Osseointegration Research

Webster, Joseph B.; Bachus, Kent N.; Beck, James P.; Jeyapalina, Sujee; Drew, Alex J.; Bloebaum, Roy D.

doi:10.1007/978-1-4939-7247-0_10

Cited by 9 publications

(12 citation statements)

References 86 publications

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“…The implant consists of three components: the fixture, which a threaded, cylindrical implant that integrates into the residual bone; the abutment, which is the percutaneous component that press fits into the distal end of the fixture thereby allowing attachment to the external prosthesis; and the abutment screw, which connects the fixture to the abutment (Fig. 1) [63]. In addition to the threads, there are radially placed perforations along the body of the fixture.…”

Section: The Osseointegrated Prosthesismentioning

confidence: 99%

“…The implant consists of a cobalt-chrome "endo" stem that press fits into the intramedullary canal and an "exo" module. The "endo" stem is coated in metal spongiosa to create a deep porous surface for bony ingrowth [63,69]. While porous coatings are used extensively in arthroplasty, extensively coating the implants can cause stress shielding and bone resorption and make removing the implants for revision surgery more difficult.…”

Section: Osseointegrated Prosthetic Limb (Opl) and The Integral-leg Prothesis (Ilp)mentioning

confidence: 99%

“…The Osseointegrated Prosthetic Limb (OPL) (Paramedica, Milan, Italy) is a modified version of the original ILP prosthesis that is used for transfemoral and transtibial amputees [63,69]. The implant is made of titanium rather than a Co-Cr alloy to better match the elastic modulus of the host bone.…”

Section: Osseointegrated Prosthetic Limb (Opl) and The Integral-leg Prothesis (Ilp)mentioning

confidence: 99%

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The state of the art of osseointegration for limb prosthesis

Overmann

Forsberg

2019

Biomed. Eng. Lett.

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Osseointegration (OI) is the direct attachment of bone onto a titanium implant. Recently, the term is used to describe "transdermal" implants that allow an external prosthesis to be connected directly to the skeleton. This technology eliminates the challenges of conventional socket-based prostheses, such as skin breakdown and poor fit, which are common in patients with major extremity amputations. Osseointegration patients demonstrate encouraging improvements in quality of life and function. Patients report improvement in prosthetic use, prosthetic mobility, global health, and pain reduction on a variety of clinical assessment tools. Various implants have been developed for osseointegration for amputees. These implants use a variety of fixation strategies and surface augments to allow for successful integration into the host bone. Regardless of design, all OI implants face similar challenges, particularly infections. Other challenges include the inability to determine when integration has occurred and the inability to detect loss of integration. These challenges may be met by incorporating sensing systems into the implants. The percutaneous nature of the metal devices can be leveraged so that internal sensors need not be wireless, and can be interrogated by external monitoring systems, thus providing crucial, real-time information about the state of the implant. The purpose of this review is to (1) review the basic science behind osseointegration, (2) provide an overview of current implants, practice patterns, and clinical outcomes, and (3) preview sensor technologies which may prove useful in future generations of transdermal orthopaedic implants.

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Section: The Osseointegrated Prosthesismentioning

confidence: 99%

Section: Osseointegrated Prosthetic Limb (Opl) and The Integral-leg Prothesis (Ilp)mentioning

confidence: 99%

Section: Osseointegrated Prosthetic Limb (Opl) and The Integral-leg Prothesis (Ilp)mentioning

confidence: 99%

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The state of the art of osseointegration for limb prosthesis

Overmann

Forsberg

2019

Biomed. Eng. Lett.

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“…In parallel to prosthesis development, research on percutaneous osseointegrated (OI) endoprostheses for prosthesis attachment has rapidly progressed. By eliminating the socket, these systems bypass problems of poor fit and discomfort and allow for quicker prosthesis don and doff time [5]. In the United States, transfemoral percutaneous OI endoprostheses have undergone FDA evaluation, with one gaining humanitarian use approval (OPRA™, Integrum) and another (POP, DJO Global) undergoing clinical trials (NCT02720159).…”

