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Modern lower limb prostheses are devices that replace missing limbs, making it possible for lower limb amputees to walk again. Most commercially available prosthetic limbs lack intelligence and passive adaptive capabilities, and none available can adapt on a step by step basis. Often, amputees experience a loss of terrain adaptability as well as stability, leaving the amputee with a severely altered gait. This work is focused on the development of a semi-active damping system for use in intelligent terrain adaptive ankle prostheses. The system designed consists of an optimized hydraulic cylinder with an electronic servo valve which throttles the hydraulic fluid flowing between the cylinder’s chambers, acting on the prosthesis joint with a moment arm in series with a carbon spring foot. This provides the capability to absorb energy during the amputees gait cycle in a controlled manner, effectively allowing the passive dynamic response to be greatly altered continuously by leveraging a small energy source. A virtual simulation of an amputee gait cycle with the adaptive semi-active ankle design revealed the potential to replicate adaptive abilities of the human ankle. The results showed very similarly that irregularities in amputee biomechanics can be greatly compensated for using semi-active damping.

Purpose: The purpose of this study is to evaluate how implant-supported fixed dental prosthesis (FDP) restorations with a cantilever at abutment level resist fatigue by dynamic loading and thermocycling depending on the fixture diameters.   Material and method: The study involved two groups with three specimens in each group, based on the diameter of the fixture, 3.5 or 5.0 mm (D3.5 and D5.0). The specimens consisted of two ASTRA TECH platforms, either 3.5 mm or 5.0 mm, 20°Uni Abutments, and a standardized milled CoCr FDP at abutment level with a cantilever. A mounting jig was designed and 3D printed. The specimens underwent a dynamic fatigue test with thermocycling, 5°C and 55°C, and a 250 N load at a frequency of 1.5 Hz for maximum 6×10⁵ cycles, until the specimen either fractured or displayed visible deformation. Fractured specimens were examined under microscope.    Results: In group D3.5, one specimen survived 600,000 cycles without loosening or fracturing, one displayed screw loosening, and one screw fracturing. In group D5,0, two specimens displayed screw fracturing and one screw/abutment loosening.   Conclusions:  · Implant-supported FDP restorations with a cantilever at abutment level tend to resist fatigue better with a larger fixture diameter than with a smaller fixture diameter. · Fixtures with a diameter of 5.0 mm show higher tendency for screw fracturing and loosening compared to fixtures with 3.5 mm.  · More extensive studies regarding implant-supported FDP restorations with cantilever at abutment level and different fixture diameters are required to confirm the results. / Syfte: Syftet med studien är att utvärdera hur implantat-förankrade bro-konstruktioner på distansnivå med frihängande led motstår utmattning genom dynamisk belastning och termocykling beroende på fixturens diameter.   Material och metod: Totalt framställdes två grupper beroende på fixturens diameter, 3,5 eller 5,0 mm, med tre provkroppar per grupp (D3,5 och D5,0). Provkropparna bestod av två fixturer motsvarande position 34 och 35 och ett frihängande led på 36 med plattformarna ASTRA TECH 3,5×9,0 mm eller 5,0×9,0 mm inkluderat distanser 20° Uni Abutment och standardiserade frästa broar i CoCr på distansnivå. Ett dynamiskt utmattningstest genomfördes med hjälp av tuggsimulator med samtidig termocykling 5°C och 55°C. Belastningen på 250 N applicerades på det frihängande ledet under maximalt 6×105 cykler med 1,5 Hz. Provkropparna kontrollerades visuellt och taktilt var 50 000:e cykel för att undersöka om fraktur, deformation eller påverkan på skruvförband uppstått. De frakturerade provkropparna undersöktes i ljusmikroskop för att analysera frakturytor och eventuella deformationer.   Resultat: I grupp D3,5 klarade en provkropp 600 000 cykler utan att lossna eller frakturera, en fick skruvlossning och en fick skruvfraktur. I grupp D5,0 fick två provkroppar skruvfraktur och en fick skruv-/distanslossning.  Slutsats:  · Implantat-förankrade bro-konstruktioner på distansnivå med frihängande led tenderar att motstå utmattning bättre med mindre fixturdiameter än med större fixturdiameter. · Fixturer med diameter 5,0 mm visar större tendens för skruvfrakturer och skruvlossning jämfört med fixturer med 3,5 mm. · Mer omfattande studier beträffande implantat-förankrade bro-konstruktioner på distansnivå med frihängande led och olika fixturdiametrar krävs för att säkerställa resultaten.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: A silorane based resin composite, Filtek LS restorative, has been introduced to overcome the polymerization shrinkage of the methacrylate based resin composite. The repair of resin composite may hold clinical advantages. Currently, there is no available information regarding the repair potential of silorane resin composite with either silorane or methacrylate based resin composite. Objectives: The purpose of this study was to compare the repaired microtensile bond strength of aged silorane resin composite using different surface treatments and either silorane or methacrylate based resin composite. Methods: One hundred and eight silorane resin composite blocks (Filtek LS) were fabricated and aged by thermocycling between 8oC and 48oC (5000 cycles). A control (solid resin composite) and four surface treatment groups (no treatment, acid treatment, aluminum oxide sandblasting and diamond bur abrasion) were tested. Each treatment group was randomly divided in half and repaired with either silorane resin composite (LS adhesive) or methacrylate based resin composite (Filtek Z250/Single Bond Plus). Specimens were 12 blocks and 108 beams per group. After 24 hours in 37oC distilled water, microtensile bond strength testing was performed using a non-trimming technique. Fracture surfaces were examined using an optical microscopy (20X) to determine failure mode. Data was analyzed using Weibull-distribution survival analysis. Results: Aluminum oxide sandblasting followed by silorane or methacrylate based resin composite and acid treatment with methacrylate based resin composite provided insignificant differences from the control (p>0.05). All other groups were significantly lower than the control. Failure was primarily adhesive in all groups. Conclusion: Aluminum oxide sandblasting produced comparable microtensile bond strength compared to the cohesive strength of silorane resin composite. After aluminum oxide sandblasting, aged silorane resin composite can be repaired with either silorane resin composite with LS system adhesive or methacrylate based resin composite with methacrylate based dentin adhesive.

