Low cost through knee prostheses. TaKeuP

柬埔寨是世界上受地雷影响最严重的国家之一，自1979年以来有64，000多人伤亡，25，000多人被截肢。此外，道路交通事故造成的截肢人数也有所增加。目前，东南亚、印度和斯里兰卡约有1 000万人需要但无法获得假肢和矫形服务，专业人员短缺约40 000人。该项目直接面向柬埔寨的最终用户（假肢医生和截肢者），以期通过与假肢和矫正非政府组织Exceed Worldwide和Exceed Research Network的战略伙伴关系，在未来扩展到菲律宾、缅甸、印度尼西亚和斯里兰卡。我们与英国（和欧洲）假肢制造商（Blatchfords，Otto Bock，Össur），NHS假肢和康复服务以及国防国家康复中心海德利法院积极合作。医疗护理的最新发展导致手术首选经膝截肢，而以前认为膝上截肢更可取。膝关节截肢术允许假肢的承窝安装在残肢上，这样通过假足和膝盖的载荷直接传递到残肢的末端;这通过大腿骨保持健康、正常的载荷。膝上截肢不允许这种正常的负荷;接受腔必须将负荷一直传递到骨盆骨，部分绕过大腿，引起压疮，抑制截肢肢体的活动范围，并在大腿中产生骨脆性。因此，通过膝关节截肢导致疼痛减少，肌肉内骨形成（高度衰弱的并发症）的发生率更低，能够承受显著更高的负荷，并保持骨骼健康。成本（每个设备> 50，000英镑）和所需的维护使得为通过膝关节截肢者设计的现代插座和动力膝关节机制不适合在低收入和中等收入国家使用。目前由红十字会膝关节假体的改进提供的低成本解决方案存在主要的局限性，例如不能锁定在伸展中，对导致社会排斥的美观外观的严重损害，和一个很低的假膝关节（由于长的大腿组件）产生其他功能缺陷。在本项目中，我们将开发一种低成本的通过-膝关节假体，其最初概念是由申请人通过与柬埔寨合作伙伴的先前工作开发的。这将进一步发展，以创建一个途径，以支持未来的节俭技术项目（在制造和维护方面成本低的项目）的翻译，我们将通过一系列截肢者的假肢和矫形器项目来填充这个节俭技术途径。最后，我们将确保有一条途径来利用低收入和中等收入国家的节俭技术发展，以造福英国的医疗保健。该项目将创建一个由研究人员、工程师和临床医生组成的社区，开发和翻译负担得起的假肢。

Cambodia is one of the world's most landmine affected countries with over 64,000 casualties recorded since 1979 and over 25,000 amputees. Added to this there is also a rise in the number of amputations resulting from road traffic accidents. Currently around 10 million people in South East Asia, India and Sri Lanka need but do not have access to prosthetic and orthotic services and there is a deficit of circa 40,000 professionals. This project directly targets end-users (Prosthetists and amputees) in Cambodia with a view to future expansion into the Philippines, Myanmar, Indonesia and Sri Lanka through strategic partnership with Prosthetics and Orthotics NGO Exceed Worldwide and the Exceed Research Network. We have active collaborations with UK (and European) prosthetics manufacturers (Blatchfords, Otto Bock, Össur), NHS prosthetics and rehabilitation services, and the Defence National Rehabilitation Centre Headley Court. Recent developments in medical care have resulted in a surgical preference for through-knee amputation where previously above knee amputation was considered preferable. Through-knee amputations allow the socket for the prosthesis to fit on the stump so that the load through the artificial foot and knee is transmitted directly to the end of the stump; this maintains healthy, normal load through the thigh bone. An above knee amputation does not permit this normal loading; the socket has to transmit the loads all the way to the pelvic bone, partially bypassing the thigh, causing pressure sores, inhibiting the range of motion of the amputated limb, and producing bone fragility in the thigh. Therefore, through-knee amputations result in a reduction in pain, fewer incidences of bone formation within muscle (a highly debilitating complication), the ability to bear significantly higher loads, and maintain bone health.The cost (>£50,000 per device) and maintenance required make modern sockets and powered knee mechanisms designed for through-knee amputees inappropriate for use in low and middle income countries. Current low cost solutions for this provided by the adaptation of Red Cross knee joint prostheses suffer from major limitations such as an inability to be locked in extension, severe compromises on cosmetic appearance resulting in social exclusion, and a very low prosthetic knee joint (due to the long thigh component) producing other functional deficits.In this project we will develop a low-cost through-knee prosthesis the initial concept for which has been developed by the applicants through prior work with partners in Cambodia. This will be developed further to create a pathway to support the translation of future frugal technology projects (projects that are low cost in terms of manufacture and maintenance) and we will populate this frugal technology pathway with a series of follow on prosthetics and orthotics projects for amputees. Finally, we will ensure that there is a route to harness the frugal technology development for low and middle income countries for the benefit of healthcare in the UK. This project will create a community of researchers, engineers and clinicians developing and translating affordable prostheses.