Bug-free prostheses: Reducing infection risk and improving reliability

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In this feasibility study, we propose to investigate key controls on the coupled mechanical and biological performance of prostheses with the aim of building a unique cross-disciplinary research team to design novel antimicrobial lining materials and prosthetic interface systems. In the UK there are approximately 62,000 amputees and conservative estimates suggest that there are more than 10 million people in the world who live with limb loss. Thus, developing functional, comfortable, cheap and safe prosthetic limbs has social and economic impacts that spread through the developed world and beyond. A major cause of prostheses failure is bacterial fouling of the socket, which occurs in up to 50% of patients in the developed world. A prosthetic socket envelops the residual limb snugly to provide two main functions: (1) a solid interface to transmit forces created through the interaction with the environment onto the residual limb and (2) an attachment point for the components replacing the missing body parts. Through this tight connection between the prosthesis and the limb, a closed environment is generated that provides ideal conditions for bacterial growth. Bacteria not only cause unpleasant odour but also lead to infection and ultimately a breakdown of the whole prosthetic system. Even if a user keeps a prosthetic socket meticulously clean, it is inevitable that over the lifetime of a prosthetic socket (max 3 years) bacteria will settle. Skin problems are frequent and studies on lower limb prosthetics users have shown they occur in 34% to 50% of patients. Infections can have a major negative impact on the use of the prosthesis and hence are highly detrimental to the users' quality of life.The feasibility study will begin to collect data on the microbial populations present on the skin and within the liner. Molecular techniques will be used to sequence microbial DNA to determine the species present and catalogue the genes which may play key roles in community function. Electron microscopy will be used to image the structure of the microbial populations living upon the liner. Once these data are available, we will begin to develop multidisciplinary models of the prosthetic interface. This model development is made possible by the wide range of expertise provided by the cross-disciplinary team: we will develop both conceptual and mathematical models that describe existing interfaces and proposals for new lining materials and prosthetic interface systems.