Osseointegration for Lower-Extremity Amputees

Abstract

Osseointegration for lower-extremity amputees, while increasing in frequency, remains in its relative infancy compared with traditional socket-based prostheses.» Ideal candidates for osseointegration have documented failure of a traditional prosthesis and should be skeletally mature, have adequate bone stock, demonstrate an ability to adhere to a longitudinal rehabilitation protocol, and be in an otherwise good state of health.

Osseointegration for Lower Limb Amputation

“…Ideal candidates for lower limb osseointegration have mature bone stock and no active infection or history of poor wound healing 11 . At our institution, a team-based approach to single-stage implantation is used.…”

“…Orthopedic surgery secures the implant into the residual femur or tibia and may place a bone graft at the distal bone edge. Next, plastic surgery forms a water-tight seal around the bone-metal interface with a muscular scarf 11,12 . Excess soft tissue is excised, often in the form of a medial and/or lateral thigh lift, and peripheral nerves are addressed with targeted muscle reinnervation (TMR) with or without regenerative peripheral nerve interfaces (RPNI).…”

“…[8][9][10] Ideal candidates for lower limb osseointegration have mature bone stock and no active infection or history of poor wound healing. 11 At our institution, a team-based approach to single-stage implantation is used. Orthopedic surgery secures the implant into the residual femur or tibia and may place a bone graft at the distal bone edge.…”

“…Next, plastic surgery forms a water-tight seal around the bone-metal interface with a muscular scarf. 11,12 Excess soft tissue is excised, often in the form of a medial and/or lateral thigh lift, and peripheral nerves are addressed with targeted muscle reinnervation (TMR) with or without regenerative peripheral nerve interfaces (RPNI). Targeted muscle reinnervation and RPNI were both originally performed in amputees for use in bioelectric prostheses but have also been shown to reduce the incidence of residual limb pain and phantom limb pain.…”

Transcutaneous osseointegration for amputees

“…The emergence of targeted muscle reinnervation as another aspect of the surgical reconstruction of an amputated limb, complimenting the contributions of TOFA, is an additional consideration that falls far beyond the scope of the discussion here. 9,13 As with all surgical procedures, patient selection is perhaps the most critical component of the algorithm leading to the highest rate of successful outcomes. 11,14,15 The importance of the multidisciplinary team in preoperative evaluation and perioperative management is another mandatory component of the protocol, and the value of shared decision-making with an informed, motivated patient with realistic patient-specific goals cannot be over emphasised.…”