32. When to Expect the Unexpected: A Timeline of Complications in Lower Limb Osseointegrated Protheses

Abstract

PURPOSE: Osseointegrated prostheses are a novel alterative to socket-suspended prostheses that have been shown to improve mobility, nerve pain, and other issues associated with poorly tolerated sockets. However, osseointegrated prostheses themselves can lead to post-operative complications that rely on plastic surgery intervention. Little is known about the timeline of these complications as few centers currently perform the procedure. METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Time-to-event analyses were performed for identified complications. RESULTS: Our study included 70 patients: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. Patients were followed for 19.6 months on average. Hardware failures(2) occurred on postoperative days 7 and 245. Limb fractures(4) occurred on average at 135 days post-op. Neuromas(3) occurred on average at 306 days post-op. Cases of osteomyelitis(5) occurred on average at 332 days post-op. Revisions of soft tissue(7) occurred on average at 389 days post-op. Soft tissue infections(26) occurred on average at 129 days post-op. 50% of soft tissue infections occurred within one month post-operatively, and 81% within four months. CONCLUSION: Certain postoperative complications often occur shortly after implantation (Soft tissue infections, limb fractures), while others occur at later timepoints (neuromas, osteomyelitis, soft tissue excess). These results can help elucidate the etiologies of observed complications, and aid surgeons in anticipating when osseointegrated prostheses complications may occur in future patients.