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Article ; Online: The Moment Criterion of Anthropomorphicity of Prosthetic Feet as a Potential Predictor of Their Functionality for Transtibial Amputees.

Pitkin, Mark

Biomimetics (Basel, Switzerland)

2023 Volume 8, Issue 8

Abstract: The purpose of this paper is to discuss a new quantitative mechanical parameter of prosthetic feet called the Index of Anthropomorphicity ( ...

Abstract	The purpose of this paper is to discuss a new quantitative mechanical parameter of prosthetic feet called the Index of Anthropomorphicity (
Language	English
Publishing date	2023-11-28
Publishing country	Switzerland
Document type	Journal Article
ISSN	2313-7673
ISSN (online)	2313-7673
DOI	10.3390/biomimetics8080572
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Article ; Online: New Training System Based on the Discovery of Subperiosteal Transmission of Pressures Between Joint Capsules.

Pitkin, Mark

Military medicine

2021 Volume 186, Issue Suppl 1, Page(s) 814–819

Abstract: Background: A new training and rehabilitation methodology called Sanomechanics® is presented based on a recent discovery of the anatomical system called Floating Skeleton System (FSS) responsible for redistributing contact pressures in the joint ... ...

Abstract	Background: A new training and rehabilitation methodology called Sanomechanics® is presented based on a recent discovery of the anatomical system called Floating Skeleton System (FSS) responsible for redistributing contact pressures in the joint capsules and thus minimizing the loads on joint cartilages. Materials and methods: The main idea behind the Sanomechanics® methodology (SMM) is that when this system of subperiosteal pressure transmission is disrupted, the overloading of cartilages may occur leading to trauma, osteoarthritis and other related pathologies. Conversely, if functioning of the FSS is adequately restored and continuously maintained, the pathological developments can be effectively stopped. Results: Analysis of existing training systems using mind-body approach revealed that they are lacking the understanding of a physiological mechanism of their success or failure in training. It is postulated that maintaining/restoration of transmission of pressure between the joint capsules is necessary component of preventing overloading of joint cartilages occurring in military training and operations and in civilian life. Visualization of this concept has been suggested as a key element to the SMM training system. Conclusions: The FSS provides for a guidance for development of scientific approaches to the training and rehabilitation techniques. The SMM is balanced mind-body training system, which can help U.S. Servicemen and Servicewomen be better prepared for extreme load during their service.
MeSH term(s)	Cartilage, Articular ; Humans ; Joint Capsule ; Osteoarthritis
Language	English
Publishing date	2021-01-26
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usaa476
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Article: Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

Pitkin, Mark

EC orthopaedics

2018 Volume 9, Issue 5, Page(s) 285–292

Abstract: Background: Using the marrow canal of a tubular bone as a holding compartment for implant stems has been the paradigm in total joint arthroplasty for more than a century, and for direct skeletal attachment of limb prostheses for about forty years. Both ... ...

Abstract	Background: Using the marrow canal of a tubular bone as a holding compartment for implant stems has been the paradigm in total joint arthroplasty for more than a century, and for direct skeletal attachment of limb prostheses for about forty years. Both interventions rely on the osteogenesis in the inner walls of the marrow canal in a direction radially inwards. It so remains despite the frequent aseptic loosening of the implant stems caused by the resorption of the marrow canal's inner walls which increases the canal's diameter and reduces its capacity to hold the implant. Materials and methods: To improve the bone-device bond, we suggest an implantation methodology that activates positive osteogenic remodeling in the circular direction rather than radially inwards. The rationale is that circular osteogenesis is a component of natural healing of bone fractures and its activating may mitigate the consequences of resorption caused by stress shielding, bone developmental growth and other factors. Results: Circular osteogenesis occurs in response to the distraction of slots precut into the bone tube. We call this methodology distraction implantation (DI) because of its debt to Ilizarov type distraction osteogenesis (DO). The methodology is accompanied by a design of an implant stem, and has been investigated in a previous pilot animal study. Conclusion: Distraction implantation is based on a component of natural healing of bone fractures and therefore has merit to be investigated further.
Language	English
Publishing date	2018-04-26
Publishing country	England
Document type	Journal Article
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Article: What can normal gait biomechanics teach a designer of lower limb prostheses?

