Ă–ssur
No. 2 2019
News
The important role of relatives The phenomenon of MR fluid Advent of the exoskeleton
Sarah Reinertsen paratriathlete & inspirer
Managing osteoarthritis of the knee
Innovation in every step
Being brave and taking the plunge
Talk to us! Welcome behind the scenes! Learn about innovations and tutorials and gets lots of inspiration via Össur’s very own channels.
@ossur ÖSSUR NEWS – P. 2
t the time of writing, July has just begun and the holiday season is approaching. The Nordic spring brought glorious weather and continual, much welcomed light. Now, as you open the magazine, the days will be shorter and the temperatures lower. We hope you will devote a few minutes to this third issue of Össur News by lamplight. A magazine that, we hope will, once again, offer interesting reading as well as beneficial dialogue. GETTING IT just right isn’t easy – like sitting here at the height of summer and producing something that will be read in the autumn. Will it be realistic and timely? This leads me right on to our products. How will a solution be received in the right way, at a given time? What do we risk by not doing something, as compared to by doing it? There are endless answers to these questions, but sometimes you just have to be brave and take the plunge, despite a degree of uncertainty. We asked these questions many times at the beginning of the year, and, armed with courage and great self-awareness, we introduced some solutions “once again” to the market. LOOKING BACK, NOW, we note that it was right to take the risks of refining the solutions and doing the right thing with PROPRIO FOOT and Pro-Flex Pivot. We are more than excited about the success of Unloader One X – a major investment, where we once again need to be courageous and willing. Only when the complete item reaches you and the users that we know whether or not we have succeeded. As always when launching incremental or radical innovations, our ambition and aim is for as many as possible to be more than satisfied. WE LOOK FORWARD to continuing to share with you what we are doing by way of new projects, ideas and solutions. Keep an eye on our social media and our website – or why not get in touch or pop in to our new office in Kista? We’d love to hear your comments, thoughts and musings.
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Happy reading!
Johanna Östergren Managing Director Össur Nordic
ossur.com
Contents
No. 2 - 2019
Life without limitations
IN PROGRESS
05.
REVOLUTIONARY I-LIMB WRIST
06.
THE IMPORTANT ROLE OF RELATIVES
08.
ACL EXAMINATION
09.
ÖSSUR + NIKE = EXELLENCE
10.
SARAH REINERTSEN
13.
THE ADVENT OF THE EXOSKELETON
14.
HOW MDR WORKS
16.
ASK THE EXPERT
18.
SCHOLARSHIP WINNER ELMAR HERBST
20.
THE PHENOMENON OF MR FLUID
22.
MAGNETIC OIL – GENTLER CONTROL
24.
OSTEOARTHRITIS OF THE KNEE
26.
THE EINDHOVEN WAREHOUSE
Össur News is produced by Glory Days on behalf of Össur Nordic. Publisher & Project Manager, Össur: Johanna Östergren Editor and Production Manager: Pål Johansson Art Director: Love Eneroth Writers: Anders Lindgren, Fridah Jönsson, Eva-Lotta Sigurdh, Pål Johansson & Niklas Simonsson. Photography (unless otherwise stated): Össur Nordic Illustrations: Love Eneroth
Össur Nordic Visiting address Kistagången 12 • 164 40 Kista
E&OE – the editorial team. You are welcome to quote us, but please cite the source.
Mailing address Box 7080 • SE-164 07 Kista
Our registered trade marks are RHEO KNEE®, PROPRIO FOOT®, Rebound®, Unity®, Pro-Flex®, Seal-In®-liners and Unloader One®
info@ossur.com +46 (0)18 18 22 00
ÖSSUR NEWS – P. 3
04.
ÖSSUR NEWS – P. 4
In the works
THE FORMFIT PRO FAMILY IS GROWING Last year saw the launch of the first wave of Össur’s Formfit PRO products. Light-and-airy orthoses based on a specific knitting technique that gives the user a high level of comfort and stability and are also best in class when it comes to wicking away moisture from the body. The existing range is soon to be supplemented with new models – so, watch this space!
Don’t mi s s ! CTI AT GOTLAND GRAND NATIONAL On 25–26 October, the world’s biggest endurance contest takes place at Tofta firing range outside Visby. The 36rd Gotland Grand National attracts more than 3,000 riders, who will face slippery limestone, terrain with water, mud and fast trails. Össur Nordic will be part of the action with its CTi Knee Braces brand. Knee braces protect the knee ligament from major pressure and are extensively used preventively by endurance riders.
NEW PREMISES FOR ÖSSUR NORDIC We’ve moved and from now on you can find us at Kistagången 12 in Kista, just outside Stockholm. You’re welcome to drop in for a coffee or a chat if you’re passing by. Or why not let us invite you to a training day about our solutions? Our workshop is ready for action! We look forward to your visit!
