{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T14:16:31Z","timestamp":1781360191580,"version":"3.54.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["W81XWH-16-1-0791"],"award-info":[{"award-number":["W81XWH-16-1-0791"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["HD057492 and HD090768"],"award-info":[{"award-number":["HD057492 and HD090768"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The three major unresolved problems in bone-anchored limb prosthetics are stable, infection-free integration of skin with a percutaneous bone implant, robust skeletal fixation between the implant and host bone, and a secure interface of sensory nerves and muscles with a prosthesis for the intuitive bidirectional prosthetic control. Here we review results of our completed work and report on recent progress.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Eight female adult cats received skin- and bone-integrated pylon (SBIP) and eight male adult cats received SBIP-peripheral neural interface (PNI) pylon into the right distal tibia. The latter pylons provided PNI for connection between a powered sensing transtibial prosthesis and electrodes in residual soleus muscle and on residual distal tibial nerve. If signs of infection were absent 28-70 days after implantation, cats started wearing a passive prosthesis. We recorded and analyzed full-body mechanics of level and slope locomotion in five cats with passive prostheses and in one cat with a powered sensing prosthesis. We also performed histological analyses of tissue integration with the implants in nine cats.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:label\/>\n                  <jats:p>Four pigs received SBIPs into the left hindlimb and two pigs\u2014into the left forelimb. We recorded vertical ground reaction forces before amputation and following osseointegration. We also conducted pullout postmortem tests on the implanted pylons. One pig received in dorsum the modified SBIPs with and without silver coating.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Six cats from the SBIP groups had implant for 70 days. One cat developed infection and did not receive prosthesis. Five cats had pylon for 148 to 183 days, showed substantial loading of the prosthesis during locomotion (40.4% below presurgery control), and demonstrated deep ingrowth of skin and bone tissue into SBIP (over 60%). Seven of eight cats from the SBIP-PNI group demonstrated poor pylon integration without clinical signs of infection. One cat had prosthesis for 824 days (27 months). The use of the bidirectionally controlled prosthesis by this animal during level walking demonstrated increased vertical loading to nearly normal values, although the propulsion force was significantly reduced.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:label\/>\n                  <jats:p>From the study on pigs, it was found that symmetry in loading between the intact and prosthetic limbs during locomotion was 80\u2009\u00b1\u20095.5%. Skin-implant interface was infection-free, but developed a stoma, probably because of the high mobility of the skin and soft tissues in the pig\u2019s thigh. Dorsal implantation resulted in the infection-free deep ingrowth of skin into the SBIP implants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Cats with SBIP (n\u2009=\u20095) and SBIP-PNI (n\u2009=\u20091) pylons developed a sound interface with the residuum skin and bone and demonstrated substantial loading of prosthetic limb during locomotion. One animal with SBIP developed infection and seven cats with SBIP-PNI demonstrated poor bone integration without signs of infection. Future studies of the SBIP-PNI should focus on reliability of integration with the residuum. Ongoing study with pigs requires decreasing the extra mobility of skin and soft tissues until the skin seal is developed within the SBIP implant.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaa445","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T01:54:22Z","timestamp":1611626062000},"page":"688-695","source":"Crossref","is-referenced-by-count":11,"title":["Recent Progress in Animal Studies of the Skin- and Bone-integrated Pylon With Deep Porosity for Bone-Anchored Limb Prosthetics With and Without Neural Interface"],"prefix":"10.1093","volume":"186","author":[{"given":"Mark","family":"Pitkin","sequence":"first","affiliation":[{"name":"Poly-Orth International, Sharon, MA, 02067, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Cassidy","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine, Boston, MA, 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim A","family":"Shevtsov","sequence":"additional","affiliation":[{"name":"Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences, Laboratory of Biomedical Nanotechnologies, Petersburg, 194064, Russia"},{"name":"Department of Biotechnology, First Pavlov State Medical University of St. Petersburg, Petersburg, 197022, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua R","family":"Jarrell","sequence":"additional","affiliation":[{"name":"School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hangue","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Electrical & Computer Engineering. Texas A&M University, College Station, TX, 77843, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad J","family":"Farrell","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Georgia State University, Atlanta, GA, 30302, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F","family":"Dalton","sequence":"additional","affiliation":[{"name":"Georgia Hand, Shoulder & Elbow, Atlanta, GA, 30309, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W Lee","family":"Childers","sequence":"additional","affiliation":[{"name":"Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio, Ft. Sam