Perioperative and early rehabilitation outcomes following osseointegration in UK military amputees

Wood, P.R.; Small, Charlotte; Mahoney, Peter F.

doi:10.1136/jramc-2019-001185

Cited by 11 publications

(17 citation statements)

References 18 publications

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“…In the 12 articles (3, 15, 28 to 35, 39, 40) reporting fracture incidence from the two-stage approach, the mean incidence was 12% (0% to 50%; SD 14%). There was one case of intraoperative fracture in the one-stage cohort, 27 and eight reported cases of intraoperative fracture in the first stage of the two-stage approach. 39…”

Section: Resultsmentioning

confidence: 99%

“…Table I provides a summary of study characteristics. There were 19 included studies: four reported results for the one-stage approach, 17,25-27 14 reported outcomes for the two-stage approach, 3,14,28-39 and one article with both one- and two-stage groups. 40 Osseointegration is a relatively new procedure, and included studies were published between 2010 and 2020.…”

Section: Resultsmentioning

confidence: 99%

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The safety of one-stage versus two-stage approach to osseointegrated prosthesis for limb amputation

Banducci,

Al Muderis,

et al. 2023

Bone Jt Open

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AimsSafety concerns surrounding osseointegration are a significant barrier to replacing socket prosthesis as the standard of care following limb amputation. While implanted osseointegrated prostheses traditionally occur in two stages, a one-stage approach has emerged. Currently, there is no existing comparison of the outcomes of these different approaches. To address safety concerns, this study sought to determine whether a one-stage osseointegration procedure is associated with fewer adverse events than the two-staged approach.MethodsA comprehensive electronic search and quantitative data analysis from eligible studies were performed. Inclusion criteria were adults with a limb amputation managed with a one- or two-stage osseointegration procedure with follow-up reporting of complications.ResultsA total of 19 studies were included: four one-stage, 14 two-stage, and one article with both one- and two-stage groups. Superficial infection was the most common complication (one-stage: 38% vs two-stage: 52%). There was a notable difference in the incidence of osteomyelitis (one-stage: nil vs two-stage: 10%) and implant failure (one-stage: 1% vs two-stage: 9%). Fracture incidence was equivocal (one-stage: 13% vs two-stage: 12%), and comparison of soft-tissue, stoma, and mechanical related complications was not possible.ConclusionThis review suggests that the one-stage approach is favourable compared to the two-stage, because the incidence of complications was slightly lower in the one-stage cohort, with a pertinent difference in the incidence of osteomyelitis and implant failure.Cite this article: Bone Jt Open 2023;4(7):539–550.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The safety of one-stage versus two-stage approach to osseointegrated prosthesis for limb amputation

Banducci,

Al Muderis,

et al. 2023

Bone Jt Open

View full text Add to dashboard Cite

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“…Although critical to successful clinical outcomes, rehabilitation procedures (e.g., training exercises) and prosthetic fitting recommendations (e.g., setting of components) for new solutions are often areas of continuous development and, therefore, are under-reported (53)(54)(55)(56)(57)(58)(59). The level of understanding and acceptance of pre-and postoperative clinical care may vary between interventions for lower or upper bionic limbs.…”

Section: Need For More Information About Rehabilitation and Prostheti...mentioning

confidence: 99%

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

Frossard

Conforto

2022

Front. Rehabilit. Sci.

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Importance of residuum healthThe use of a prosthesis is essential to maintain function and wellbeing of individuals suffering from limb absence (1, 2). Consequently, providers of prosthetic care recommend bespoke interventions to sustain lenient interactions between individuals' residual limb and their prosthesis (3-7). The clinical management of this interface is critical because it greatly affects the residuum health (8).Residuum health is influenced by intrinsic determinants inherent to personal demographics (e.g., gender, age, weight, and height) and surgical amputation (e.g., length of bone, muscle reassignments, muscle strength, and adipose tissue distribution) and extrinsic determinant-associated attachment (e.g., socket design and direct skeletal attachment) and prosthetic components (e.g., choice and alignment of components, control of the prosthetic joint movements, use of walking aids, and level of activity) (8). In all cases, interactions between intrinsic and extrinsic determinants are critical as residual tissues have limited physiological capacity to withstand direct loading applied by typical socket-suspended prostheses during daily activities (e.g., chafing and rubbing) (5, 9-12). In addition to general neurological residuum and phantom pain, individuals can experience a range of incapacitating neuromusculoskeletal dysfunctions compromising residuum health, such as acute and chronic skin issues, edema, neuroma, tendinitis, muscle contractures, stress fractures, osteopenia, and heterotopic bone growth, which altogether increases the risks of sound lower joints osteoarthrosis, and hyperlordosis (6,13, 14).Consequently, satisfactory residuum-prosthesis interface is difficult to achieve and sustain (15). Individuals with compromised residuum health are more at risk to experience unsuccessful prosthetic fitting arrangements (4, 16). Those with healthy residuum are more likely to maximize comfort, stability, and mobility when using a TYPE