Pitkin, M

Acta of bioengineering and biomechanics

2013 Volume 15, Issue 1, Page(s) 3–10

Abstract: Compensating a limb loss with prosthesis is a challenging task due to complexity of the human body which cannot be fully matched by the available technical means. Designer of lower limb prostheses wants to know what specification of the device could ... ...

Abstract	Compensating a limb loss with prosthesis is a challenging task due to complexity of the human body which cannot be fully matched by the available technical means. Designer of lower limb prostheses wants to know what specification of the device could provide the best approximation to the normal locomotion. Deep understanding of the latter is essential, and gait analysis may be a valuable tool for this. Once prosthesis is built, gait analysis may help in comparing the wearer's performance with the new device and with the prior art, and in verification of the hypotheses being put forward during the development process. In this lecture, we will discuss some synergies of normal gait. We will focus on the required biomechanical properties of a prosthetic leg that can allow the prosthesis's inclusion in normal gait synergy without demanding excessive compensatory movements. We will consider contribution of leg joints to generation of propulsion for adequate design of lower limb prostheses especially those with power supply.
MeSH term(s)	Ankle Joint/physiopathology ; Artificial Limbs ; Biomechanical Phenomena ; Computer Simulation ; Gait/physiology ; Humans ; Joint Prosthesis ; Leg/physiopathology ; Prosthesis Design ; Treatment Outcome
Language	English
Publishing date	2013-08-16
Publishing country	Poland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2559094-7
ISSN	1509-409X
ISSN	1509-409X
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Article ; Online: Design features of implants for direct skeletal attachment of limb prostheses.

Pitkin, M

Journal of biomedical materials research. Part A

2013 Volume 101, Issue 11, Page(s) 3339–3348

Abstract: In direct skeletal attachment (DSA) of limb prostheses, a construct is implanted into an amputee's residuum bone and protrudes out of the residuum's skin. This technology represents an alternative to traditional suspension of prostheses via various ... ...

Abstract	In direct skeletal attachment (DSA) of limb prostheses, a construct is implanted into an amputee's residuum bone and protrudes out of the residuum's skin. This technology represents an alternative to traditional suspension of prostheses via various socket systems, with clear indications when the sockets cannot be properly fitted. Contemporary DSA was invented in the 1990s, and several implant systems have been introduced since then. The current review is intended to compare the design features of implants for DSA whose use in humans or in animal studies has been reported in the literature.
MeSH term(s)	Artificial Limbs ; Bone and Bones/physiology ; Humans ; Prosthesis Design
Language	English
Publishing date	2013-04-02
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2099989-6
ISSN	1552-4965 ; 1549-3296 ; 0021-9304
ISSN (online)	1552-4965
ISSN	1549-3296 ; 0021-9304
DOI	10.1002/jbm.a.34606
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Zs.A 6195: Show issues

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Article ; Online: Loading Effect of Prosthetic Feet's Anthropomorphicity on Transtibial Osseointegrated Implant.

Pitkin, Mark / Frossard, Laurent

Military medicine

2021 Volume 186, Issue Suppl 1, Page(s) 681–687

Abstract: Introduction: Osseointegrated implants for direct skeletal attachment of transtibial prosthesis carry risks that are yet to be fully resolved, such as early loosening, mechanical failure of percutaneous and medullar parts of implant, periprosthetic ... ...