PARTICIPATE IN OUR WEBINARS You must surely have noticed our webinars on our website, covering a number of different topics? If you’re unable to participate when they go live, that’s no problem. The presentation and the recording of the webinar are available, so you can look at them at a time that suits you.
i-Limb Wrist - revolutionary wrist function
The new i-Limb Wrist is based on a concept that enables simultaneous control of rotation by grip selection and revolutionary use of a multi-articulating prosthetic hand. ÖSSUR NEWS – P. 5
Text: Fridah Jönsson
signals that are associated with the movement in question. The key concept here, therefore, is simultaneous interpretation of different signals.
ssur’s and Touch Solutions’ new product will be launched after summer 2019 and will be called i-Limb Wrist. An electric wrist that works with the SMART Control function to enable simultaneous use of wrist rotation and grip selection with an i-Limb Quantum prosthetic hand. ELECTRODES AND microprocessors in prosthetic arms are inherently nothing new. These have been used for a couple of decades to filter and interpret the electrical impulses that the brain sends to the muscles every time we make a movement. But, in conventional use of a myo-electrical prosthetic hand and an electric wrist, the user has had to use a muscle trigger or a manual coupler to switch between the functions in the prosthetic hand and the wrist. This is where the i-Limb Wrist stands out from
other electrical wrists. The i-Limb Wrist makes use of digital electrodes which, combined with microprocessors and sensors, simultaneously interpret the user’s various muscle signals and enable the hand and wrist to communicate in real time. Now the user does not need to switch from hand to wrist, but can simply use the muscle
THE I-LIMB WRIST IS an example of the Pattern Recognition concept that the industry has been talking about more frequently in recent years; it is about capturing information in order to be able to interpret more complex movements from thought patterns. By being able to map the majority of different movements and interpret these, the user can now gain more natural use of the prosthesis. The need to come up with alternative strategies to control the prosthesis has thus been reduced. WITH THE I-LIMB WRIST, the user no longer needs to think about switching between different functions, but can use the prosthesis in a manner that is as close as possible to the natural way. In fact, that is Össur’s goal for all its products.
The
role
ÖSSUR NEWS – P. 6
important
of relatives
Behind each patient is a relative, someone who contributes massively to recovery. However, the ability to be there in the best way possible is dependent on good cooperation with the healthcare service, and good selfcare for the relative. Text: Eva-Lotta Sigurdh
HER THESIS, Everyday life among Next of Kin of Haemodialyses Patients (and her study Maintaining families well-being in everyday life) has put the invaluable role of relatives on the map and thus helped gain greater recognition for this group. The thesis focuses on the complete change in everyday life for those affected and their next of kin after leaving hospital. “All of a sudden, all the responsibility is placed on the relative, who often only now realises the implications of all the challenges ahead – without having any idea where to start. That’s why it’s important to be well prepared before the patient comes home,” Kristina emphasises. According to her, two things are vital for ensuring the relative will have good support in this new situation – trust your instincts insisting on care, and taking care of yourself. The first aspect requires the relative
to take the initiative directly for a follow-up consultation with the doctor and nurse in charge, as the healthcare service rarely does this, and, prior to coming home, demand clear answers to questions such as: what is the best information and support for me specifically, and how should I interpret the available information? What happens from here onwards? Who will be my contact? Good cooperation with the healthcare service means a lot, Kristina emphasises; she recommends daily catch-up times, for example short walks or little breaks as tools for relatives to take care of themselves as a coping strategy. “Other tips are to join various associations and networks for others in the same situation and to read patient blogs, available on many County Council websites. ALTHOUGH THE ROLE of relatives has long been neglected, more and more research is now being done in this area. One example is cancer researcher Gunnar Steineck’s studies into how relatives of cancer patients themselves run the risk of becoming ill (above all, mentally) if they do not receive timely and clear information about diagnoses and prognoses from the healthcare service. “In our studies, we’ve seen it’s important for relatives to be able to prepare for what will happen,” according to one of the study participants, senior lecturer Arna Hauksdóttir, in the article I den sjukes skugga [in the shadow of the patient] (by Fredrik Hedlund, Medicinsk Vetenskap 4, 2013). Just like Kristina, Gunnar Steineck also emphasises the importance of good cooperation with the healthcare service, as well as use of social media.
The Swedish Family Care Competence Centre (NkA) www.anhorig.se is another source of support.
ÖSSUR NEWS – P. 7
hen someone is very ill or seriously injured, it is not only that person’s life but also the lives of relatives are turned upside down. Despite this, relatives, as a category, have long been neglected in the healthcare world, both clinically and in research. But one person who has taken an integrative view and put the spotlight on relatives is Kristina Ziegert, a nurse turned professor of care. “I was struck by the lack of patient knowledge that the healthcare professionals had, which in turn required us to rely on information provided by relatives to fill in the gaps. This information is vital for us to simplify everyday life and help the affected person recover faster. That’s why I decided to quit nursing and conduct research into this,” Kristina reports.
Alternative to ACL surgery
May saw the start of an assessment of the Rebound ACL brace. This was a fact-finding exercise about its efficacy as an alternative to ACL surgery. Text: Niklas Simonsson
P
ach year, 8,000– 9,000 patients have ACL surgery in Sweden. With this trial assessment of the Rebound ACL brace, Össur intends to review the possibility of healing cruciate ligament injury conservatively, a te riv i.e. without surgery. :P to ho “As a company, we believe strongly in this, as do the participating doctors. We had a preliminary meeting in Edinburgh last year with doctors from all over the world, and all of them were very interested in this,” says Nils Inngul, sales manager for Össur bracing and supports in the Nordic region. THE REBOUND ACL concept is based on the Rebound PCL orthosis, intended for the posterior cruciate ligament. What matters is the position of the knee and that dynamic construction can follow the force-extension curve of knee movement. Nils Inngul feels Össur has hit the spot with Rebound ACL.
