2вЂ“ 9 Therefore, the need for modern, intuitively controllable and naturally perceived prosthesis is nowadays even more pronounced. We may have reached the pinnacle of prosthetic aesthetics, but the patientвЂ™s control and вЂfeelingвЂ™ of these artificial replacements is still very problematic. Prostheses try to replicate the appearance and functionality of limbs to the finest detail.

Yet, prostheses are still an important aspect of orthopaedic practice, since traffic accidents, tumours and especially diabetes are widely present and these patients very often have non-reconstructable limbs. Alternatively, we have recently witnessed a successful cadaveric limb transplantation, 22вЂ“ 24 albeit followed by a requirement for life-long immunosuppressive therapy and the patientвЂ™s difficult psychological acceptance of the dead-donor hand. 20, 21 From our experience, in cases of severe limb trauma with mangled extremities, microsurgical reconstruction, if indicated and successful, gives much better results than any other possible solution. In the case of a traumatic amputation and if there is an indication for it to be performed, replantation is always the treatment of choice. 3, 17 They usually feel the prosthesis as a foreign body (low embodiment), therefore there is a need to provide new prosthetic solutions, which should be more efficient and more easily accepted/embodied by patients. Patients have difficulties being fully reintroduced to their workplaces in the post-amputation period. Amputations have a devastating impact on a patientsвЂ™ health and produce psychological distress with consequent economic loss. 12вЂ“ 16 This poses a huge medical and economic problem. 12 Inferred from statistics for Germany, Italy, Ireland and the USA, the EU has approximately 3.18 million limb amputees (4.66 million for all of Europe) and around 295,000 amputations are performed each year (431,000 for all of Europe). There are around 2 million limb amputees in the USA with 185,000 amputations performed annually. The surgical procedure for electrode implantation consists of targeting the proximal nerve area, competently introducing, placing, and fixing the electrodes and cables, while retaining movement of the arm/leg and nerve, and avoiding excessive neural damage.ДЄdvantages of bionic limbs are: the improvement of sensation, improved reintegration/embodiment of the artificial limb, and better controllability.Д¬ite this article: EFORT Open Rev 2020 5:65-72. This can improve sensation in the phantom limb. The third group is the direct interfacing of the residual nerves using implantable electrodes that enable reception of electric signals from the prosthetic sensors. With direct muscle interfacing, direct intramuscular implants record muscular contractions which are then wirelessly captured through a coil integrated in the socket to actuate prosthesis movement. Targeted muscular reinnervation (TMR) involves the transfer of the remaining nerves of the amputated stump to the available muscles. The main characteristic of bionic limbs is that they establish an interface between the biological residuum and an electronic device, providing not only motor control of prosthesis but also sensitive feedback.Д«ionic limbs can be classified into three main groups, according to the type of the tissue interfaced: nerve-transferred muscle interfacing (targeted muscular reinnervation), direct muscle interfacing and direct nerve interfacing. Amputations have a devastating impact on patientsвЂ™ health with consequent psychological distress, economic loss, difficult reintegration into society, and often low embodiment of standard prosthetic replacement.

Rimworld implants and bionics