Houston, TX, 78234, USA"},{"name":"Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio, Ft. Sam Houston, TX, 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S","family":"Kistenberg","sequence":"additional","affiliation":[{"name":"School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyunggeune","family":"Oh","sequence":"additional","affiliation":[{"name":"School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander N","family":"Klishko","sequence":"additional","affiliation":[{"name":"School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris I","family":"Prilutsky","sequence":"additional","affiliation":[{"name":"School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"issue":"3","key":"2022012513471559400_R1","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1682\/JRRD.2008.06.0080","article-title":"One hundred patients treated with osseointegrated transfemoral amputation prostheses\u2014rehabilitation perspective","volume":"46","author":"Hagberg","year":"2009","journal-title":"J Rehabil Res Dev"},{"key":"2022012513471559400_R2","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0022-3913(83)80101-2","article-title":"Osseointegration and its experimental studies","volume":"50","author":"Br\u00e5nemark","year":"1983","journal-title":"J Prosthet Dent"},{"issue":"Suppl 38","key":"2022012513471559400_R3","first-page":"1","article-title":"Vital microscopy of bone marrow in rabbit","volume":"11","author":"Br\u00e5nemark","year":"1959","journal-title":"Scand J Clin Lab Invest"},{"issue":"1","key":"2022012513471559400_R4","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1302\/0301-620X.96B1.31905","article-title":"A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: a prospective study of 51 patients","volume":"96-B","author":"Branemark","year":"2014","journal-title":"Bone Joint J"},{"issue":"10","key":"2022012513471559400_R5","doi-asserted-by":"crossref","first-page":"2947","DOI":"10.1007\/s11999-014-3695-6","article-title":"Implant survival, adverse events, and bone remodeling of osseointegrated percutaneous implants for transhumeral amputees","volume":"472","author":"Tsikandylakis","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"8","key":"2022012513471559400_R6","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention guideline for the prevention of surgical site infection","volume":"152","author":"Berrios-Torres","year":"2017","journal-title":"JAMA Surg"},{"key":"2022012513471559400_R7","author":"FDA: Listing of CDRH Humanitarian Device Exemptions"},{"key":"2022012513471559400_R8","first-page":"95","article-title":"A real-time closed-loop control system for modulating gait characteristics via electrical stimulation of peripheral nerves","author":"Park","year":"2016"},{"issue":"5","key":"2022012513471559400_R9","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1152\/jn.00385.2010","article-title":"Electrical stimulation of the sural cutaneous afferent nerve controls the amplitude and onset of the swing phase of locomotion in the spinal cat","volume":"105","author":"Ollivier-Lanvin","year":"2011","journal-title":"J Neurophysiol"},{"issue":"257","key":"2022012513471559400_R10","doi-asserted-by":"crossref","DOI":"10.1126\/scitranslmed.3008933","article-title":"An osseointegrated human-machine gateway for long-term sensory feedback and motor control of artificial limbs","volume":"6","author":"Ortiz-Catalan","year":"2014","journal-title":"Sci Transl Med"},{"issue":"1","key":"2022012513471559400_R11","doi-asserted-by":"crossref","DOI":"10.1186\/s12984-017-0320-4","article-title":"Restoration of motor control and proprioceptive and cutaneous sensation in humans with prior upper-limb amputation via multiple Utah Slanted Electrode Arrays (USEAs) implanted in residual peripheral arm nerves","volume":"14","author":"Wendelken","year":"2017","journal-title":"J Neuroeng Rehabil"},{"issue":"1","key":"2022012513471559400_R12","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-67985-5","article-title":"Neural feedback strategies to improve grasping coordination in neuromusculoskeletal prostheses","volume":"10","author":"Mastinu","year":"2020","journal-title":"Sci Rep"},{"issue":"1","key":"2022012513471559400_R13","doi-asserted-by":"crossref","DOI":"10.1186\/s12984-020-00737-8","article-title":"Sensitivity to temporal parameters of intraneural tactile sensory feedback","volume":"17","author":"Valle","year":"2020","journal-title":"J Neuroeng Rehabil"},{"issue":"3","key":"2022012513471559400_R14","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/BF00235013","article-title":"The role of cutaneous afferents from the distal hindlimb in the regulation of the step cycle of thalamic cats","volume":"24","author":"Duysens","year":"1976","journal-title":"Exp Brain Res"},{"issue":"2","key":"2022012513471559400_R15","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/BTO.0000000000000194","article-title":"Targeted muscle reinnervation for the upper and lower extremity","volume":"32","author":"Kuiken","year":"2017","journal-title":"Tech Orthop"},{"key":"2022012513471559400_R16","first-page":"5469","article-title":"Split-belt adaptation and gait symmetry in transtibial amputees walking with a hybrid EMG controlled ankle-foot prosthesis","author":"Kannape","year":"2016"},{"issue":"23","key":"2022012513471559400_R17","doi-asserted-by":"crossref","first-page":"4183","DOI":"10.1016\/j.biomaterials.2006.03.041","article-title":"Development of a soft tissue seal around bone-anchored transcutaneous amputation prostheses","volume":"27","author":"Pendegrass","year":"2006","journal-title":"Biomaterials"},{"issue":"5","key":"2022012513471559400_R18","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1002\/jbm.a.34807","article-title":"Effects of pore size, implantation time, and nano-surface