Abstract	Introduction: Osseointegrated implants for direct skeletal attachment of transtibial prosthesis carry risks that are yet to be fully resolved, such as early loosening, mechanical failure of percutaneous and medullar parts of implant, periprosthetic issues, and infections. Underloading could lead to early loosening and infection. Overloading might compromise the bone-implant interface. Therefore, Goldilocks loading regimen applied by transtibial bone-anchored prostheses is critical for safe and efficient development of osseointegration around the implant during rehabilitation and beyond. We hypothesized that Goldilocks loading could be achieved when ambulating with a so-called anthropomorphic prosthetic ankle showing moment-angle relationship similar to a sound ankle. Materials and methods: Quantitative characteristics of the moment-angle curve of the sound ankle during dorsiflexion phase of a free-pace walking were extracted for 4 able-bodied participants (experiment 1). A slope of the moment-angle curve (stiffness) was calculated twice: for the first half and for the second half of the moment-angle curve. The difference of stiffnesses (those at the second half minus at the first half) was called the index of anthropomorphicity (IA). By definition, positive IA is associated with concave shape of the moment-angle curve, and the negative IA is associated with convex shape. In experiment 2, the same recordings and calculations were performed for 3 participants fitted with transtibial osseointegrated fixation during walking with their usual feet and the Free-Flow Foot (Ohio Willow Wood). The Free-Flow Foot was selected for its anthropomorphicity demonstrated in the previous studies with amputees using traditional socket attachment. Results: The IA was 5.88 ± 0.93 for the able-bodied participants, indicating that the stiffness during the first part of the dorsiflexion phase was substantially fewer than during the second parts, as the calf muscles resisted to angulation in ankle substantially less than during the second part of dorsiflexion phase. For amputees fitted with Free-Flow Foot, IA was 2.68 ± 1.09 and -2.97 ± 2.37 for the same amputees fitted with their usual feet. Conclusions: Indexes of anthropomorphicity, while of different magnitude, were positive in control able-bodied group and in the amputee group wearing Free-Flow Foot, which was qualitatively associated with concave shape of their moment-angle curves. The 3 usual feet worn by the participants were classified as nonanthropomorphic as their individual moment-angle curves were convex and the corresponding IAs were negative. Furthermore, this study showed that a foot with anthropomorphic characteristics tends to decrease maximal loads at the bone-implant interface as compared to the nonanthropomorphic feet and possibly may minimize the risks to compromise the integrity of this interface.
MeSH term(s)	Amputees ; Artificial Limbs ; Biomechanical Phenomena ; Bone-Anchored Prosthesis ; Gait ; Humans ; Ohio ; Walking
Language	English
Publishing date	2021-01-23
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usaa461
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Article: Principle of Spectral Reciprocity in Biomechanics of Locomotion and Rehabilitation.

Pitkin, Mark

The open rehabilitation journal

2016 Volume 8, Page(s) 1–4

Abstract: Providing the technical means to prevent collapse or falls in patients with different types of pathology in motion and balance control is one of the traditional problems in rehabilitation engineering. A means of addressing the problem using assistive ... ...

Abstract	Providing the technical means to prevent collapse or falls in patients with different types of pathology in motion and balance control is one of the traditional problems in rehabilitation engineering. A means of addressing the problem using assistive devices, including prostheses, is to restrict the mobility in certain anatomical or artificial joints by applying corsets, braces, brakes and locks. The restriction of mobility in the joints increases local stiffnesses, and in a sense, tunes the spectrum of oscillations in these joints out of resonantly dangerous zones. So far, these efforts for limiting unwanted mobility are mostly empirical within rehabilitation technologies, and we suggest that they can be optimized with algorithms for controlling the spectrum of oscillations used in multi-linked technical systems. Further, we suggest that tuning out of resonance is inseparable from the phenomenon of tuning into resonance that is widely recognized in biomechanics of locomotion. These considerations result in our postulating the principle of spectral reciprocity in locomotion.
Language	English
Publishing date	2016-01-13
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2459094-0
ISSN	1874-9437
ISSN	1874-9437
DOI	10.2174/1874943700801010001
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Article: Study of Growth Processes in Bone and Skin Tissues in Porous Implants Designed for Fixation of External Prosthesis after Amputation of Extremities.

Galibin, O V / Protasov, M V / Chikhovskaya, Yu V / Belyaeva, I G / Pitkin, M P

Cell and tissue biology

2024 Volume 1, Issue 3, Page(s) 272–275

Abstract: Modeling in vivo (on Wistar rats) was carried out by the method of complete integration of the prosthesis of an amputated extremity with a residuum; in this procedure the prosthesis is fixed to the residuum with a metal pylon one end of which is ... ...