“We’ve had very good discussions with leading doctors in cruciate ligament research. There is strong healing potential for the anterior cruciate ligament, particularly with the help of a dynamic brace. Very exciting to see,” according to Nils Inngul. FORTY PATIENTS ARE taking part in the assessment. The treating doctors are firmly in control and are collecting data. There are hopes of presenting a final result around the New Year or Q1 2020. The method is primarily intended for non-elite sportspeople, who generally need four months’ rehabilitation prior to surgery. Rebound ACL enters the picture in a much earlier phase: treatment should start ten days to three weeks after the injury. “Afterwards, we monitor healing by means of high-resolution MRI. And, if the results turn out to be as good as we think, we’ll follow this up with a high-quality study,” Nils Inngul concludes.
Össur Nike
Excellence ÖSSUR NEWS – P. 9
The combination of Nike expertise in the development of sports footwear and Össur’s expert knowledge of sports prostheses gives sports amputees the means of achieving fantastic results. Text: Anders Lindgren
n 2011, Össur began working with Nike to create a sole for the Flex-Run foot prosthesis. The inventor of the sole is Sarah Reinertsen, amputee Paralympian and triathlete. It is designed to raise the user’s performance as well as improving efficacy and results for the orthopaedic engineer. “The unique, removable sole replaces conventional methods where soles from ordinary running shoes or treads from car tyres are glued onto the prostheses. It goes without saying that a sole specially designed for its purpose will perform and last better,” according to Brooke Rash, Global Creative Director at Össur. THE VENTURE COMBINES Össur’s expertise in running prostheses with Nike’s sole and surfacegripping technology. The venture involves both companies’ R&D teams, with small teams of product designers and engineers working together to develop the soles. To bring in experience and opinions from runners and integrate them into the product development process, sportspeople and brand ambassadors regularly visit the Össur R&D facility in Iceland.
When Nike launched its new FlyEase shoe technology, mannequins with amputated legs were used in the Niketown store in London. Alongside the engineers, they work with product testers and provide feedback. “The facility is equipped with the latest gait analysis and high-speed filming technology. THE FIRST Nike Sole was launched in 2011 and has been warmly welcomed by runners. Since then, a pad with studs for the Cheetah foot has been added, and development is ongoing. The company also cooperates on sportswear and mannequins. “When Nike launched its new FlyEase shoe technology, mannequins with amputated legs and Össur prostheses were used in the Niketown store in London. The response has been overwhelmingly positive, which encourages other sites to be included in the campaign as well, Brooke Rash concludes.
Photo: Atli Thor Alfredsson
ÖSSUR NEWS – P. 10
Sarah was the first amputee featured on the cover of Runner’s World and ESPN Magazine, and the first to take part in The Amazing Race reality series.
“Fear less, live more” Sarah Reinertsen truly follows her motto, “Fear less, live more”. Besides the fact that, as a sportswoman, she has beaten several world records, she has overcome many obstacles and preconceived ideas about what amputees should be able to do. Text: Anders Lindgren
SHE WAS A lively child and was keen to participate in various sports. But she was excluded from playing in team sports. “My parents did their best to help me. But the narrow-mindedness around us meant doors were closed and opportunities were withheld, and I remained on the sidelines,” she reports. When Sarah’s father saw his daughter struggling with team sports, he looked up amputee marathon runner Paddy Rossbach during a competition near the family home on Long Island. “I was 11 when I met Paddy, and that completely changed my life. She became my mentor and made me aware of my potential. The inspiration, motivation and self-confidence I gained from her led to me
starting to compete in sprinting,” Sarah recalls. She was now welcomed into a community of medallists from international competitions and was soon an outstanding sprinter. As early as her first international competition, at the age of 13, she beat the world 100 m record for women with a transfemoral amputation. She was a member of the US Disabled Track Team for seven years, and represented the US in the Barcelona Paralympics in 1992. And her world record (T42) for the 400 m, which she set in 1999, remains unbeaten. WHEN SHE WAS 17, however, something happened that would change her life forever. “I met paratriathlete Jim MacLaren, who had completed an Ironman competition with a prosthetic leg. I knew immediately that I, too, wanted to compete in an Ironman, and show that a girl with a prosthetic leg can do this. So, he became my new example and mentor.” Around that time, in 1992, Sarah was still a sprinter and she could not swim or cycle. But her determination to complete an Ironman gradually changed her focus from short distance to long
“I knew immediately that I wanted to do an Ironman.”
ÖSSUR NEWS – P. 11
merican paratriathlete Sarah Reinertsen was born with a rare condition, proximal femoral focal deficiency (PFFD), which meant that her left leg was considerably shorter than her right leg. And, at the age of 7, her left leg was amputated above the knee.
distance and triathlon. In 1997, she ran her first marathon in New York. After that, she took part in races all over the world and beat the world record many times over. In the 2000s, she also began competing in the International Triathlon Union’s (ITU) World Championships, winning gold in 2003.
