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Leijendekkers R.A.1, Marra M.A.2, Ploegmakers M.J.M.3, van Hinte G.1, Frölke J.P.4, van de Meent H.5, Staal J.B.6,7, Hoogeboom T.J.6, Verdonschot N.2,8, Nijhuis-van der Sanden M.W.G.1,5,9, van Heusden-Scholtalbers L.1,6
1Radboud University Medical Center, Department of Orthopaedics, Physical Therapy, Nijmegen, Netherlands, 2Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Nijmegen, Netherlands, 3Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, Netherlands, 4Radboud University Medical Center, Department of Surgery, Nijmegen, Netherlands, 5Radboud University Medical Center, Department of Rehabilitation, Nijmegen, Netherlands, 6Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands, 7HAN University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, Nijmegen, Netherlands, 8University of Twente, Laboratory for Biomechanical Engineering, Enschede, Netherlands, 9Radboud University Medical Center, Scientific Center for Quality of Care, Nijmegen, Netherlands
Background: In patients with a lower extremity amputation severe muscle atrophy of the residual limb is present compared to the sound side. Bone-anchored prostheses are an alternative for conventional socket prostheses in patients suffering from socket-related problems. The effect of bone-anchored prostheses on tissue level is unknown. A potentially feasible method to evaluate this is three-dimensional magnetic resonance imaging (MRI) muscle reconstruction.
Purpose: Our primary aim was to examine the feasibility of a three-dimensional MRI muscle reconstruction technique in a patient with a cobalt-chrome-molybdenum press-fit bone-anchored prosthesis. Our secondary aim was to describe the change of hip abductor muscle volume over time after implantation of a bone-anchored prosthesis.
Methods: In this single case one-year follow-up study we reconstructed the three-dimensional hip abductor muscle volumes semiautomatically from 1.5T MRI scans at baseline, six- and twelve-months follow-up using Mimics software (Materialise, Leuven, Belgium). The degree of adverse events, difficulties in accurate data analysis, time investment and patient burden determined the level of feasibility.
Results: We included a man (70y) with a transfemoral amputation who received a bone-anchored prosthesis after 52 years of socket prosthesis usage. No adverse events, such as heating of the metal parts, have occurred. Artifacts were mainly present in the most distal part of the residual limb, but caused no difficulties in the 3-D reconstruction of the hip abductor muscles. The accuracy of the reconstruction is potentially reduced by severe intra- and intermuscular adipose tissue. Data analysis was very time-intensive (115 hours). Patient burden was acceptable. Severe muscle volume asymmetry was present at all assessments. The residual limb had 34-37% less overall hip abductor muscle volume compared to the sound side. Compared to baseline, the overall hip abductor volume of both the residual limb (six-months: 5.6%; twelve-months: 7.4%) and sound limb (six-months: 7.8%; twelve-months: 5.5%) increased.
Conclusion(s): This study demonstrated that the 3-D MRI muscle reconstruction technique appears feasible in a patient with a cobaltchromemolybdenum bone-anchored prosthesis, in a scientific setting. Future research should focus on further automation of the 3-D reconstruction technique, analysis of the muscle tissue composition to quantify the level of intramuscular adipose tissue and the feasibility of this technique in other common bone-anchored prostheses, such as implants with a titanium alloy.
Implications: In potential 3-D muscle reconstruction of muscles is of added value because it can give insight in the impact of bone-anchored prostheses surgery on tissue level. Currently the timing of the onset of muscle volume decrease, the increase of adipose tissue and the extent of reversibility is not clear. Further knowledge is necessary to determine the optimal inclusion moment for bone-anchored prostheses surgery.
Funding acknowledgements: We received funding from the European Commission FP7 Programme (TLEMsafe-project) and the European Research Council (FP/2007-2013) / ERC-Grant- Agreement (n.323091).
Topic: Disability & rehabilitation
Ethics approval: The protocol of this study was approved by the Ethics Committees of Radboud university medical center.
All authors, affiliations and abstracts have been published as submitted.
