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Table 5 Studies on DTI in transtibial prosthetic users using FE analysis

From: Exploring the role of transtibial prosthetic use in deep tissue injury development: a scoping review

Author and year

Type of study

Methodology

Input data

Assumptions

Outcome measures

Portnoy et al. 2008 [34]

Experimental study (aetiological)

- 3D FEa model

- Donning and static load bearing of one TTAb

- Analysis of internal loading state

- Interface pressure

(pressure sensor)

- Tissue morphology and vertical displacement (MRIc)

- Shear modulus, friction between skin and socket (literature)

- Muscle: isotropic, homogenous, viscoelastic

- Skin: isotropic, homogeneous, hyperelastic

- No differentiation btw. Muscle and fat

- No friction between soft tissue layers

- SEDd, principal compressive and tensile stress and strain, max. Shear stress and strain, von Mises stress

Portnoy et al. 2009 [30]

Experimental study (aetiological)

- 3D FE model [34]

- Static load bearing of five TTAs

- Analysis of internal loading state and interpatient variability

- Evaluation of DTI risk

- See Portnoy et al. 2008

- Soft tissue: isotropic, homogeneous, hyperelastic

- Differentiation btw. Muscle and fat

- Addition of 2 mm skin layer

- No friction between soft tissue layers

- Volume of muscle skin with compressive, tensile, shear strains above threshold value [43]

Portnoy et al. 2011 [33]

Experimental Study (aetiological)

- 3D FE model [34]

- Sitting with 30° and 90° knee flexion in one TTA

- Assessment of internal loading state and estimation of damage area over time

- See Portnoy et al. 2008

- Soft tissue: isotropic, homogeneous, hyperelastic

- Differentiation btw. Muscle and fat tissue

- Addition of 1 mm skin layer

- No friction between soft tissue layers

- Principal tensile and compressive stress, max. Shear stress, von Mises stress

- Time-dependent volume of damaged muscle [43]

- Rate of damage progression [44]

Portnoy et al. 2009 [36]

In silico study (risk factors)

- 3D FE model [34] of one TTA

- Changes in morphological and mechanical parameters

- See Portnoy et al. 2008

- See Portnoy et al. 2009 [30]

- SED, principal compressive and tensile stress and strain, max. Shear stress and strain, von Mises stress,

- Volumes of areas with concentrated elevated stress

Lenz 2017 [38]

In silico study

(PhD thesis, risk factors)

- Analysis of internal loading state with simplified cuboid FE model

- Simulation of different liners and socks

- Differentiation between slip and no-slip condition

- Liner displacement and mechanical properties (motion capturing)

- Normal and shear interface forces (two-axis load cell)

- Shear modulus, friction between skin and liner, soft tissue and liner thickness (literature)

- Muscle: isotropic, homogeneous, hyperelastic

- Differentiation btw muscle, skin, gel liner

- No friction between soft tissue layers

- Friction between skin and gel liner (slip vs. no-slip)

- Principal compressive stress, max. Shear stress, von Mises stress

Portnoy et al. 2007 [29]

Experimental Study (clinical)

- 2D FE model for real time stress analysis

- Application on 5 TTAa s during treadmill walking

- Interface pressure (pressure sensor)

- Elastic modulus (Indentation test)

- Tissue morphology

- (X-Ray)

- Soft tissue: isotropic, homogenous, linear elastic

- No differentiation btw. Muscle, fat, and skin

- Principal compressive stress and strain, shear stress, von Mises stress

  1. a Finite Element; b Transtibial amputee; c Magnetic Resonance Imaging; d Strain Energy Density