SHE CONTINUED TO complete in the ITU world championships, taking gold in 2007 and 2009, and silver in 2011. In 2018, she became the first amputee in the world to complete a World Marathon Challenge, running seven half-marathons on seven continents in seven days. And when the Ironman World Championships celebrated their 40th year last year, she reached her target in 14 hours and 41 minutes, beating her 2005 world record by 24 minutes. In interviews, she has said this was probably her last major
extraordinary life. She is a graduate in communication and international affairs, and has a master’s in broadcast journalism.
THE ONE-TIME sports journalist still lives in California with her husband, but now works in the “Innovation Kitchen” at Nike’s global headquarters in Oregon. Here she helped to develop the Nike Sole, the first shoes for a running prosthesis, launched in 2012. She also worked on Nike’s first adaptable closure technology, FlyEase. The technology means the shoes have an adjustable strap linked to a wraparound zipper, which opens and closes with a single AS SPOKESPERSON responsive action. Perfect for The Challenged for people with a leg or SARAH Athletes Foundation arm prosthesis. REINERTSEN (CAF), she is keen “Although I’m Age: 44 to share her drive to proud of my sporting Lives in: Orange motivate others. The accomplishments, I’m County, California Foundation contributes even more enthusiastic Family: Husband Brooke Raasch finance for adaptive about working with Interests: Philanthropy, sports equipment, partners like Össur, travel, yoga, music and coaching and mentoring CAF and Nike to help all things Norwegian. to allow children with sportspeople of all disabilities the chance to abilities to step off the make the most of their sidelines and start to sporting talents and their lives. Sarah take part in the big game of life. We’ve is also a writer and motivational just begun – so you can expect lots of speaker, sharing her life experience and fantastic new innovations and exciting addressing topics such as setting goals, ventures for a long time to come, facing down your fears and living an ” Sarah concludes.
Photo: Atli Thor Alfredsson
Being an example and a mentor for the next generation of disabled sportspeople is one of my biggest enterprises so far.
ÖSSUR NEWS – P. 12
IN 2004, SHE finally became the first female amputee ever to participate in an Ironman competition with a leg prosthesis. Unfortunately, she missed the cut-off time in the cycling round by 15 minutes and was disqualified. Disappointed, but determined, she longed for a comeback. One year later, she was back, in Kona, Hawaii. And this time she managed all the cut-off times and completed the entire 226.26 km course in 15 hours and five minutes.
competition. So, what will she be doing next? “I’ve spent 30 years crossing finishing lines. Now I want to help other people reach their starting lines.” Sarah is an outspoken person who encourages people to fear less and live more. And, just as she has been beating sporting records, throughout her life she has been overcoming obstacles and preconceived ideas that stand in the way of what amputees are perceived as being able to do. “I love doing things that haven’t been done before and pushing the boundaries. That’s what drives me on.”
for relief and increased mobility
It looks like futuristic gear straight out of a science fiction film, but it could be a natural part of our everyday life in the near future. Text: Pål Johansson
xoskeleton is a mechanical skeleton fitted outside the body to improve the wearer’s mobility, endurance or strength. The mobile machine is operated by a system of electric motors, pneumatics, levers and hydraulics, or a combination of technologies. This aid is already being used in the armed forces, the manufacturing industry and healthcare. ONE EXAMPLE IS the Lockheed Martin defence company, which is
developing a robotic suit for American soldiers in the field. The technology, based on the B-Termias exoskeleton for civilian use, is intended to boost the wearer’s strength by almost 30% and multiply working capacity up to 27 times. China and Russia area also investing large sums in research into military exoskeletons. THE COST OF AN advanced exoskeleton remains high, but prices are predicted to fall as more investors come forward and research is stepped up. Today’s technology is already advanced enough to produce sufficiently small and cheap
ÖSSUR NEWS – P. 13
Exoskeleton
variations for use on the factory floor. One company to have introduced this aid is Ford, with an exoskeleton vest by Ekso Bionics. The vest has been designed to reduce shoulder and back injuries from repetitive work, giving the wearer additional lift of between two and seven kilograms per arm. EXOSKELETONS ARE BEING studied in healthcare, too. One example is the robotic suit HAL (Hybrid Assistive Limb), developed by Cyberdyne Inc. This exoskeleton has been undergoing testing for six years in stroke rehabilitation at the University Clinic Department of Rehabilitation Medicine and Karolinska Institute, Danderyd Hospital, with very good results. HAL reinforces body movements by reading nerve signals via the skin. The signals are reinforced and used to control the motors in the suit. The suit has also been used in cases of functional impairment following injury or disorders of the nervous system and, in Germany, for patients with spinal cord injuries.
MDR
– how the new regulation works Next year, Europe will introduce new legislation governing medical devices, affecting suppliers and patients alike. Össur News explains the concept of how the new MDR Regulation will work.
