Tuesday, 30 November 2021

Symposium “Mechatronic knee joints: Safety. Performance. Perception. From Catchphrase to Consolidation”

MPKs in low mobility Patients

The symposium (30 Nov.) provided an overview with experts sharing their research and progress in promoting good quality of life for users.

Arun Jayaraman, PhD (Executive Director Technology & Innovation Hub at Shirley Ryan Ability Lab, Chicago), focused on his research in dysvascular transfemoral amputations. Through a longitudinal randomized clinical trial, he and his research team have studied the potential benefits for patients of a more advanced prosthesis: “This showed us that providing someone with a microprocessor controlled knee (MPK), together with the appropriate foot complex, transitions someone who is at a K2 level to a higher functional level, which means that, with appropriate acclimatization and home use, we can see people getting better. These are significantly clinically meaningful improvements,” says Dr Jayaraman. His aim was to investigate how individuals with transfemoral amputation at MFCL K2 level and a C-Leg with appropriate foot, were affected in terms of mobility, safety and ability everyday tasks. The research findings show clinically meaningful improvements in walking speed, reduction in falls and high participation scores, overall showing an improved quality of life.

Speakers Fiona Davie-Smith, PhD (Clinical Coordinator Scottish Specialist Prosthetics Service, NHS Greater Glasgow and Clyde) and Bruce Carse, PhD (Clinical Scientist, West of Scotland Mobility and Rehabilitation Centre, NHS Greater Glasgow and Clyde), presented their findings of real-world data from patients transitioning from a mechanical to a microprocessor knee. The basis for the study was patients with low activity who had undergone a unilateral transfemoral amputation. Previous research shows that this patient group benefits from the use of MPK based on them being older, having low mobility and having a higher propensity to fall. Through gait analysis, the research team was able to identify kinematic changes linked to the use of MPK. During the talk, two patient cases were presented, attendees saw videos showing gait improvement, and Davie-Smith and Carse explained the patient history and the evaluation of patient-specific outcomes.

The study by Carse and Davie-Smith shows sufficient data to support MPK in low-activity prosthetic users. They summarize benefits as improved confidence, fewer fall incidents and reduced gait deviations, but also changing to a MPK potentially being transformative to the low activity user. By way of conclusion, the team presented a quote from one of the participants, showing his experience of transitioning to a MPK: “I can walk like normal, people seeing me in the street don't think I am an amputee with this leg but the old one, it was away out and doing big circles.”

Dr Andreas Hahn (Vice President Clinical Research & Services Ottobock HealthCare Products GmbH, Vienna) shared a meta-analysis evaluating the effects of MPK. Clinical research is showing benefits regarding the use of MPK in terms of performance, safety, perception and cost-effectiveness. However, access to MCFL-2 is limited and one reason for this was often claimed to be the lack of clinical evidence. Through a systematic review of nine databases, study outcomes were categorized according to safety, performance and perception. The analysis shows how clinical evidence has increased significantly, and the study results support MPK as a valuable therapeutic option for individuals with transfemoral amputation and low mobility where lack of evidence may no longer be claimed: “We can see that this has been a very active field of research over the years. A vast number of studies of good validity are shown. Not a single result of these studies favors NMPK over MPK, which I think is remarkable.”

Moderator Prof Dr Frank Braatz (Head of Medical Orthobionics, Clinic for Orthopaedic and Trauma Surgery at Göttingen University Hospital and Professor for Medical Orthobionics at PFH) summarized the webinar: “Safety and quality of life are very important for patients with amputation and limited mobility. There are many studies on the use of MPKs in patients with lower K values and the symposium gave us an excellent overview of the current studies. Even so, the continuously growing evidence support clinicians in their decisions further and we are looking forward to future research.”

You can watch a video of the online event here.

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Maja Hoock

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