CORR Insights®: What Are the Risk Factors for Mechanical Failure and Loosening of a Transfemoral Osseointegrated Implant System in Patients with a Lower-limb Amputation?

Abstract

such a registry exists [15]*. If you are performing osseointegration surgery for patients with limb loss, please participate.

CORR Insights®: Have Surgery and Implant Modifications Been Associated With Reduction in Soft Tissue Complications in Transfemoral Bone-anchored Prostheses?

“…Which is to say, I don’t think this question is likely to be definitively answered. Rather, we will accept that this is “what we are doing now,” much like the shift to predominantly titanium implants in THA [8].…”

“…The strength of these findings and determining whether the learning curve differs for different implants and techniques would be greatly improved by registry participation. As mentioned in my previous CORR Insights article [8], an osseointegration registry already exists (for more information on registry participation, please email Osseointegration_registry@hjf.org). Moreover, because many surgeons and centers are now seeking to establish osseointegration programs (and for best results, these do need to be programs; it shouldn’t just be surgeons doing procedures), most of these programs will, by definition, be low-volume, low-experience-level endeavors at first.…”

“…O sseointegration for persons with limb loss refers to the direct, transcutaneous skeletal attachment of a prosthesis to bone. The advantages that derive from these technologies (compared with conventional, socket-based prostheses) include ease of use and good physical function, patient-reported outcome measures, and even improved quality of life [4,8,9]. Other putative benefits such as quantitative gait improvements, as well as novel concepts such as osseoperception and osseoproprioception, remain less-well proven but are areas of active investigation.…”

“…Currently, we know that superficial infections after transcutaneous osseointegration are expected and (usually) minor, and could to some degree be considered part of the natural history of this treatment modality; we would nonetheless like to prevent or minimize these superficial infections if we can. As I have written in another CORR Insights ® commentary [8], soft tissue management strategies for osseointegration have gradually evolved toward a less-is-more approach, what my friend Dr. Jason Souza (a plastic and reconstructive surgeon and former colleague) has termed "trading blood supply for stability" (verbal communication, Jason Souza MD, 2022). The findings of Atallah et al [2] provide objective evidence that, at least within the constraints of our current state of complimentary infection prevention and mitigation technologies, this trade is a good one.…”

A preliminary, observational study using whole-blood RNA sequencing reveals differential expression of inflammatory and bone markers post-implantation of percutaneous osseointegrated prostheses

“…However, some currently used implant systems fail to maintain permanent osseointegration because the design configuration intrinsic to the implant does not support bone deposition and over time encourages stresh shielded bone loss. Such resorption can also result in stomal collapse if the skin around the percutaneous post is attached to this underlying resorbing [ 9 – 12 ]. To date, there are no techniques that are capable of predicting early implant demise secondary to the failure of the process of osseointegration.…”