properties on rat skin ingrowth into percutaneous porous titanium implants","volume":"102","author":"Farrell","year":"2014","journal-title":"J Biomed Mater Res A"},{"issue":"8","key":"2022012513471559400_R19","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1002\/jor.22081","article-title":"Efficacy of a porous-structured titanium subdermal barrier for preventing infection in percutaneous osseointegrated prostheses","volume":"30","author":"Jeyapalina","year":"2012","journal-title":"J Orthop Res"},{"issue":"11","key":"2022012513471559400_R20","doi-asserted-by":"crossref","DOI":"10.1007\/s10856-017-5980-x","article-title":"A 24-month evaluation of a percutaneous osseointegrated limb-skin interface in an ovine amputation model","volume":"28","author":"Jeyapalina","year":"2017","journal-title":"J Mater Sci Mater Med"},{"key":"2022012513471559400_R21","first-page":"1","article-title":"Skin Integrated Device","volume":"No 8257435","author":"Pitkin","year":"2012","journal-title":"US Patent"},{"issue":"3","key":"2022012513471559400_R22","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1682\/JRRD.2008.09.0123","article-title":"Mathematical modeling and mechanical and histopathological testing of porous prosthetic pylon for direct skeletal attachment","volume":"46","author":"Pitkin","year":"2009","journal-title":"J Rehabil Res Dev"},{"issue":"4","key":"2022012513471559400_R23","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1002\/jbm.b.32663","article-title":"Mechanical properties of totally permeable titanium composite pylon for direct skeletal attachment","volume":"100B","author":"Pitkin","year":"2012","journal-title":"J Biomed Mater Res B Appl Biomater"},{"key":"2022012513471559400_R24","first-page":"1","article-title":"In-bone implantable shaft for prosthetic joints or for direct skeletal attachment of external limb prostheses and method of its installation, 2015","volume":"8992615","author":"Pitkin","journal-title":"US Patent No"},{"issue":"3","key":"2022012513471559400_R25","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.clinbiomech.2013.12.014","article-title":"An animal model to evaluate skin-implant-bone integration and gait with a prosthesis directly attached to the residual limb","volume":"29","author":"Farrell","year":"2014","journal-title":"Clin Biomech"},{"key":"2022012513471559400_R26","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jbiomech.2018.05.021","article-title":"Kinetics of individual limbs during level and slope walking with a unilateral transtibial bone-anchored prosthesis in the cat","volume":"76","author":"Jarrell","year":"2018","journal-title":"J Biomech"},{"key":"2022012513471559400_R27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fnins.2018.00471","article-title":"A prototype of a neural, powered, transtibial prosthesis for the cat: benchtop characterization","volume":"12","author":"Park","year":"2018","journal-title":"Front Neurosci"},{"issue":"5","key":"2022012513471559400_R28","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1109\/TBME.2012.2187784","article-title":"Recording of electric signal passing through a pylon in direct skeletal attachment of leg prostheses with neuromuscular control","volume":"59","author":"Pitkin","year":"2012","journal-title":"IEEE Transactions on Bio-edical Engineering"},{"issue":"5","key":"2022012513471559400_R29","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1159\/000323678","article-title":"Short-term motor compensations to denervation of feline soleus and lateral gastrocnemius result in preservation of ankle mechanical output during locomotion","volume":"193","author":"Prilutsky","year":"2011","journal-title":"Cells Tissues Organs"},{"issue":"1","key":"2022012513471559400_R30","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/jbm.b.34108","article-title":"Evaluation of the temporary effect of physical vapor deposition silver coating on resistance to infection in transdermal skin and bone integrated pylon with deep porosity","volume":"107","author":"Shevtsov","year":"2019","journal-title":"J Biomed Mater Res B Appl Biomater"},{"key":"2022012513471559400_R31","doi-asserted-by":"publisher","DOI":"10.1002\/jbm.b.34725","article-title":"Protecting the skin-implant interface with transcutaneous silver-coated skin-and-bone-intergrated-pylon (SBIP) in pig and rabbit dorsum models","author":"Shevtsov","year":"2020","journal-title":"J Biomed Mater Res B Appl Biomater"},{"issue":"9","key":"2022012513471559400_R32","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1007\/s10856-013-4975-5","article-title":"Pig dorsum model for examining impaired wound healing at the skin-implant interface of percutaneous devices","volume":"24","author":"Holt","year":"2013","journal-title":"J Mater Sci Mater Med"},{"issue":"10","key":"2022012513471559400_R33","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1038\/nri.2016.90","article-title":"Sex differences in immune responses","volume":"16","author":"Klein","year":"2016","journal-title":"Nat Rev Immunol"},{"key":"2022012513471559400_R34","author":"OPRA: OPRA Implant System Instructions for Use","year":"2016"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/186\/Supplement_1\/688\/36145478\/usaa445.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/186\/Supplement_1\/688\/36145478\/usaa445.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T13:48:42Z","timestamp":1643118522000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/186\/Supplement_1\/688\/6119476"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,1]]},"references-count":34,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2021,1,25]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaa445","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,1,1]]},"published":{"date-parts":[[2021,1,1]]}}}