Implications of the world’s most expensive prosthetic arm

This article was co-authored by Abdo Haidar, Prosthetist, The London Prosthetics Centre.

The prosthetics industry has seen great technological advancements in the last decade. This has been partially driven by greater exposure to the plight and needs of the number of servicemen losing limbs in recent conflicts, and by the increase in profile brought on by events such as the Invictus Games and the Paralympics.

Lower limb prostheses have developed significantly. We have seen the influx of microprocessors, an integrated computer circuit, and power propulsion products, which provides energy and movement. These developments increase functionality, stability and control. In the vast majority of cases this has led to greater levels of mobility and independence for the amputee.

We have also seen significant advances being made with upper limb prosthetics. In recent years, we have seen the introduction of osseointegration, which is the formation of a direct interface between an implant and bone, myoelectric prostheses, which is externally-powered artificial limbs, and Targeted Muscle Reinnervation, which is a surgical procedure used to improve the control of upper limb prosthesis.

One of the latest products on the market is the LUKE arm system (LUKE arm), the first ever powered shoulder joint. Despite the potential positive impact this will have on amputees, there is no knowledge about the long term effects and the lengths of time it can be worn. The LUKE Arm size, weight and practicality of use are areas that need to be considered carefully prior to provision. The LUKE arm is also significantly more expensive than all prosthetic products available on the market.

LUKE arm system

The LUKE arm is a modular prosthetic arm suitable for different levels of upper limb amputation, whether that be through, across or below the forearm, across the upper arm or by separating two bones at the shoulder joint.

The LUKE arm is made up of several different components and offers flexion and extension in the hand, rotation of the shoulder and rotation of the elbow. It has the option to be controlled, through an intuitive wireless foot control, which is placed in the user's shoes. This control has been likened to that of a PlayStation control in terms of ease of use and is a viable option for amputees who have no muscle signals and are unable to use other devices.

This all sounds like an amazing opportunity for amputees, however there are downsides to this product, not least the high cost per unit and potentially short life cycle. The LUKE arm is not yet CE marked and so does not conform to relevant health and safety standards. As such, UK users are not allowed to take the arm for home trials. The estimated cost of a five-day demonstration in the UK is approximately £25,000, which includes the presence of the US team in the UK. If you compare this with other options, the pros do not necessarily outweigh the cons.

Pros Cons
Only powered shoulder joint available on the market. Costs £200k per unit.
Provides increased functionality. Estimated short lifecycle and only a two year warranty. The likely outcome is that it will need replacing every two years.
Has a unique alternative control method – the foot control. Does not conform to UK safety standards.
The use of the foot control is very easy, especially compared to targeted muscle control, which requires lots of training. Only US-based – owned by one small company. The potential therefore of delays is great.
  Battery power is relatively poor in comparison to other options.
  No knowledge of long term effects.
  Extremely heavy so likely to only be worn for short periods of time. For instance, at a shoulder level the LUKE arm fitted to a socket weighs over 10kg.

Comment

It is still early days for the product. There remain very few users worldwide (less than ten) and consequently there is very little data to test the long term capability of the product at this stage. The early research indicates that there are still significant technical areas of development for the prosthesis as well as practical problems that make other products on the market more attractive to the amputee. In addition, there is the geographical hurdles, as the LUKE arm is not currently produced or approved outside the US, and most still need to be fitted there.

Whilst the prosthetics industry shows no signs of slowing down, it is likely that upper limb prostheses will show the greatest technological development in the short term future. The LUKE arm remains a work in progress but is undoubtedly a product that could benefit certain upper limb amputees if development continues. For the time being, however, the significant price differential for much smaller functional gain means that the LUKE arm is unlikely to be suitable in most cases, particularly where there is a compensation shortfall due to a liability split.

This article was co-authored by Abdo Haidar, Prosthetist, The London Prosthetics Centre.

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