ÖSSUR NEWS – P. 14
Text: Fridah Jönsson
ay 2020 will see the new MDR legislation come into force in Europe. The Medical Device Regulation will re-draw the map for suppliers and providers, and for customers and users of medical devices. The definition of the concept is very broad and includes everything from pacemakers and prostheses to hospital beds and wheelchairs – all types of instruments or apparatus used for medical purposes. THE MDR REGULATION was voted through in 2017 and, as of May 2020, will replace the earlier Medical Devices Directive (MDD) and the Active Implantable Medical Devices Directive (AIMDD). Users will not necessarily know these directives like the backs of their hands, but there are advantages to being familiar with MDR, as patients will be able to have greater insight into the production of medical devices as of 2020. THE NEW MDR REQUIREMENTS are being imposed on suppliers early, as all manufacturers will have to have at least one person who is responsible for ensuring the organisation is compliant with the regulation. The individual in question must have specific expertise in medical devices and must be responsible
for financial oversight, technical documentation, product control and reporting obligations, to which new guidelines will also apply. The new reporting obligations accompanying MDR will mean, among other things, that product manufacturers will have a duty to publish safety reports about their products providing more up-to-date and current knowledge about the items in question. There will also be tougher requirements for follow-up of how the devices actually work among end-users.
Patients with an implantable device will notice a distinct change as a result of the MDR Regulation. FURTHERMORE, THERE WILL be more rules on transparency and traceability. A comprehensive European database on medical devices (EUDAMED) will be introduced; in this database, manufacturers will be required to register updates about everything from accidents involving the
device to ongoing safety information. Some parts of the database will be open to public scrutiny. PATIENTS WITH AN implantable device will notice a distinct change through the MDR Regulation. Everyone who is given an implant will also receive an “implant card” with information about the type of device implanted. This dovetails with the manufacturers of certain drugs having to report exactly what substances are used in the manufacture of their products, making for greater transparency in healthcare; this will be particularly beneficial for patients with a sensitivity to certain substances. FOR ÖSSUR SPECIFICALLY, MDR will entail a number of practical updates. Össur is busy taking stock of all the devices in its range and establishing new contracts with all suppliers in order to ensure MDR compliance. For example, the global quality system will have to be updated, the devices will have to be registered with EUDAMED, and new follow-up methodologies will have to be launched. There is also a strong focus on further developing the work of the global R&D departments to demonstrate the clinical efficacy of the solutions being developed and presented to the market – all with a focus on a safer environment for the individual user and a more transparent and reliable production process.
ÖSSUR NEWS – P. 15
ÖSSUR NEWS – P. 16
“If you don’t look ahead, you can’t move forward” Contemplating the future was most difficult when Eva’s husband Håkan was due for an amputation. She only wishes she’d known then how well everything would turn out. A positive attitude to life and advanced orthopaedic technology were key to an active, enriched life for Håkan and the rest of the family. Text: Eva-Lotta Sigurdh Photo: Eva Axelsson
my head was whirring with thoughts about what life would be like.” But she needn’t have worried. Just over one year on, life was almost back to what it had been before the accident. “Håkan practised hard with the prosthesis and I pushed on. We realised it was just a matter of getting on with it, thanks to all the modern technology, such as the ‘running leg’ and prostheses that can be attached directly to skis, and our own positive attitude. Your approach is the be-all and end-all. If you don’t look ahead, you can’t move forward.” Eva reports that, despite this, she had downtimes when life felt tough, such as when their youngest son was so upset before the amputation, and in the immediate aftermath of the operation when the workload was sometimes overwhelming.
HOWEVER, A FULL SIX years were to pass before this became relevant. Six years of unsuccessful operations, constant pain and no chance of continuing a previously active life. But, also, six years of getting used to the idea of an amputation. The last straw came when Håkan slipped on ice and fell, around the same time that he found out he had an untreatable eye condition. That was when the realisation dawned that he would never regain an active, pain-free life without doing something drastic – and he finally elected to have the amputation.
How did you take care of yourself in the midst of all that? “I made sure I was able to get away from time to time and do things with my friends. That was particularly important at the beginning, when things were toughest. We were lucky enough always to have lots of people around us who were willing to lend a hand.”
How did the decision to amputate affect you and your family? “I and our older children had already reconciled ourselves to the idea and it actually came as a relief, but our youngest son was very upset about a body part being removed.” How did you manage your son’s concerns? “We got in touch with other amputees with a good quality of life to let him see it wasn’t the end of the world.” THE ACTUAL AMPUTATION went well, although the immediate aftermath was tough, Eva recalls. Håkan felt bad about not being able to move like he used to, and she had to take over all responsibility for the family, in parallel with working full time to keep their finances in order. “I had to be strong for everyone, even though
What would be your advice to other relatives? “If you have younger children, get in touch with existing amputees to help take the drama out of the amputation. We invited our friends to dinner the night before so the children and I could chat without things getting too heavy. It was nice and we felt well prepared. And consider your attitude. Try to think positively and support the affected person. There’s a solution to everything!” What does life look like today? “It’s really good and I no longer regard Håkan as functioning differently. Life is just normal” Perhaps ‘normal’ is an understatement. Despite impaired eyesight and the loss of a leg, since the amputation the family have gone on foreign holidays, walks and ski trips, and Håkan himself has taken part in the Paralympics, the Gothenburg half-marathon and the Halvvasan skiing race… “Just imagine if I’d known that when the anxiety hit,” Eva laughs.
