Osseointegrated Transtibial Implants in Patients with Peripheral Vascular Disease

Atallah, Robin; Li, Jiao Jiao; Lu, William; Leijendekkers, Ruud A.; Frölke, Jan Paul M.; Muderis, Munjed Al

doi:10.2106/jbjs.16.01295

Cited by 29 publications

(52 citation statements)

References 37 publications

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“…The patients in the latter studies overlapped with those in another study already included in the review. The remaining 22 articles comprising 13 unique studies met the inclusion criteria and were included in the review.…”

Section: Resultsmentioning

confidence: 99%

“…The mean age of study participants at implantation ranged from 42 to 48 years. In a case series of five patients with peripheral artery disease (PAD), age at implantation ranged from 56 to 84 years. The mean interval between amputation and implantation, and the mean duration of follow‐up after implantation ranged from 9 to 19 years and 1·0 to 8·0 years respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies evaluated mobility using one or two of the following measures: LIFE‐H, LEFS, AMPPRO score, K‐levels and the Q‐TFA subitem prosthetic mobility score ( Table S2 , supporting information). All studies reported improved mobility after osseointegration surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies assessed general and/or condition‐specific health‐related quality of life using the LIFE‐H, LEFS, SF‐36® and Q‐TFA global score. These outcomes at follow‐up were compared with the preoperative status or when using socket prostheses.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen articles reported on infections. Given that some of the studies were conducted in the same setting, there was a possibility of overlap and so the pooled infection rate was not estimated across the studies.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of the safety and efficacy of osseointegration prosthesis after limb amputation

Kunutsor

Gillatt

Blom

2018

British Journal of Surgery

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Background Osseointegration, an approach for direct skeletal attachment of a prosthesis to an amputated limb, may address many of the problems associated with socket prostheses. The safety of osseointegration remains uncertain. The aim of this study was to summarize evidence on functional and clinical outcomes, as well as adverse effects of osseointegration for patients with a limb amputation. Methods MEDLINE, Embase, Web of Science and the Cochrane Library were searched to April 2018. Eligible studies were observational, case and qualitative studies, and RCTs conducted in patients with a limb amputation, who were managed with osseointegrated prostheses and had follow‐up data. Results Twenty‐two eligible articles comprising 13 unique studies were included. No RCT was identified. Apart from three case reports that comprised one to five patients, the sample size of studies ranged from 11 to 100 participants. All relevant studies reported improvement in functional outcomes (walking ability, prosthetic use and mobility), satisfaction and quality of life following osseointegration, compared with their preoperative status or when using a conventional socket prosthesis. Infection rates ranged from 1 (95 per cent c.i. 0 to 5) to 77 (59 to 88) per cent. The majority of infections were described as low‐grade soft tissue or superficial infections related to the skin–implant interface, and were treated effectively with antibiotics. None of the studies reported additional amputation or death as a result of osseointegration. Conclusion Osseointegration after limb amputation improves prosthetic use, comfort when sitting, walking ability, mobility, gait and quality of life. However, it is associated with an increased risk of soft tissue infection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic review of the safety and efficacy of osseointegration prosthesis after limb amputation

Kunutsor

Gillatt

Blom

2018

British Journal of Surgery

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Cortical and medullary morphology of the tibia

Taylor

Henninger

Bachus

2020

The Anatomical Record

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Bone resorption caused by stress shielding and insufficient bone‐implant contact continues to be problematic for orthopedic endoprostheses that utilize osseointegration (OI) for skeletal fixation. Morphologic analyses have helped combat this issue by defining anatomic parameters to optimize endoprosthesis loading by maximizing bone‐implant contact. These studies have not typically included diaphyseal medullary morphology, as this region is not pertinent to total joint replacement. To the contrary, percutaneous OI endoprostheses for prosthetic limb attachment are placed in the diaphysis of the long bone. This study examined the cortical and medullary morphology of 116 fresh‐frozen human cadaveric tibia using computed tomography. Anatomic landmarks were selected and custom MATLAB scripts were used to analyze the cross‐sectional cortical and medullary morphology normalized to biomechanical length (BML). BML measured the distance between the tibial plateau and the tibial plafond. Properties such as cortical thickness, medullary diameter, and circularity of the medullary canal were quantified. We tested the influence of sex and laterality on morphology, and examined variations along the length of the bone. Results showed that while both sex and laterality impacted the location of anatomic landmarks, only sex influenced cross‐sectional morphology. Overall, morphology significantly affected shape along the length of the bone for all examined properties except medullary circularity. This analysis found that distal to 35% BML, the canal is conducive to a circular implant, with medullary diameter ranging from 13 to 32 mm between 20 and 80% BML. A large size range is necessary for sufficient implant contact in order to accommodate residual limb length after amputation.

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Case Series and Case Reports

Fabricant

2024

Practical Clinical Research Design and Application

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Osseointegrated Transtibial Implants in Patients with Peripheral Vascular Disease

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 29 publications

References 37 publications

Systematic review of the safety and efficacy of osseointegration prosthesis after limb amputation

Systematic review of the safety and efficacy of osseointegration prosthesis after limb amputation

Cortical and medullary morphology of the tibia

Case Series and Case Reports

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