No abstract

Background: The osseointegrated implant system is a treatment option for people with transfemoral amputation, but implant removal is not uncommon. The association between bone mineral density changes or bone turnover markers and the need for implant removal has not previously been investigated. Objectives: The aim was to evaluate changes in bone mineral density and bone turnover markers in people with transfemoral amputations treated with osseointegrated implants. Study design: This is a prospective cohort study. Methods: Nineteen patients were followed up for 30 months or until implant removal. Bone mineral density was measured in the lumbar spine, proximal femur and seven periprosthetic regions. 25-hydroxyvitamin (D2 + D3), parathyroid hormone, N-terminal propeptide of type-I procollagen, C-telopeptide of type-I collagen, bone-specific alkaline phosphatase and osteocalcin were measured in blood samples. Results: Four fixtures and three abutments were removed. Patients with removed implants had a decreased bone mineral density in the seven periprosthetic regions between 27% (95% confidence interval = 6; 43) and 38% (95% confidence interval = 19; 52) at 30-month follow-up compared to baseline ( p < 0.02), whereas bone mineral density around non-removed implants normalized to baseline values ( p > 0.08). C-telopeptide of type-I collagen was significantly different between the groups at 18- and 24-month follow-up ( p < 0.05). None of the measured variables were significant predictors of implant removal ( p > 0.07). Conclusion: Implant removal was associated with loss of periprosthetic bone mineral density and increase in C-telopeptide of type-I collagen in the years following osseointegrated surgery. Clinical relevance This study offers new insight into changes in bone mineral density and bone turnover markers that precipitate aseptic or septic osseointegrated implant removal. Results of this study could contribute to clinical guidelines for monitoring rehabilitation progress and implant removal through dual-energy X-ray absorptiometry or surrogate markers like C-telopeptide of type-I collagen.

All the participants experienced increased action space and a more positive outlook on life. However, it took determination and stamina to become a user of an osseointegrated prosthesis, and participants faced several challenges throughout this process. Consequently, it remains important to raise awareness of the difficulties faced during this process. Implications for Rehabilitation The findings from this study suggest an increased healthcare support to users of an transfemoral osseointegrated prosthesis in the period of rehabilitation and adjustment, as the results of being able to use the osseointegrated prosthesis may outweigh the obstacles of getting there. Implementation of long-term follow-up and psychosocial support initiatives may improve the adjustment process following osseointegration. Support of patients with an osseointegrated prosthesis may be facilitated through formation of specific rehabilitation groups together with increased use of information technology such as social media and relevant online communities which provide forums for interaction and dialog with people in similar situations.

No abstract

Abstract. Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain (n = 26), gait difficulties (n = 10) and intermittent fever (n = 9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) (n = 24), computer tomography (CT) (n = 17) and/or PET-CT (n = 10), predominantly displaying bone destruction/erosion of the symphysis (n = 13), abscess (n = 12) and/or fistula (n = 5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.

No abstract

No abstract