ÖSSUR NEWS – P. 17
eing next-of-kin to someone who is forced to have an amputation can be almost as overwhelming as being the amputee. Suddenly, your life is turned upside down and you are expected to be there totally for your partner, while perhaps your children may be upset and need particular care, while family activities have to roll on as normal. This was the situation facing Eva Axelsson, whose husband Håkan chose to have his left lower leg amputated after an accident. “His leg got trapped in snow grooming equipment, but he ‘ just’ needed surgery to start with,” Eva, who nevertheless recalls with horror the doctor’s indication that an amputation might be necessary.
ESSKA 2020 ÖSSUR NEWS – P. 18
is approaching
The preparations are already in full swing for the 2020 European Society for Sports Trauma, Knee Surgery and Arthroscopy (ESSKA) International Congress, set to take place in Milan. In addition to lectures and workshops, the Jón Karlsson Award scholarship will be awarded. Össur News was able to talk to one of last year’s winners. Text: Eva-Lotta Sigurdh Illustration: Love Eneroth
hirty-seven years have passed since a group of knee surgeons met in Berlin and decided to establish a joint European forum for researchers and clinical practitioners in their line of work. The aim was to improve quality of life for patients with sports injuries and other knee and hip-related issues. By bringing together expertise from all over the world and addressing and debating new research in the field, they hoped to speed up the development of surgical techniques and equipment.
ANOTHER NEW ASPECT of the record-breaking conference in Glasgow was the establishment of Össur’s Jón Karlsson Award, a grant awarded to promising young orthopaedic students with research ambitions. One of last year’s proud winners was German medical student Elmar Herbst, now working as an ST doctor (medical specialist) in knee orthopaedics with a focus on sports injuries at Münster University Hospital. He received the accolade for his studies into the difference it makes to ACL reconstruction patients if they have surgery soon after the injury compared to having to wait a while. He came to the surprising conclusion, compared to previous studies, that the waiting period does not have any short-term impact on the outcome. What did you think when you received the award? “I was pleasantly surprised. So much research has been done into this, so I’m very flattered that my particular study got noticed,” Elmar Herbst comments. Did the fact that it was in the name of Jón Karlsson make it extra special? “Yes, he’s been my great example ever since I got started in this field. With his whole fund of
knowledge and long experience, he’s a real guru of the orthopaedic world.” You’ve even got to know Jón Karlsson personally a little bit. What’s he like as a person? “An amazing guy. For example, I had the honour of looking after him when he was invited as a guest professor at Pittsburgh University, where I was on a research placement for a while. We did a lot of cool stuff together, like visiting art exhibitions and American football matches. But, more than anything, he showed me how much of a family man he was. He’d promised his daughter a pair of shoes that you could only get there, and we drove around for hours until we found the shop. Those were brilliant, amazing days.” Tell us about your own career path. How did you come to read medicine, and what made you specialise in orthopaedics and sports injuries? “I’ve always been interested in sports and I was an active Alpine skier for many years. But I kept getting injured. So, the combination of general interest in diet and exercise, and my constant visits to the emergency department, determined my choice of career. I was fed up with lying on the operating table and wanted to have a more active role in the operating theatre instead.” And now the dream has come true… So, what’s your life like today? “I still love skiing and also do some training with my girlfriend. But, quite honestly, I don’t have a lot of leisure time. But, I’m lucky enough to have a job that I regard as one of my greatest interests.”
ÖSSUR NEWS – P. 19
THE FIRST CONGRESS, designated ESSKA (European Society for Sports Trauma, Knee Surgery and Arthroscopy), took place just two years later in Berlin, and was a success. It attracted more than 800 delegates and has seen steady growth ever since, with conferences taking place alternate years. The most recent, in 2018, was in Glasgow, and hosted 3,200 delegates.