Abstract	Modeling in vivo (on Wistar rats) was carried out by the method of complete integration of the prosthesis of an amputated extremity with a residuum; in this procedure the prosthesis is fixed to the residuum with a metal pylon one end of which is implanted into the bone of the residuum, while the other end traverses the residuum tissues and skin 5-7 cm above the residuum surface. This procedure includes not only successful implantation in the residuum bone, but also the possibility that the pores in the metal pylon can be filled with skin cells in the area of the pylon which traverses the tissues of the residiuum. The porous titanium pylon was implanted into the bone of experimental animals with amputated extremities. Penetration of bone and skin cells into the pores of the studied material was demonstrated, which provides tighter fixation in the bone and shows promise for the development of a natural cutaneous barrier to infection.
Language	English
Publishing date	2024-05-02
Publishing country	Russia (Federation)
Document type	Journal Article
ZDB-ID	2390107-X
ISSN	1990-5203 ; 1990-519X
ISSN (online)	1990-5203
ISSN	1990-519X
DOI	10.1134/s1990519x07030091
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Article: Mathematical modeling of fixation of a bone fragment in a new Double-needle external Fixator compared to hoffmann ii fixator.

Pitkin, M / Shukeylo, Y / Gritsanov, A

Series on biomechanics

2016 Volume 23, Issue 1, Page(s) 96–103

Abstract: The outcome of rehabilitation after multiple bone fractures can be improved, and the reduction of the rate of amputation due to severe trauma can be achieved with the early use of external fixators [1, 2]. Effectiveness of the fixator depends on the ... ...

Abstract	The outcome of rehabilitation after multiple bone fractures can be improved, and the reduction of the rate of amputation due to severe trauma can be achieved with the early use of external fixators [1, 2]. Effectiveness of the fixator depends on the stability of the bone fragments during the evacuation of a patient to specialized facilities [3, 4]. The paper is devoted to the mathematical modeling of the stability of a bone fragment in an external fixator. The vertical displacement of the end of a bone fragment loaded with a standardized force and moment is suggested to be the measure of stability. The finite element analysis (FEA) model developed has been applied to the new Double-Needle Ilizarov External Fixator (DNIF) [5], which does not penetrate the medullary canal, and to the Hoffmann II external fixator. Vertical displacement in DNIF (4.78·10
Language	English
Publishing date	2016-04-18
Publishing country	Bulgaria
Document type	Journal Article
ISSN	1313-2458
ISSN	1313-2458
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Article ; Online: Temporary Botulinum Immobilization of Residuum Muscles for Facilitation of the Initial Ingrowth of Skin to the Porous

Bohart, Zachary / Cassidy, Charles / Merrill, David / Villani, Mario / Villani, Rosanna / Cappabianca, Leo / Pitkin, Mark

Frontiers in rehabilitation sciences

2022 Volume 3

Abstract: Enhancing the technology of bone-anchored limb prosthetics, we present a modified porcine model for developing an infection-free integration between the skin and a percutaneous bone implant. The deeply porous Skin and Bone Integrated Pylon (SBIP) ... ...

Abstract	Enhancing the technology of bone-anchored limb prosthetics, we present a modified porcine model for developing an infection-free integration between the skin and a percutaneous bone implant. The deeply porous Skin and Bone Integrated Pylon (SBIP) presented an infection-free skin-implant interface both after implantation into the dorsum and after implantation into the residuum after below-knee amputation. However, deep ingrowth of skin into the porous cladding of the SBIP was achieved better in the dorsal procedure, while implantation to the residuum sometimes developed a stoma, probably due to the high mobility of the skin and soft tissues in the pig's thigh. Uncontrolled high skin mobility during the first week after implantation constituted a limitation for the porcine animal model, which we tried to address in the current study. As our previous studies showed that casting of the leg residuum did not sufficiently limit the skin's movement around the implant, we tested a modified protocol of the implantation, which included injection of botulinum toxin into the thigh muscles. During the course of the study, we identified proper botulinum toxin componentry, dosage, and the period after injections to achieve a maximal effect of immobilization of the muscles affecting skin movements. To verify the immobilization, we used kinetic data on the asymmetry of loading during gait with the Strideway System, Tekscan, Inc., Boston, MA, USA. We found that injections in the four muscles of the distal thigh of the left hind leg with MYOBLOC® (rimabotulinumtoxinB; 5,000 units/muscle) were sufficient to provide noticeable immobilization by the fourth week after the procedure. This conclusion was made based on the analysis of the dynamics of asymmetry in vertical ground reactions on the injected (left hind) and uninvolved (right hind) legs during gait over an instrumented walkway.
Language	English
Publishing date	2022-03-03
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-6861
ISSN (online)	2673-6861
DOI	10.3389/fresc.2022.758238
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