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Upper-Limb Prosthetic Devices 215

2.4 3D Prototyping
3D printers with new materials are becoming available, for example, carbon
fiber. In addition, laser sintering machines using metal would provide more
durable components (Weir, 2017). This in conjunction with many open-
source hand designs (Krausz et al., 2016) can enable rapid manufacturing
of the prosthesis components at the prosthetic facility or at home and the
prosthesis to be fitted at home by a prosthetist or the amputee prints and
takes his/her components of the prosthesis at the prosthetic facility.

2.5 Osseointegration—Osseoperception

Professor Per-Ingvar Bra ˚nemark discovered in the 1950s that bone can inte-
grate and coexist “peacefully” with titanium components. He defined
osseointegration as “A direct structural and functional connection between
ordered living bone and the surface of the load—covering implant”
(Branemark et al., 1969). Osseointegration has been proposed for upper-
limb prostheses since 1980s after the success of dental implants (Childress,
1997, 1998). The major problem of this technique has been the risk of infec-
tion at the skin to implant area (Childress, 1997, 1998). There has been a lot
of effort in the past years to optimize implants design, the process and the
rehabilitation protocol in order to minimize the risk of infection. In
1999, a treatment protocol called OPRA (Osseointegrated Prostheses for
the Rehabilitation of Amputees) was established. Although there is
>20years of experience in transhumeral osseointegration procedures, the
orthopedic community still is skeptical of this technique (Tsikandylakis
et al., 2014). Results of the first 18 transhumeral patients following the
OPRA protocol for upper limb are promising, with a 83% implant survival
rate at 5years and a 38% 5year incidence of infectious complications of
which most of them were not serious and were treated with nonsurgical
interventions (Tsikandylakis et al., 2014). Integrum, the company that is
commercializing the Osseointegration technology OPRA, was given
Humanitarian approval in 2016 from the FDA, to perform 18 Clinical trials
for upper-limb amputees in the United States (Li, 2016).
The biggest benefit that Osseointegration provides as a procedure and
methodology, other that it eliminates the need of a socket and provides
wider range of motion (Fig. 19A), is that there is direct link between the
bone, muscles, tendons, receptors, and the prosthesis (Fig. 19). This direct
link and engagement provides Osseoperception, the ability of the amputee