Orthopaedic Osseointegration: State of the Art

Abstract

Osseointegration is a surgical approach that permitted the direct attachment of an external prosthesis to the skeleton in some select patients with amputation, who had failed to tolerate conventional sockets, thereby obviating related issues such as discomfort, skin breakdown, and poor fit. In this specific population, osseointegration offers the potential for enhanced biomechanical advantage and rehabilitative potential. Multiple percutaneous implant systems exist for clinical use internationally, each attempting to create a stable bone-implant interface while avoiding complications such as infection and loosening. Prospective clinical trials are now underway in the United States. This article will review the history and biology of osseointegration, indications and contraindications for use of currently available implant systems, and reported outcomes. Future directions of orthopaedic osseointegration technology, including electronic systems capable of biomimetic bidirectional volitional motor control of, and sensory/proprioceptive feedback from, external prosthetic devices, will also be discussed.

Osseointegrated reconstruction and rehabilitation of transtibial amputees: the Osseointegration Group of Australia surgical technique and protocol for a prospective cohort study

“…The findings of the study would assess whether osseointegration in TTA is feasible in terms of risks and benefits and also make an important contribution to the otherwise limited literature regarding outcomes of osseointegration in lower extremity amputations. As evidenced by literature, TTA using TSP suffer from same difficulties involving skin breakdown, 8 suboptimal fit 49 and pain 4 as do the transfemoral ones, which ultimately affect their prosthetic use, mobility and overall quality of life. As the dramatically different concept of osseointegration proved life-changing in management of TFA with established safety, it is only logical to extend the science to TTA and document the outcomes.…”

“…All implants are connected to a dual cone adapter with Morse-taper ends connecting the implant with the external prosthesis. The surface of the dual cone adapter is highly polished and coated with titanium-niobium oxide, an alloy known to have bacterial repellent properties, 4 which also facilitates the excursion of the soft tissues and skin over it avoiding adhesions. A safety mechanism is built into the dual cone, with a safety pin that breaks to reduce the chance of periprosthetic fractures or implant breakage.…”

“… 2 For centuries, the conventional way of rehabilitating such individuals has been via traditional socket-mounted prostheses (TSP), 3 and despite significant technological innovations to both socket materials and design, there has been very little change to the overall prosthetic-residuum interface from a moulded compression cone to modern suction-based socket suspension. 4 …”

“…Open access rehabilitating such individuals has been via traditional socket-mounted prostheses (TSP), 3 and despite significant technological innovations to both socket materials and design, there has been very little change to the overall prosthetic-residuum interface from a moulded compression cone to modern suction-based socket suspension. 4 The use of TSP is associated with a spectrum of complications arising mainly out of the socket-residuuminterface that causes reduction in prosthesis use, ability to mobilise and quality of life. 1 5-7 These include skin problems such as infections, and skin breakdown due to chronic irritation and thermal injury, [8][9][10][11] mechanical problems such as suboptimal fit, pain and pistoning 12 and problems with proprioception that leads to loss of balance and falling.…”

“…16 It involves insertion of porous metal implant in the medullary cavity of the bone in a screw or press-fit technique, over which compact cortical bone grows without any intervening soft tissue in a short course of time, integrating the implant structurally and functionally to the bone. 17 This integration of non-vital component into living bone was first discovered serendipitously in 1950s in rabbit models 4 and has been well established in the field of dentistry for the treatment of edentulous jaws for many years with a 10-year survival of dental implants in mandibular bone of 95%. [18][19][20][21] Since its first introduction in 1990s in individuals with amputations, osseointegration has been predominantly used for the treatment of individuals with transfemoral amputation demonstrating multiple potential advantages such as improved walking ability, daily prosthetic use, reduced energy consumption, sitting comfort and osseoperception.…”