Osseointegration is the firm anchoring of a surgical implant (as in dentistry or in bone surgery) by the growth of bone around it without fibrous tissue formation at the interface. This can be done in the femur, tibia, humerus, radius/ulna & digits
Components to Implant
Two Approaches To Osseointegration Surgery
First is the original screw-fixation system, the Osseoanchored Prosthesis for rehabilitation of Amputees(OPRA) Implant System. Manufactured by Integrum AB In Molandal, Sweden.
- only available with transfemoral amputees and is performed via a two stage technique with six months in between 1st and 2nd stage
(uses a hollow implant that takes longer for Osseointegration bone formation to fill cavity)
Second is the press fit implants that are manufactured by various countries like the Dutch and Aussies. This allows for immediate implant stability allowing earlier weight bearing activities. Performed on both AKA’s and BKA’s
(uses a solid core that is porous coated which allows for bone and structure to be one)
Rehabilitation
OPRA SYSTEM – screw fixation
1st stage-implant only
- includes a 2-3 stay in hospital after 1st surgery
- 6 months of non-weight bearing
- between 1st & 2nd stage patient can wear a socket but it is rare
2nd stage- creating stoma and soft tissue rearrangement
- Includes a 7 day stay in hospital
- 6 weeks of non weight bearing and limited hip range of motion
- goal is to have patient walking 1yr from 1st stage procedure
Rehabilitation After Surgery
PRESS FIT SYSTEM
1st stage
- 2-3 day hospital stay after 1st stage
- non weight bearing for 6 weeks
- soft tissue rearrangement
- cannot use a traditional socket
2nd stage
- creating stoma and some soft tissue rearrangement
- same day surgery
- followed by partial weight bearing using a scale to full time weight bearing using prosthesis
- sometimes will do the procedure in one stage but there could be difficulties(skin retraction, infection, hypergranulization, most
importantly doesn’t give the soft tissue time to recover and mature)
What are the Advantages of Osseointegration Over Traditional Prosthetic Limbs
- improves mobility
- improves proprioception or what is called osseoperception
- typically will reduce nerve pain
- eliminates problems associated with sockets
- better physical control, energy transfer
- can feel vibrations as it is connected to the bone
- actually can tell when standing on uneven terrain
- lower energy consumption
- increase joint range of motion
- allow more stability
What are the Disadvantages of Osseointegration Over Traditional Prosthetic Limbs
- muscle/joint pain during the healing phase/walking do to soft tissue reconstruction, Using different muscles
- stoma infection which is the interface between implant and soft tissue. Infections are common but not serious typically controlled
by oral antibiotics. - over granulation/irritation which is overgrowth of skin at stoma site,fixed with surgery.
- deep tissue infection with signs of drainage or build up of fluid within soft tissue usually IV antibiotics are needed
- Implant loosening which is very rare
- bone infection very rare will need to be removed and can be replaced after infection goes away
- implant breakage very rare but has occurred do to wrong implant size or patient fault
- bone fracture has occurred but usually above implant, osteoporosis
- tissue retraction which is seen more in in single stage surgeries
Who Is A Candidate For Osseointegration
- those who are having difficulty with traditional sockets
- short, wide, scarred, painful
- traumatic amputation
Who Is Not A Candidate For Osseointegration
- diabetic
- vascular disease
- osteoporosis
- other underlying medical conditions
- but this is changing with more Osseointegration occurring
How Long Does Osseointegration Last
- the implant will last for many years as long as there are no complications. This is relatively new as the Swedes had only been doing this since the early 90’s. So we do not have a lot of history as of yet
From Physical Rehab Prospective
To manage soft tissue pain control
- pendulums
- offloading weight through arms
- bike with no resistance
Main principles guiding press fit Osseointegration and optimizing rehab
- must achieve 2 point gait pattern
- accomplished by using crutches and moving onto walking sticks
- important to have lateral pelvic weight shift during stance phase
From Physical Rehab Perspective
Why do we recommend bilateral assistive devices
- Neurological principles
- Optimized biomechanics
- Improved weight shift over prosthetic side
From Prosthetist Prospective
Regular servicing every 3 months should consist of checking
- tightness of dual cone screw
- tightness of taper sleeve screw
- taper sleeve removed and inspected will also allow for easier removal if it
needs to be replaced
Surgeon & Prosthetists Dilemma
- Osseointegration is considered a class 2 device
- So Doctors are the ones that are licensed to use these devices, but
- The external portions, like the taper sleeve and screws are left up to the prosthetist to tighten and remove
- The doctors are responsible for the dual cone,abutment and internal bone fixation
- So anything exposed is the prosthetists problem anything internal is the doctors problem
What Components Should Be Considered With Osseointegration Fittings
- torsion adapter
- shock absorber
- compliant prosthetic foot
- Microprocessor knee
Osseointegration Frequently Asked Questions
- Can I do sports?
- The recommendation is that you don’t run, hop, skip for the 1st year. If you decide to do a impact after a year its at your own risk. There is not enough data to determine the capabilities do to it being so new.
- Will I still need to see a prosthetist?
- Yes, there are screws that need to be checked every 3-4 months to make sure they are not loose and to
have an overall follow up to make sure everything is ok - How much does it cost?
- It is different for every amputee. Depending on the level of amputation, the cause of amputation, bone quality, muscle/soft tissue and the integrity of the skin of the residual limb. These are all factors that need to be considered when planning the surgery that will influence cost. Many providers are willing to work with you and some insurances cover the cost. We can do the research for you and let you know.
- How many operations are there?
- One major operation to do the implant with a hospital stay of 2-3days. A second operation to possibly revise any soft tissue if needed, this is same day surgery and you go home.
- How long before I can walk on the prosthesis?
- With the OPRA(screw) system the goal is to be walking within 1yr of having 1st operation. With pressed fit approximately 6 weeks before you start to weight load the residual limb.
- Can I swim
- Absolutely…..Salt water is recommended whether its a pool or the ocean. This actually helps with healing and there is less chances of getting an infection in a chlorinated pool. Once done swimming it is recommended that you wash the stoma site