Abstract
Background: Traditional socket-based prostheses are an important rehabilitation tool in lower limb amputation, however, patients often experience skin-related problems, pain, stump volume fluctuations and poor suspension. Osseointegration offers a suitable alternative by providing direct skeletal attachment for limb prosthesis. This study aims to review the complications following osseointegration for lower limb amputation, with attention to mechanical abutment failure. Method: A retrospective chart review was undertaken of all patients who underwent transfemoral osseointegration between January 2000 and June 2019 through the osseointegration and targeted muscle reinnervation surgical and rehabilitation program at The Alfred in Victoria, Australia. Ethics approval was obtained through The Alfred’s ethics committee (414/16). In 2016 this program was redesigned and in 2017 the osseointegration implant system was modified. Patients underwent a two-stage surgical procedure followed by a rehabilitation protocol that gradually increased their activity. Results: A total of 19 limbs were osseointegrated in 18 patients during the study period. Two patients had their implant removed due to failure of osseointegration. The most common complication was a mechanical abutment failure, occurring 46 times in 11 patients. Patients who suffered an abutment failure reported higher levels of postoperative activity. Soft-tissue infections occurred in five patients: three superficial skin infections and two collections. There were no mechanical abutment failures noted in the updated program.Conclusion: Osseointegration is a good option for patients who may have difficulties with traditional socket prosthesis. However, complications such as abutment fracture can occur, and appropriate patient selection and counselling are required
Highlights
Transfemoral amputations have devastating consequences—patients are left with significant functional, psychological and social issues that decrease their quality of life.[1,2,3,4,5] Currently a socket prosthesis is the most common means of improving function in the residual limb.[4,6,7,8] high forces are applied from a prosthetic socket to the soft tissue of the residual limb.[6]
Osseointegration is a good option for patients who may have difficulties with traditional socket prosthesis
Osseointegration provides an alternative for patients who are suffering from the adverse effects of traditional socket prosthesis.[1,2,3,4,5,6,7,8,9,10]
Summary
Transfemoral amputations have devastating consequences—patients are left with significant functional, psychological and social issues that decrease their quality of life.[1,2,3,4,5] Currently a socket prosthesis is the most common means of improving function in the residual limb.[4,6,7,8] high forces are applied from a prosthetic socket to the soft tissue of the residual limb.[6]. Osseointegration provides an alternative for patients who are suffering from the adverse effects of traditional socket prosthesis.[1,2,3,4,5,6,7,8,9,10] The aim of osseointegration is to create a direct transcutaneous skeletal attachment for a prosthesis, negating the need for a socket.[1,6,8,9,10] Patients who successfully undergo osseointegration may have improvements in quality of life, prosthetic use, range of motion in the residual limb, mobility, prosthetic fixation and sensory perception compared with traditional socket prosthess.[6,8]. Osseointegration offers a suitable alternative by providing direct skeletal attachment for limb prosthesis. This study aims to review the complications following osseointegration for lower limb amputation, with attention to mechanical abutment failure
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