Section: Introductionmentioning

confidence: 99%

Upper extremity prosthetic selection influences loading of transhumeral osseointegrated systems

et al. 2020

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Percutaneous osseointegrated (OI) implants are increasingly viable as an alternative to socket suspension of prosthetic limbs. Upper extremity prostheses have also become more complex to better replicate hand and arm function and attempt to recreate pre-amputation functional levels. With more functionality comes heavier devices that put more stress on the bone-implant interface, which could be an issue for implant stability. This study quantified transhumeral loading at defined amputation levels using four simulated prosthetic limbtypes: (1) body powered hook, (2) myoelectric hook, (3) myoelectric hand, and (4) advanced prosthetic limb. Computational models were constructed to replicate the weight distribution of each prosthesis type, then applied to motion capture data collected during Advanced Activities of Daily Living (AADLs). For activities that did not include a handheld weight, the body powered prosthesis bending moments were 13-33% (range of means for each activity across amputation levels) of the intact arm moments (reference 100%), torsional moments were 12-15%, and axial pullout forces were 30-40% of the intact case (p�0.001). The myoelectric hook and hand bending moments were 60-99%, torsional moments were 44-97%, and axial pullout forces were 62-101% of the intact case. The advanced prosthesis bending moments were 177-201%, torsional moments were 164-326%, and axial pullout forces were 133-185% of the intact case (p�0.001). The addition of a handheld weight for briefcase carry and jug lift activities reduced the overall impact of the prosthetic model itself, where the body powered forces and moments were much closer to those of the intact model, and more complex prostheses further increased forces and moments beyond the intact arm levels. These results reveal a ranked order in loading magnitude according to complexity of the prosthetic device, and highlight the importance of considering the patient's desired terminal device when planning post-operative percutaneous OI rehabilitation and training.

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“…Osseointegration surgery has revolutionized amputee rehabilitation by eliminating socket-interface problems 18 - 20 . Osseointegration is performed predominantly for transfemoral amputees 21 - 25 , consistently improving prosthetic use, proximal joint range of motion, mobility level, walking ability, and QoL, and reducing energy consumption 26 - 29 compared with traditional socket prosthesis.…”

mentioning

confidence: 99%

Transtibial Osseointegration for Patients with Peripheral Vascular Disease

et al. 2021

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Background: The management of peripheral vascular disease (PVD) can require amputation. Osseointegration surgery is an emerging rehabilitation strategy for amputees. In this study, we report on 6 patients who had PVD requiring transtibial amputation (PVD-TTA) and either simultaneous or subsequent osseointegration (PVD-TTOI). Methods: Six patients (aged 36 to 84 years) with transtibial amputation and preexisting PVD underwent osseointegration between 2014 and 2016 and were followed for 3 to 5 years. Pre- and postoperative clinical and functional outcomes (pain, prosthesis wear time, mobility, walking ability, and quality of life) and adverse events (infection, fracture, implant failure, revision surgery, additional amputation, and death) were prospectively recorded. Results: All patients’ mobility improved following osseointegration. Three patients initially had required the use of a wheelchair, precluding baseline walking tests; the other 3 were classified as K level 1 or 2, with mean baseline Timed Up and Go (TUG) test = 14.0 ± 2.2 s and 6-Minute Walk Test (6MWT) = 262 ± 75 m. At the time of the latest follow-up, all patients were K level 2 or 3; mean TUG = 12.7 ± 7.2 s and 6MWT = 353 ± 148 m. Four patients wore their prosthesis ≥16 hours daily. Three patients had superficial soft-tissue infections. One other patient experienced recurrent infections 2.8 years after osseointegration requiring debridements and transfemoral amputation; the patient died 2 days following surgery from myocardial infarction caused by coronary atherosclerosis. Conclusions: All 6 patients who underwent PVD-TTOI in this case series survived through 2 years. Patients who initially had used a wheelchair achieved and maintained independent, unaided ambulation until PVD-related impairments in the contralateral leg occurred in 1 patient. Patients previously using a traditional socket prosthesis reported improvement in mobility and quality of life. One patient’s death underscores the importance of careful patient selection. However, marked improvement in the other 5 patients suggests cautious optimism that PVD-TTA is not an absolute osseointegration contraindication. Conscientious further investigation seems appropriate. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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Osseointegration Research

Cited by 9 publications

References 86 publications

The state of the art of osseointegration for limb prosthesis

The state of the art of osseointegration for limb prosthesis

Upper extremity prosthetic selection influences loading of transhumeral osseointegrated systems

Transtibial Osseointegration for Patients with Peripheral Vascular Disease

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