Rehabilitation of the transfemoral amputee with an osseointegrated prosthesis

Sulliván, John; Uden, Maggie; Robinson, K. P.; Sooriakumaran, S.

doi:10.1080/03093640308726667

Cited by 169 publications

(160 citation statements)

References 1 publication

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“…This represents a remarkable achievement, particularly in patients with short residual limbs or multiple limb amputations. Understandably, the persistent 18 to 56 percent rate of infection has in the past limited the worldwide acceptance of this technology [2,22,25]. Through empirically determined but clinically derived prosthetic design and surgical technique changes and implementation of longestablished surgical principles of wound care, we feel that we have significantly improved infection control using the design C device (initial absolute risk reduction of 42% and late absolute risk reduction of 55%).…”

Section: Trochantermentioning

confidence: 99%

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

et al. 2015

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Abstract-Integral-Leg-Prosthesis (ILP) is a comparatively new attachment system that allows direct skeletal docking of artificial limbs. Between January 1999 and December 2013, 69 patients with transfemoral amputation were fitted with ILPs by a single German surgeon. Device design iterations and surgical techniques evolved during these years. For the purposes of comparison, patients receiving the first two designs and procedure iterations were placed in group 1 and the patients fitted with the final design were placed in group 2. Infection rate and planned and unplanned surgical interventions were statistically compared using Fisher exact test. Data demonstrated that the high rate of stoma-associated infections seen in group 1 was dramatically reduced in group 2. Of the 39 patients with 42 implants in group 2, none had operative interventions secondary to infection. All group 2 patients remained infection-free without the use of antibiotics by following a simple but defined wound-hygiene protocol. We concluded that the final iteration of the osseointegrated intramedullary device with a low energy surface at the soft tissue and prosthesis interface allowed a biologically stable skin stoma that remained infection-free without chronic use of antibiotics. The reduction in the infection rate was attributed to the clinically based, empirically driven changes in design and surgical techniques.

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Section: Trochantermentioning

confidence: 99%

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

et al. 2015

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“…One is the relatively low number of patients included. However, the 17 patients in the OI group represented more than 10 percent of the existing population of patients treated with TFA OI prostheses worldwide at the time of the study [9][10]. Moreover, the number of participants is comparable to other studies in the prosthetic and orthotic field [35,[39][40][42][43].…”

Section: Discussionmentioning

confidence: 68%

“…Moreover, at follow-up the OI group had a lower detection threshold than the group of controls at both 125 and 250 Hz ( Table 3). The improved osseoperception might help to explain why patients with OI prostheses have reported their prosthesis to become "as a part of me" [15], and the result adds to the published benefits of OI prosthesis [10,[39][40][41].…”

Section: Discussionmentioning

confidence: 92%

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Vibrotactile evaluation: Osseointegrated versus socket-suspended transfemoral prostheses

Häggström

Hagberg²,

Rydevik³

et al. 2013

J Rehabil Res Dev

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Abstract-This study investigated detection thresholds of vibrometric stimuli in patients with transfemoral amputation supplied with osseointegrated (OI) and socket-suspended prostheses. It included 17 patients tested preoperatively with socket-suspended prostheses and after 2 yr with OI prostheses and a control group (n = 17) using socket-suspended prostheses, evaluated once. Assessments on the prosthetic and intact feet were conducted at six frequencies (8,16,32, 64, 125, and 250 Hz). Furthermore, measurements were conducted to investigate how vibrometric signals are transmitted through a test prosthesis. The results showed that the OI group had improved ability to detect vibrations through the prosthesis at 125 Hz (p = 0.01) at follow-up compared with the preoperative measurement. Compared with the control group, the OI group at follow-up had better ability to detect high frequency vibrations through the prosthesis (125 Hz, p = 0.02; 250 Hz, p = 0.03). The vibrometric signal transmitted through the test prosthesis was reduced at 8, 125, and 250 Hz but was amplified at 16, 32, and 64 Hz. Differences between the OI and the control groups were found in the highest frequencies in which the test prosthesis showed reduction of the vibrometric signal. The study provides insight into the mechanisms of vibration transmission between the exterior and bone-anchored as well as socketsuspended amputation prostheses.

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“…In osseointegration, a titanium fixture is inserted into the bone remnant of the residuum and a skin-penetrating abutment is used for attaching the prosthesis. Despite the promising integration of a titanium implant with residual bone, the problem of the deviceskin interface where the implant penetrates the residual limb remains unsolved [2]. Attempts at optimizing the roughness of the abutment to achieve a reliable deviceskin interface were unsuccessful [3], and ongoing subject trials use abutments with a smooth surface [4].…”

Section: Introductionmentioning

confidence: 99%

Skin and bone integrated prosthetic pylon: A pilot animal study

Pitkin¹,

Raykhtsaum²,

Galibin³

et al. 2006

JRRD

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Abstract-Direct skeletal attachment of limb prostheses is a viable alternative to traditional techniques that are based on a socket-residuum interface. Direct skeletal attachment may be a better or even the only method for patients with a very short residuum and high soft-tissue volume. The problem of integrating the prosthetic pylon with residual skin during direct skeletal attachment of a limb prosthesis has not been solved, and the use of a completely porous prosthetic pylon has not been the subject of focused, systematic research. In this in vivo study, we investigated cell (osteocyte, fibroblast, and keratinocyte) adhesion and penetration into the pores of a titanium pylon implanted in Wistar rats. The porous titanium pylon was implanted in the bone of the thigh residua of four rats. Electronic scanning and morphological analysis demonstrated integration of the pylon with the surrounding skin. These findings support the possibility of developing a natural barrier against the infection associated with direct skeletal attachment of limb prostheses.

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Rehabilitation of the transfemoral amputee with an osseointegrated prosthesis

Cited by 169 publications

References 1 publication

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

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

Vibrotactile evaluation: Osseointegrated versus socket-suspended transfemoral prostheses

Skin and bone integrated prosthetic pylon: A pilot animal study

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