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“…, reimbursement standards) including surgical (e.g., one-off and on-going cost for primary surgical implantation, refashioning of residuum, reamputation, reimplantation), rehabilitation (e.g., physiotherapy), medical (e.g., pain killers, antibiotics), and prosthetic (e.g., socket fittings, interim and definitive prostheses) care costs More holistic CUAs could reveal the true costs of infections and subsequent surgical revisions. 2,98,99 Future studies should also focus on societal perspective (e.g., the impact of BAP on employment, productivity, living assistance costs). Finally, future studies should also consider consumer perspective, often neglected but equally relevant (e.g., gap fees, out-of-pocket expenses, overseas travelling costs, prosthetic components, medication).…”

Section: Future Workmentioning

confidence: 99%

Health Service Delivery and Economic Evaluation of Limb Lower Bone-Anchored Prostheses: A Summary of the Queensland Artificial Limb Service’s Experience

Frossard

Berg²

2021

Can. Prosthet. Orthot. J.

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The emergence of skeletal prosthetic attachments leaves governmental organizations facing the challenge of implementing equitable policies that support the provision of bone-anchored prostheses (BAPs). In 2013, the Queensland Artificial Limb Service (QALS) started a five-year research project focusing on health service delivery and economic evaluation of BAPs. This paper reflects on the QALS experience, particularly the lessons learned. QALS’ jurisdiction and drivers are presented first, followed by the impact of outcomes, barriers, and facilitators, as well as future developments of this work. The 21 publications produced during this project (e.g., reimbursement policy, role of prosthetists, continuous improvement procedure, quality of life, preliminary cost-utilities) were summarized. Literature on past, current, and upcoming developments of BAP was reviewed to discuss the practical implications of this work. A primary outcome of this project was a policy developed by QALS supporting up to 22 h of labor for the provision of BAP care. The indicative incremental cost-utility ratio for transfemoral and transtibial BAPs was approximately AUD$17,000 and AUD$12,000, respectively, per quality-adjusted life-year compared to socket prostheses. This project was challenged by 17 barriers (e.g., limited resources, inconsistency of care pathways, design of preliminary cost-utility analyses) but eased by 18 facilitators (e.g., action research plan, customized database, use of free repositories). In conclusion, we concluded that lower limb BAP might be an acceptable alternative to socket prostheses from an Australian government prosthetic care perspective. Hopefully, this work will inform promoters of prosthetic innovations committed to making bionic solutions widely accessible to a growing population of individuals suffering from limb loss worldwide. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36210/28330 How To Cite: Berg D, Frossard L. Health service delivery and economic evaluation of limb lower bone-anchored prostheses: A summary of the Queensland artificial limb service’s experience. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.12. https://doi.org/10.33137/cpoj.v4i2.36210 Corresponding Author: Laurent Frossard, PhD, Professor of BionicsYourResearchProject Pty Ltd, Brisbane, Australia.E-Mail: laurentfrossard@outlook.comORCID number: https://orcid.org/0000-0002-0248-9589

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Perioperative and early rehabilitation outcomes following osseointegration in UK military amputees

Cited by 11 publications

References 18 publications

The safety of one-stage versus two-stage approach to osseointegrated prosthesis for limb amputation

The safety of one-stage versus two-stage approach to osseointegrated prosthesis for limb amputation

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

Health Service Delivery and Economic Evaluation of Limb Lower Bone-Anchored Prostheses: A Summary of the Queensland Artificial Limb Service’s Experience

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