The purpose of this study was to evaluate the effectiveness of aspirin (ASA) and porcine endothelial cell seeding in improving the patency rate of vena cava grafts. Thirty-nine dogs underwent infrarenal vena cava replacement by 10 cm lengths of 8 mm I.D. ringed polytetrafluoroethylene grafts. Thirty-one grafts were seeded with 1-1.5 x 10(6) porcine aortic endothelial cells while eight were not (GIII). Of the seeded group, 16 animals received no ASA (GI), while 15 others (GII) were given ASA (325 mg) daily starting two days preoperatively and continuing until sacrifice. Venograms were performed on the fourth postoperative day. Grafts were harvested 32 days after insertion and evaluated for patency rate and endothelialized surfaces. The 32-day patency rate was significantly higher for GII than for GI and III animals (67% vs. 13 and 25% respectively). Endothelialized surface was higher in GII than Gi and III (67% vs. 16% and 18% respectively). We conclude that endothelial cell seeding alone does not prevent graft closure and that a combination of ASA and cell seeding significantly increases the patency rate of vena cava grafts.

Background: The influence of typical manufacturing regimes for producing fixed dental prostheses (FDPs) from yttria partly-stabilized zirconia polycrystals (3Y/4Y/5Y-TZP) on the phase composition is quantified. Methods: Fixed dental prostheses (FDPs) were designed using a CAD process and machined from different Y-TZP blanks from two manufacturers differing in yttria contents. Subsequent to sintering, the FDPs were glaze fired and air-blasted using alumina particles. Phase composition was determined with X-ray diffraction and quantified with Rietveld refinement. Results: The blanks from VITA Zahnfabrik (VITA YZ HT, VITA YZ ST, VITA YZ XT) and Dental Direct (DD Bio ZX2, DD cube ONE, DD cube X2) featured a rhombohedral portion with rather small crystallites and a small monoclinic portion for 3Y/4Y-TZPs, which increased after machining and disappeared after sintering. Glaze firing and air-blasting with alumina particles had no significant influence on the phase composition. Conclusion: The phase history of dental zirconia is revealed, which may have implications on further processing and aging of the FDP (e.g. low temperature degradation) in mouth.

