Osseointegrated Titanium Implants for Limb Prostheses Attachments: Infectious Complications

Abstract

Background The concept of osseointegration involves direct contact between titanium implant and bone. This transcutaneous prosthetic system for amputees is intended to assure stable long-term fixation. Most metal transcutaneous implants have failed, primarily owing to infection.Questions/purposesWe determined the frequency and describe the presentation of infectious complications with this novel method. We also evaluated the bacterial flora at the skin-penetration area and its relation to the development of local and implant-related infection.Patients and MethodsWe prospectively followed 39 patients with arm and leg amputations fitted with transcutaneous osseointegrated titanium implants a mean of 56 months earlier (range, 132–133 months). There were 33 femoral, one tibial, four ulnar, four radial, and three humeral implants. Patients were selected during a 6-month period in 2005 and identically reevaluated after 3 years. Implant infection was defined as definite, probable, or possible based on clinical, radiologic, and microbiologic evidence.ResultsThe frequency of implant infection was 5% at inclusion and 18% at followup. One patient with infection recovered owing to antibiotic treatment and another patient had the implant removed. Most implant infections had low infectious activity, and in five of the seven patients with infections, prosthetic use was not affected. The most common bacteria in superficial and deep cultures were Staphylococcus aureus and coagulase-negative staphylococci.ConclusionsDespite frequent colonization around the skin-implant interface by potentially virulent bacteria such as Staphylococcus aureus and bacteria associated with biomedical device infections such as coagulase-negative staphylococci, this titanium implant system for bone-anchored prostheses caused few infections leading to disability or implant removal.Level of EvidenceLevel IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model

“…In this study, antibiotic administration based upon results of the preliminary study regarding the antibiotic sensitivities of the causative organism may have effectively prevented infection recurrence. Additionally, the titanium implant we used has shown the ideal biocompatibility [39,40]. In a perspective we may expect that the use of new biomaterial could lead to a better outcome for the treatment of spinal infection.…”

Fifteen years of experience with Integral-Leg-Prosthesis: Cohort study of artificial limb attachment system

“…While it seems intuitive that any percutaneous device that is chronically attached to bone would rapidly become infected, the entire European experience of osseointegrated prosthetic attachment has a historical long-term success rate of 70 to 80 percent [4,8,22]. Patients with these devices live for years with infection-free, skeletally attached artificial limbs; significantly improved activity levels; and a high quality of life [5,7,[9][10]18,[23][24].…”

From Bench to Bedside: A Perfect Fit? Osseointegration Can Improve Function for Patients with Amputations

“…Subsequently, Horst Aschoff in Germany developed a press-fit implant for transcutaneous osseointegration [2]. Initial progress was slow, and setbacks and treatment failures common, until Brånemark's team adopted a standardized treatment protocol [6]; likewise, Aschoff's design has been modified twice to transition the transcutaneous portion of the implant from a porous interface to a polished design, resulting in a dramatic reduction in skin complications and infection rates. The technologies have since spread to several programs throughout Europe and in Australia based on variations of these two implant designs.…”

“…Most importantly, patient comfort can be dramatically improved by obviating socket related problems and residual limb pain. Aseptic loosening (2%-6%) and periprosthetic fracture (0%-4%) have occurred at relatively low and ostensibly acceptable rates [2,3,6,9]. However, concerns regarding infection by way of the skin-implant interface persist.…”