Dr Laura Witte
The United States has approximately two million people living with a lower limb amputation.1 Prothesis which were developed to enhance mobility and independence but have had complications with fit leading patients to forgo use. Osseointergration was developed as an alternative to traditional prosthesis and is directly anchored to the residual bone thru and opening thru an opening thru the skin.2 This paper is to explore the types of implants available, complications associated with Osseointergration systems and functional outcomes of osseointergration in patient with transfemoral amputations.
There are several osseointegration implant types on the market at this time. The Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA) by Integrum has the longest follow-up with three decades of use.2 Studies have shown improvements in patient functional outcomes compared to socket prostheses for all of the osseointegration implant types studied. There were statistically significant improvements in the Questionnaire for Persons with Transfemoral Amputations, 6-minute walk test, and Timed Up-and-Go test. Gait analysis showed that patients with osseointegration had similar cadence and duration of the gait cycle to patients without amputations.4,7,10,16,18,19,20-23
Contraindications for osseointegration initially were patients with peripheral vascular disease, diabetics, age above 70, ongoing chemotherapy, irradiated limbs, skeletal immaturity, and pregnancy. Also, those with psychiatric conditions causing compliance concerns were excluded from consideration for osseointegration. Similar to the evolution of arthroplasty, surgeons are now expanding their indications for osseointegration to include the elderly amputees and patients with amputations performed for peripheral vascular disease. However, there have been no studies with long-term follow-up on elderly or peripheral vascular disease amputees.2
Infection remains the most common complication following osseointegration with superficial infections requiring local wound care and deep infections necessitating revision. Other complications noted were periprosthetic fractures, loosening, soft tissue complications, and mechanical complications with the abutment.17
Osseointegration has been successful in improving the quality of life for amputees as well as increasing prostheses use. Although traditional socket prostheses are the standard of care, as further research is conducted with long-term follow-up, there will likely increase in the number of patients opting for osseointegration versus traditional prostheses.
Amaya A. Osseointergration for Treatment of Lower Limb Amputations. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2021; 3(3).
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