The University of Southampton

Author: Phoebe Rathborn

Steady Shoulders: Tailoring Arthroplasty for Epileptic Patients

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Epilepsy is a chronic non-communicable disease of the brain characterised by recurrent seizures generally brought on by specific triggers. The most widely accepted description of seizures is tonic-clonic seizures, in which there are brief periods of both tonic (stiffening) and clonic (twitching/jerking) muscle activity but epileptic seizures can manifest in a variety of ways, including absence or loss of consciousness.

My brother is one of the 50 million people worldwide who suffer from this illness and over the previous six years, he has suffered from sporadic, severe tonic-clonic seizures that have irreparably damaged his shoulder, necessitating a shoulder arthroplasty. I didn’t consider the long-term effects of epilepsy as a neurological condition on wider parts of the body until my brother experienced recurring seizures that damaged his shoulder. Upon further research, I have found that shoulder instability is a widely experienced deficit in epileptic patients due to the common risk of dislocation in a tonic-clonic state but can also be caused by the lack of education in seizure management, e.g. restraining someone’s arms during convulsions.

The most common type of instability seen in patients suffering from convulsive seizure conditions is a posterior dislocation alongside skeletal lesions, mainly reverse Hill-Sachs lesions. If the Hill-Sachs lesion covers more than 20% of the humerus head then a surgical procedure is the needed modality of treatment such as a remplissage procedure to fill the indent caused by the lesion or a bone graft to insert additional tissue into the humerus. However if it is not possible to reach clinically defined stability with other procedures or there is simply too much damage to the humerus, scapula and other bone tissues then a full or partial shoulder replacement will be considered. Reverse shoulder replacements are considered when considerable damage has occurred in the rotator cuff so that the replacement will rely on the deltoid to move the arm instead.

Normal shoulder without shoulder replacement
Anatomical shoulder replacement
Reverse shoulder replacement
Explanatory video outlining how a total reverse shoulder replacement is carried out
Explanatory video outlining how a total shoulder replacement is carried out

Some considerations to be addressed when importing an artificial shoulder into an epileptic patient range from seizure control during and post-operation, material compatibility, fracture and wear resistance and potential reoperation risks. In my opinion, the most important qualities needed from the shoulder replacement are high fracture and wear resistance due to the unpredictable nature of seizures making epileptic patients more prone to traumatic injuries. Furthermore, material compatibility is vital in ensuring the arthroplasty fully integrates with the patient and certifies a low risk of shifting during a convulsive seizure.

Material compatibility and fracture and wear-resistance are two factors that seem to work on a pivot as upon further research it seems that materials such as Ti-6Al-4V (titanium aluminium valium) alloys are less wear-resistant but are very effective in osteointegration and hold good osteoconduction properties. Up-and-coming research into joint replacements has already seen impressive benefits in using ceramic and pyrolytic carbons as alternative bearing materials and chemical modifications to polyethelene such as cross-linking, minimizing oxidation, and vitamin E impregnation, have been developed to minimize wear. Improving the bioactivity of orthopedic materials such as mechanically reinforced UHMWPE has been shown as successful and a great candidate to be used for bone replacements (Senra et Al, 2020).

To conclude, shoulder arthroplasty is a safe and beneficial surgical treatment for recurrent shoulder dislocation in seizure-prone epileptic patients (Austin et al, 2023). Upon asking my brother, he has seen a massive improvement in his quality of life thanks to the replacement surgery as he now has a better range of motion, reduced pain and increased stability without having to worry about complications if he dislocates his shoulder during a future seizure. I’d never considered the benefits of replacement body parts, such as shoulders, for patients suffering from neurological conditions but now I can see what is achievable in improving their quality of life when dealing with a debilitating disorder such as epilepsy.

Sources:

https://www.who.int/news-room/fact-sheets/detail/epilepsy

https://www.sciencedirect.com/science/article/pii/S1045452722000803#:~:text=The%20safety%20of%20shoulder%20arthroplasty,cuff%20disruption%2C%20or%20implant%20failure.

https://www.sciencedirect.com/science/article/pii/S1058274602000228?via%3Dihub#bib20

https://my.clevelandclinic.org/health/diseases/24304-hill-sachs-lesion#management-and-treatment

https://pubmed.ncbi.nlm.nih.gov/32890047/#:~:text=The%202%20main%20metal%20alloys,improved%20osseointegration%20and%20osteoconduction%20properties.

Bridging Realities: Prosthetics in Fiction, Is Any Of It Real?

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In the realm of fiction, prosthetics often take center stage, portraying characters who transcend physical limitations with cutting-edge technology. From Luke Skywalker’s robotic hand to Iron Man’s sleek armor, prosthetics in popular culture captivate audiences with their seemingly limitless capabilities. But how accurate are these portrayals when compared to the advancements in real-world prosthetics?

While the prosthetics depicted in fiction may appear futuristic and awe-inspiring, the truth is that they often stretch the boundaries of scientific feasibility. However, that’s not to say that there aren’t elements of truth behind these imaginative creations. Many fictional prosthetics are inspired by real-world advancements in prosthetic technology.

One area where fiction tends to diverge from reality is in the speed and ease with which characters adapt to their prosthetics. In many stories, characters seamlessly transition from being disabled to mastering their new limbs or devices in a matter of moments. In reality, the process of adjusting to a prosthetic limb can be long and challenging, requiring extensive physical therapy and training to regain functionality. The Portsmouth Regional Prosthetic Service outline a 5 Stage Rehabilitation Process and they state it usually takes 3-6 months to adjust using the prosthetic limb, such as a leg, through intensive physiotherapy.

Moreover, while fictional prosthetics often boast superhuman abilities, such as enhanced strength or agility, real-world prosthetics are still limited by the constraints of current technology. While significant advancements have been made in creating prosthetic limbs that mimic natural movement, they are still a far cry from the fantastical capabilities seen in movies and television shows.

However, that’s not to say that real-world prosthetics aren’t impressive in their own right. In recent years, advancements in materials science, robotics, and neuroscience have led to significant improvements in prosthetic technology. For example, prosthetic limbs equipped with myoelectric sensors can detect electrical signals from remaining muscles, allowing users to control their prosthetics with astonishing precision. Studies have shown promising clinical outcomes for patients after transhumeral amputation, who received a neuromusculoskeletal prosthesis that allowed intuitive and unsupervised daily use over several years.

Additionally, ongoing research in the field of brain-computer interfaces (BCIs) holds promise for the future of prosthetics. BCIs allow users to control prosthetic limbs directly with their thoughts, bypassing the need for muscle signals altogether. While this technology is still in its infancy, early experiments have shown promising results and could eventually lead to prosthetics that are even more intuitive and responsive.

In conclusion, while the prosthetics depicted in fiction may push the boundaries of scientific reality, they are often inspired by the advancements and possibilities within the field of prosthetic technology. While we may not yet have prosthetics with the capabilities of those seen in movies and TV shows, real-world prosthetics continue to evolve and improve, offering hope and opportunities for individuals with limb differences to lead fulfilling and active lives. As technology continues to advance, the line between fiction and reality may blur even further, bringing us closer to the futuristic visions of prosthetics seen on screen.

Sources:

https://www.porthosp.nhs.uk/departments-and-services/Portsmouth%20Enablement%20Centre/The%20five%20stage%20rehabilitation%20process%20leaflet.PDF

Ortiz-Catalan, M., Mastinu, E., Sassu, P., Aszmann, O., & Brånemark, R. (2020). Self-Contained Neuromusculoskeletal Arm Prostheses. New England Journal of Medicine, 382(18), 1732–1738. https://doi.org/10.1056/NEJMoa1917537