Elmar Herbst
ÖSSUR NEWS – P. 20
Phenomenon
MR f
Once activated, a magneto-rheological fluid can go from liquid to solid within a few milliseconds. This attribute means magnetic fluid can be used in anything from vehicles and earthquake-proof buildings to exercise bikes and washing machines. Text: Anders Lindgren
magneto-rheological fluid (also known as MR fluid or smart fluid) is a fluid with attributes that can be controlled by a magnetic field, usually generated by an electromagnet. Depending on the force of the magnetic field, the fluid can change from behaving like a free-flowing oil to a solid, rubbery material. The viscosity can be controlled very precisely and the transitions between different states take just a few milliseconds. THIS EFFECT IS POSSIBLE THANKS TO the fluid containing small magnetic particles, usually iron, 0.1–10 nanometres in diameter. Without a magnetic field, the particles are randomly dispersed in the oil, which makes the fluid free-flowing. However, when subjected to the current in a magnetic field, the particles align with the flux of the
magnetic field and the fluid becomes rigid. MR FLUID CAN be used in three different ways, depending on the application. In shock absorbers, the fluid flows between two plates that do not move relative to each other. In couplings and brakes, the fluid regulates shear resistance between two or more places that move relative to each other. And, in some applications, the fluid is between two layers that are pressed together or pulled, especially in millimetre-sized movements involving major forces. ALTHOUGH MAGNETIC fluids have been around since the 1940s and have been developed extensively from the 1960s onwards, there were few applications for MR fluids until around 1990. More than anything, this was because of a lack of reliable ways to control the fluid. Today, however, using signal processors and inexpensive computers, the magnetic field can be controlled with a high degree of precision. This has led to a virtual explosion in
– the magnetic oil
the number of applications, above all in the form of various dampers. For instance, its super-fast damping effect has won a place for MR fluid as a shock-absorber fluid in many car models. General Motors was first, and developed MagneRide, with the benefit that the viscosity in the shock-absorber fluid can be varied depending on loaded weight and driver preferences. However, it can also provide stability under a variety of road conditions. The readings and adjustments take just one millisecond. THE SYSTEM HAS BEEN IN USE SINCE early 2002 in the Cadillac and, one year later, also in Chevrolet and Corvette-marque passenger cars. Since then, Audi and Ferrari have also purchased licences to be able to offer MagneRide in several of their models, while Honda and Porsche, for example, have introduced their own MR technology in their cars. In construction machinery, the fluid is used as
both cab and seat shock absorbers. Another application under development is for helicopter seats, to reduce spinal injuries in the event of a crash. As the fluid can absorb strong shockwaves, it is also used in seismic shock absorbers in buildings to make them more secure against earthquakes. And a number of military organisations and universities around the world are researching the possibility of creating MR-fluid vests, or liquid armour, with a degree of absorption that could withstand bullets. A FEW MORE surprise applications for MR fluid are that it can increase the magnetic flux between loudspeaker coils and magnets in high-output loudspeakers, boosting the impact. And it has proved very precise as a polishing method, making MR fluid useful for polishing the corrective lens of the Hubble telescope, for example. Sources: Nationalencyklopedin, Ny Teknik, Wikipedia, How Stuff Works.
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fluid
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Gentler control with magnetic fluid By developing a braking system with magneto-rheological fluid, Össur has successfully created knee prostheses with a lightning response to the user’s movements and gentle control of the knee. Text: Anders Lindgren
agneto-rheological fluid, or MR fluid, is used in a number of product segments to achieve a rapid damping effect. In recent decades, the technology has been refined to the extent that it is possible to control MR fluid with a high degree of accuracy and in small magnetic fields. Össur utilises this in developing its microprocessor-controlled prosthetic knees RHEO KNEE and RHEO KNEE XC.
ÖSSUR’S KNEE has approximately 10 ml of magnetic fluid between around sixty slats. The bending resistance is governed by the strength of the magnetic field. When the MR fluid is activated, a shear resistance is created for the slats. The stronger the current, the greater the viscosity and resistance. The magnetic field, which is generated by a battery with up to 72 hours of battery life, is applied only to the knee’s braking system of slats and MR fluid. The knee’s sensors constantly read the rate of angle of movement, the angular position, gyro position, etc. The computer controls the strength of the current and the knee itself finds the best setting in each given situation. “The system uses several hundred different values to produce as even and energy-efficient a gait as possible. And, because the braking
Sven Johansson – Clinical Specialist
system shares the same centre as the prosthetic knee, it can brake equally well, regardless of the bend of the knee. All microprocessor-controlled knees respond to a large number of parameters, but with conventional solutions, resistance is difficult to control. Even the ambient temperature can affect the viscosity of the oil. But the system even compensates for that,” Sven Johansson reports. All the data is stored in a program that is being constantly developed and fine-tuned for the specific user and that user’s prosthetic solution. “The programme is autodidactic, but we don’t allow it to make too-big changes automatically. The basic settings established during commissioning remain in place until the orthopaedic engineer makes any changes or reprograms the prosthesis,” he adds. IN ANY OIL-BASED system, there is a risk of the oil wearing out. But, despite tests involving many millions of repetitions, there is no sign of the MR fluid in Rheo Knee wearing out. This is because it is a low-pressure system, Sven explains. “The MR fluid in Rheo Knee does not get squeezed through a narrow valve, so it is not exposed to the heavy load and heat development that that would entail. Being a low-pressure system also minimises the risk of oil leakage. By using MR fluid, Össur has successfully created knees that allow very good and fast adjustment of the braking effect for the user. It can take a few weeks for the prosthesis to coordinate fully with its user. But it never stops learning.
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WHEN DEVELOPING a prosthetic knee, you want it to provide as responsive and dynamic a range of movement as possible. And there are several benefits from using MR fluid instead of conventional solutions involving hydraulic cylinders to regulate bending resistance in the knee. Above all, the response is faster, as the fluid can go from zero to 100% resistance within a few milliseconds. “MR fluid gives the user a knee with gentler control, for a more natural, responsive gait. As the oil reacts instantly to changes in the magnetic field, the user can often walk at a faster natural pace than with other microprocessor-controlled prosthetic knees and also climb stair-upon-stair,” according to Sven Johansson, Clinical Specialist, Academy Össur North Europe.
The user can often walk at a faster natural pace than with other microprocessor-controlled prosthetic knees.
