The state of the art of osseointegration for limb prosthesis

Abstract

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.

A trilogy antimicrobial strategy for multiple infections of orthopedic implants throughout their life cycle

“…Prompt integration of implants into host tissue is crucial for the success of prosthesis implantation in orthopedics [ 63 ]. Distinct osseointegration levels were obtained from implants with various coating systems ( Fig.…”

Extramedullary Osseointegration—A Novel Design of Percutaneous Osseointegration Prosthesis for Amputees

“…The long-term maintenance of the bone-anchored prostheses is challenging due to the risk of mechanical failures and deep infections ( Li and Fellander-Tsai 2021 ). Previous efforts were mainly focused on improving the osseointegration efficiency by the modification of implant surface morphology, changing of implant materials, or improving surgical methods ( Overmann and Forsberg 2020 ). Our 3D finite element analysis revealed that the two maximal stress areas in the screw-type implant system located proximally to the BIC and the connecting rod to external prostheses.…”

Fifty years of bone tumors

“…In approximately 15% of cases in which amputation is indicated, advances in surgical techniques and prosthetic fabrication have led to increased patient satisfaction and acceptance related to improved function and cosmetics. Recently, prosthetic fixation using osteointegration fixation of a metal stem inserted into the medullary cavity has been shown to be especially successful in patients with high femoral amputations 59,60 . Use of this technique obviates the need for using uncomfortable, ill‐fitting sockets.…”

“…Recently, prosthetic fixation using osteointegration fixation of a metal stem inserted into the medullary has been shown to be especially successful in patients with high femoral amputations. 59,60 Use of this technique obviates the need for using uncomfortable, ill-fitting sockets.…”