of IMDs currently available and usable are very varied and capable of replacing almost any human organ. A high but imprecise percentage of Spaniards are carriers of one or more IMDs to which they often owe their quality of life or survival. IMDs are constructed with different types of materials that are often combined in the same prosthesis. These materials must combine harmlessness to human tissues with high wear resistance. Their durability depends on many factors both on the host and the type of prosthesis, but the vast majority last for more than 10-15 years or remain in function for the lifetime of the patient. The most frequently implanted IMDs are placed in the heart or great vessels, joints, dental arches or breast and their most frequent complications are classified as non-infectious, particularly loosening or intolerance, and infectious. Complications, when they occur, lead to a significant increase in morbidity, their repair or replacement multiplies the health care cost and, on occasions, can cause the death of the patient. The fight against IMD complications is currently focused on the design of new materials that are more resistant to wear and infection and the use of antimicrobial substances that are released from these materials. Their production requires multidisciplinary technical teams, but also a willingness on the part of industry and health authorities that is not often found in Spain or in most European nations. Scientific production on prostheses and IMD in Spain is estimated to be less than 2% of the world total, and probably below what corresponds to our level of socio-economic development. The future of IMDs involves, among other factors, examining the potential role of Artificial Intelligence in their design, knowledge of tissue regeneration, greater efficiency in preventing infections and taking alternative treatments beyond antimicrobials, such as phage therapy. For these and other reasons, the Ramón Areces Foundation convened a series of experts in different fields related to prostheses and IMDs who answered and discussed a series of questions previously formulated by the Scientific Council. The following lines are the written testimony of these questions and the answers to them.

OBJECTIVE: Resection of pelvic bone tumours and subsequent pelvic girdle reconstruction pose formidable challenges due to the intricate anatomy, weight-bearing demands, and significant defects. 3D-printed implants have improved pelvic girdle reconstruction by enabling precise resections with customized guides, offering tailored solutions for diverse bone defect morphology, and integrating porous surface structures to promote osseointegration. Our study aims to evaluate the long-term efficacy and feasibility of 3D-printed hemipelvic reconstruction following resection of malignant pelvic tumours.
METHODS: A retrospective review was conducted on 96 patients with primary pelvic malignancies who underwent pelvic girdle reconstruction using 3D-printed custom hemipelvic endoprostheses between January 2017 and May 2022. Follow-up duration was median 48.1 ± 17.9 months (range, 6 to 76 months). Demographic data, imaging examinations, surgical outcomes, and oncological evaluations were extracted and analyzed. The primary endpoints included oncological outcomes and functional status assessed by the Musculoskeletal Tumor Society (MSTS-93) score. Secondary endpoints comprised surgical duration, intraoperative bleeding, pain control and complications.
RESULTS: In 96 patients, 70 patients (72.9%) remained disease-free, 15 (15.6%) had local recurrence, and 11 (11.4%) succumbed to metastatic disease. Postoperatively, function improved with MSTS-93 score increasing from 12.2 ± 2.0 to 23.8 ± 3.8. The mean operating time was 275.1 ± 94.0 min, and the mean intraoperative blood loss was 1896.9 ± 801.1 ml. Pain was well-managed, resulting in substantial improvements in VAS score (5.3 ± 1.8 to 1.4 ± 1.1). Complications occurred in 13 patients (13.5%), including poor wound healing (6.3%), deep prosthesis infection (4.2%), hip dislocation (2.1%), screw fracture (1.0%), and interface loosening (1.0%). Additionally, all patients achieved precise implantation of customized prosthetics according to preoperative plans. T-SMART revealed excellent integration at the prosthesis-bone interface for all patients.
CONCLUSIONS: The use of a 3D-printed custom hemipelvic endoprosthesis, characterized by anatomically designed contours and a porous biomimetic surface structure, offers a potential option for pelvic girdle reconstruction following internal hemipelvectomy in primary pelvic tumor treatment. Initial results demonstrate stable fixation and satisfactory mid-term functional and radiographic outcomes.

暂无摘要。

BACKGROUND: Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved osteointegration, long-term stability, and anatomical fit. However, the lack of an established classification system hampers implementation and progress.
METHODS: We formulated a novel classification system based on pelvic defect morphology and 3D-printed hemipelvis endoprostheses. It integrates surgical approach, osteotomy guide plate and prosthesis design, postoperative rehabilitation plans, and perioperative processes.
RESULTS: Retrospectively analyzing 60 patients (31 males, 29 females), we classified them into Type A (15 patients: Aa = 6, Ab = 9), Type B (27 patients: Ba = 15, Bb = 12), Type C (17 patients). All underwent customized osteotomy guide plate-assisted tumor resection and 3D-printed hemipelvic endoprosthesis reconstruction. Follow-up duration was median 36.5 ± 15.0 months (range, 6 to 74 months). The mean operating time was 430.0 ± 106.7 min, intraoperative blood loss 2018.3 ± 1305.6 ml, transfusion volume 2510.0 ± 1778.1 ml. Complications occurred in 13 patients (21.7%), including poor wound healing (10.0%), deep prosthesis infection (6.7%), hip dislocation (3.3%), screw fracture (1.7%), and interface loosening (1.7%). VAS score improved from 5.5 ± 1.4 to 1.7 ± 1.3, MSTS-93 score from 14.8 ± 2.5 to 23.0 ± 5.6. Implant osseointegration success rate was 98.5% (128/130), with one Type Ba patient experiencing distal prosthesis loosening.
CONCLUSIONS: The West China classification may supplement the Enneking and Dunham classification, enhancing interdisciplinary communication and surgical outcomes. However, further validation and wider adoption are required to confirm clinical effectiveness.