Movement exercise &
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important for osteoarthritis
Osteoarthritis of the knee is a common diagnosis, but can be daunting for those first diagnosed with it. Össur reports on how the person affected can manage the diagnosis and reduce problems – e.g. using the new Unloader One X product. Text: Fridah Jönsson
he World Health Organisation WHO expects between 10 and 15 per cent of all people in the world over the age of 60 to have some kind of osteoarthritis, and with the majority having osteoarthritis of the knee. Arthritis often takes many years to develop and the articular cartilage that usually provides low slip resistance in a joint changes, reduces and can even disappear. Usually, arthritis takes hold in the hips or knees, but it can also occur in the shoulders, elbows and fingers. WHEN A KNEE is affected by arthritis, the patient feels stiff; walking can be painful, and sometimes the knee swells, as too much fluid builds up in the surrounding joint. The cartilage of the joint becomes uneven, causing the knee to click and crack. The sensation of stiffness usually occurs on exertion,
but can also happen when standing up after sitting for too long. The knee is a basic part of the body that is used every day. Accordingly, arthritis in the joint affects the person’s life both physically and mentally. It is not unusual for people to withdraw from walking long distances or stop exercising when they notice this is associated with pain – which is unfortunate, because the best remedy is movement and exercise. That does not mean an arthritis patient has to run a marathon or embark on protracted crossfit sessions. Exercise that is gentle on the body is always best, and as little as 20 minutes’ exercise biking daily has produced excellent results. Custom training sessions such as swimming and walks are very gentle and help the knees. To be certain that it really is osteoarthritis of the knee, a medical
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examination is required, sometimes combined with an X-ray. Depending on the severity, the doctor will determine the course of treatment. For very severe symptoms, an operation may be needed, but often simply physiotherapy or exercise is prescribed. Some aids may also be recommended, and are sometimes prescribed by the doctor, e.g. walking sticks or crutches. AT THE START OF 2020 Össur is launching its new Unloader One X product. It is an orthotic with biomechanical functions providing pain relief and increased functionality for patients with
As little as 20 minutes of exercise biking a day has been proved effective. osteoarthritis in one knee. Unloader One X is based on its predecessor, Unloader One, which has been used and is valued by hundreds of thousands of affected people all over the world for more than 20 years. In the run-up to the new launch, Össur has listened to users’
experiences and fine-tuned the details, improving aspects such as comfort, appearance and user-friendliness. THE TYPICAL UNLOADER ONE Xuser is an osteoarthritis patient with limited movement wishing to resume everyday activities without pain by taking the pressure off the damaged joint. The protection has even been adapted to be worn during types of exercise and activities including rambling and gentle jogging, and it can cope with the user lifting weights. For the best experience, Unloader One X should be tried with the help of a qualified professional.
Eindhoven - Össur´s hub
Eindhoven of the Netherlands has become a key location for many technology companies, including Össur. Store manager Thijs Ras takes us behind the scenes of the company’s stores. Text: Fridah Jönsson
ssur’s large-scale storage facility is located in Eindhoven, in the south of the Netherlands. This little town with a population of around 229,000 is a major industrial hub with several different companies in the fields of technology and transport, including Philips and FedEx, having large storage facilities and offices there. Thijs Ras began working for Össur in 2012, packing incoming orders. Three years on, he was offered the role of store manager, and today he oversees the work of a team of 15, processing some 700 orders per day. “We’re Dutch, and we have a reputation all over the world for being hard workers. We always try to improve things and we are quite self-critical; if something goes wrong, we want to put it right. That’s a highly valued attribute of the Dutch people,” Thijs Ras comments. THE ORDERING PROCESS is quick. As soon as an order enters the system, the product is picked, sent for packing, dispatched by UPS and reaches
the customer within two days, sometimes 24 hours. The products are sent to the rest of Europe, notably Germany and the Nordic region. Thijs believes one of the advantages of the Eindhoven location for the warehouse is that it’s an industrial town undergoing constant development. “From a distribution point of view, it’s a very attractive location. It’s got great infrastructure, which makes it easy for companies like FedEx to reach the whole of Europe, and the town is growing and is on the way to establishing itself as one of the largest in the Netherlands.” WHEN THIJS STARTED WORK at Össur, the warehouse was located elsewhere, but as more orders began to flow in, they needed more space, and then, as of three years ago, a bigger building. “Lots of people looking for jobs are surprised by two things. How light it is, and how clean it is. It’s very important to us for it to be cleaned; we’re working with medical devices, of course, and we work based on the same principles of hygiene as a hospital. Our cleaners work 36 hours a week to keep the place as clean as possible at all times,” Thijs Ras reports.
THIJS’ TIP Anyone visiting Eindhoven for the first time simply must see Stratumseind, said to be the longest pub street in Europe. And, if you’re a football fan, you must, of course, see PSV at the Philips Stadium. I try to go to as many matches as I can.
“It feels good knowing my i-Limb Quantum always gives me the function I need, whether I’m at work or pursuing any of my leisure interests.” Bertolt Meyer Professor of Organisational and Economic Psychology and DJ.
www.ossur.se/lifewithoutlimitations
“There are some things in life where we don’t have a choice. But you can always choose to feel free.” Shiori Harms Law student & passionate dancer
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© Össur, 06.2019
