Osseointegration

What is Osseointegration?

Osseointegration can allow amputees to wear a prosthesis for longer periods of time with greater comfort than a typical socket prosthesis.

The procedure allows for the direct attachment of an external prosthesis to the skeleton through the surgical titanium implantation of the intramedullary device.  Over time, the existing bone and the titanium fuse together, creating a single structure that offers a number of advantages over a prosthetic socket including:

Nearly anyone with a prosthesis can be a candidate for osseointegration, as it is currently offered for above and below knee amputees and above and below elbow amputees. In addition, osseointegration can be used to affix maxillofacial prosthetics and finger or toe prosthetics.  This is the same technology that is practiced in the dental industry.

The Procedure 

With medical advancements, a single-stage surgery was developed.  This has resulted in eliminating the need for a second operation and the associated risks, improved soft tissue management, faster rehabilitation, earlier return to work and lower overall costs. Following the procedure, the patient usually requires a period of approximately 12 months for the bone and the wounds to heal. Osseointegration is now performed in the US.  In July, 2015 the osseointegration procedure was approved by the U.S. Food and Drug Administration.

Benefits

• Eliminates all socket problems
• Lower energy consumption
• Increased joint range of motion
• Increases stability
• Restores proprioception
• Decrease of overall pain
• Faster and easier donning/doffing
• Accommodates weight gain/loss
• Zero perspiration issues, since liners aren’t required
• No pressure sores or skin irritation
• Accommodates hard-to-fit patients well, especially very short residual limbs
• Can shower and/or swim

Rehab

Rehabilitation usually starts 1 or 2 days after the surgery.  This is done in two phases and is customized by the doctor, PT and prosthetist and developed based upon the patient’s weight, health and physical abilities.

Phase 1 – Static Loading

• Weight bearing on the abutment (metal attachment) with approximately 10 lbs, and gradually increases to the target weight bearing capacity.
• This phase usually last about 6 weeks.

Phase 2 – Gait Training with the Prosthesis

• The prosthetist would attach the prosthetic components to the abutment.
• Unlimited ambulation with two crutches and adjusted according to the patient’s tolerance for pain.
• The PT would now work on strength, range of motion and balance.
• The patient would continue to follow-up with their prosthetist.

Contraindications:

• Not recommended for high impact activities
• Poor candidate for surgery
• Brittle bone