Over the last few months two of our Troopers had Osseointegration surgery in Glasgow and as you can see they are both recovering well. You can find out more about the procedure below. The following information is provided thanks to AOFE (Amputee Osseointegration Foundation Europe and was correct as of 2019.
What is Osseointegration
Osseointegration (OI), also known as direct skeletal fixation (DSF), is a pioneering procedure that involves fitting a titanium implant directly into the bone, allowing for a prosthesis to be connected to it. This method represents a significant departure from the traditional approach of fitting a socket to a residual limb, which has been the prominent method for hundreds of years.
Osseointegration was discovered in the 1950s and introduced to the UK in the 1990s. Initially an option for above the knee amputees, the technique is increasingly being used to treat below the knee and upper limb patients thanks to the increase in the collective global experience of the procedure.
The insertion of a titanium implant into the bone is performed as part of a one or two stage surgery. After this, a period of gradual and increased loading through the implant then takes place.
Why Osseointegration?
The benefits of being able to walk on prosthetics are acknowledged as being both psychological as well as physical. It can dramatically improve the lifestyle of the individual as well as their long-term health, in addition to reducing dependency and potentially providing the opportunity to return to work if they have not been able to before. Because the prosthesis is directly attached into the bone, patients feel it as being part of their own body by natural osseoperception. The removal of the need for a socket also has the benefit of eliminating any long term challenges associated with their use, such as chafing, rubbing, friction, excoriation, ulcers and infections. Good hygiene and care around the site where the abutment protrudes out of the body is essential to reduce the risk of infection, although inflammation of the bone is rare.
Above knee level
Below knee level
Above elbow level
Advantages of osseointegration
- Increased prosthetic use
- Longer walking distances
- Better sitting comfort
- No skin problems
- Stable and safer standing and walking
- Osseoperception
- Quickly on and off
- Better quality of life
Two osseointegration systems:
- Screw shape prosthesis (OPRA): This prosthesis was developed by the osseointegration pioneers in Sweden and is the system with the longest and largest follow up. The titanium prosthesis is derived from the dental implants, has a screw design and a relatively short length. There is broad experience across Europe with this osseointegration system. However the titanium screw requires a relatively long time for solid osseointegration and therefore, the rehabilitation period until full weight bearing is long- typically 6 to 12 months. Another disadvantage is that the implant may become loose and the distal abutment is relatively weak. The abutment may bend or break at higher bending forces during daily activities.
- Press fit prosthesis (ILP): The design and implantation technique was derived from orthopedic hip prostheses. This prosthesis was developed in Germany and is a chrome cobalt molybdeen alloy rod with a 3D tripod surface structure. The osseointegration capacity of this prosthesis is huge, therefore the prosthesis can be load bearing much earlier than the OPRA system. The osseointegration period is 6 weeks and there are osseointegration clinics that allow full weight bearing on the osseointegration system immediately after single stage surgery. A new generation press fit prostheses is made of titanium alloy rods with a rough surface. This titanium prosthesis has the same features as current orthopedic implants; strong and solid. The osseointegration is quick and the rehabilitation period short.
Are there any disadvantages of osseointegration ?
Osseointegration is a safe treatment. Inflammation of the bone is rare. A disadvantage is that the area where the implant penetrates the skin (=stoma) needs to be cleaned with water and soap twice daily. This is comparable with brushing teeth. In some cases the skin at the penetration area may become irritated. In the first year after implantation you may have intensive muscle pain. This muscle pain disappears as soon as the stump muscles become fitter and stronger.
What happens with the bone with an osseointegration prosthesis?
Most patients treated with osseointegration have weak bone because of disuse osteoporosis. In the socket prosthesis the bone is not loaded and the stump muscles are not active. This may result in decreased muscle volume and weaker bone. With osseointegration the natural load of the bone is restored and the stump muscles are reactivated to stabilize the bone.
In the Radboudumc Osseointegration Clinic in The Netherlands, bone remodeling processes have been evaluated and the data show that the bone around the osseointegration implant becomes thicker and stronger.
Can I do everything with my osseointegration prosthesis?
With an osseointegration prosthesis you can do all daily life activities including taking a bath, swimming in the sea, river, lake, pool, going in the sauna, bicycling, sailing etc. Contact sports including; fighting, soccer and skiing are not recommended. You may do these sports without wearing your prosthesis.
Am I suitable for osseointegration?
You are a good candidate for osseointegration when:
- you experience problems with your socket (perspiration, skin problems, pain)
- your walking distance is limited because of your socket
- you can’t sit comfortably with your socket
- you often lose your prosthesis during daily activities
- you have back pain because you stand or sit not straight or limb while you walk
The osseointegration treatment in summary
Surgery: The metal implant(Titanium) will be inserted into the bone of your stump. If necessary the length of the bone will we adjusted and the soft tissue corrected. After the implantation the wound is closed. Then a small skin incision is made and a connecting adapter of the osseointegration prosthesis is put through this incision into the implant. This skin penetration point is called a stoma. After the surgery you will be observed in the hospital for three to five days. In the hospital you will get instructions how to clean the stoma. Your prosthesis will be prepared for the connection with the osseointegrated implant by our prosthetists. After discharge from the hospital you will stay during the rehabilitation in a hotel or apartment close to the hospital.
Rehabilitation: One week after surgery the osseointegration rehabilitation starts. This takes place every day in your rehab department. You step-by-step learn how to load the prosthesis and how to walk with crutches. Below knee amputees will complete the rehabilitation in three weeks. Above knee amputees complete rehabilitation in five weeks but will have to do exercises at home before they are able to walk fully weight bearing on the osseointegration prosthesis without crutches.