The wear comfort of a prosthesis is of great importance for amputee patients. The wear comfort can be affected by changes in the interface between the residual limb and prosthesis socket, which can be caused by time-dependent volume fluctuations of the tissue, leading to unwanted local pressure marks. The basis to ensure time-independent wear comfort of a prosthesis is to identify these changes. Common techniques for identifying these variations have a negative impact on the sensitive interface between the residual limb and prosthesis. The following paper contains a proof of concept for the detection of local pressure marks without affecting the described interface using structural dynamics measurements, exemplarily shown at a prosthetic socket for transfemoral amputees in a test bench scenario. The dynamical behaviour of the investigated system is analysed in the form of frequency response functions acquired for different pressure locations and preloads using an impact hammer for excitation and a triaxial acceleration sensor. The frequency response functions show major changes for the various boundary conditions with respect to their frequency-dependent compositions. The results demonstrate how the utilised method enables the identification of changes in local pressure marks regarding the variation of position and magnitude.

In real life, immediately after joint replacement, the artificial joint is actually bathed in blood (and clotted blood) instead of synovial fluid. Blood contains large molecules and cells of size ~ 5 to 20 2m suspended in plasma and considered to be a non-Newtonian (pseudoplastic) fluid with density of 1060 Kg/m3 and viscosity ~ 0.01 Pas at shear rates of 3000 s-1 (as obtained in this work). The effect of these properties on friction and lubrication is not fully understood and, so far to our knowledge, hardly any studies have been carried out regarding friction of metal-on-metal bearings with various clearances in the presence of lubricants such as blood or a fluid containing macromolecules such as hyaluronic acid (HA) which is a major component of synovial fluid increasing its viscosity and lubricating properties. In this work, therefore, we have investigated the frictional behaviour of a group of Smith and Nephew Birmingham Hip Resurfacing implants with a nominal diameter of 50mm and diametral clearances in the range ~ 80 2m to 300 2m, in the presence of blood (clotted and whole blood), a combination of bovine serum (BS) with hyaluronic acid (HA) and carboxymethyl cellulose (CMC, as gelling agent) adjusted to a range of viscosities (~0.001-0.2 Pas), and bovine serum with CMC adjusted to a similar range of viscosities. These results suggested that reduced clearance bearings have the potential to generate high friction especially in the presence of blood which is indeed the in vivo lubricant in the early weeks after implantation. Friction factors in higher clearance bearings were found to be lower than those of the lower clearance bearings using blood as the lubricant. Similar trends, i.e. increase in friction factor with reduction in diametral clearance, were found to be also the case using a combination of BS+CMC or BS+HA+CMC as lubricants having viscosities in the range 0.1-0.2 and 0.03-0.14 Pas, respectively. On the other hand, all the lubricants with lower viscosities in the range 0.001-0.0013 and 0.001-0.013 Pas for both BS+CMC and BS+HA+CMC, respectively, showed the opposite effect, i.e. caused an increase in friction factor with increase in diametral clearance. Another six large diameter (50mm nominal) BHR deflected prostheses with various clearances (~ 50-2802m after cup deflection) were friction tested in vitro in the presence of blood and clotted blood to study the effect of cup deflection on friction. It was found that the biological lubricants caused higher friction factors at the lower diametral clearances for blood and clotted blood as clearance decreased from 2802m to 502m (after deflection). The result of this investigation has suggested strongly that the optimum clearance for the 50 mm diameter MOM BHR implants to be ¿1502m and <2352m when blood lubricant used, so as to avoid high frictions (i.e. avoid friction factors >0.2) and be able to accommodate a mixed lubrication mode and hence lower the risk of micro- or even macro-motion specially immediately after hip implantation. These suggested optimum clearances will also allow for low friction (i.e. friction factors of <0.2-0.07) and reasonable lubrication (dominantly mixed regime) for the likely cup deflection occurring as a result of press-fit fixation. / Smith & Nephew Orthopaedics Ltd.

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