Osseointegration

Osseointegration

Osseointegration is a biological phenomenon that allows a metal implant inserted into the bone to become inseparably fused with the human skeleton.

These implants are often referred to as bone-anchored implants and the terms “bone-anchor” and “direct skeletal fixation” are often used interchangeably.

As a result of recent advances in this technology, we are now able to offer upper and lower limb amputees a reliable and reproducible method for securing a prosthetic limb to their residual limb (stump) so that they do not have to endure the problems associated with a standard socket-mounted prosthesis.

The scientific discoveries underpinning this type of surgery were first made in the 1950’s. Therefore, this is a robust and well understood technology. The use of osseointegration of metal implants into the human skeleton has now become routine – mainly to provide secure fixation for dental implants.

In contrast, the use of osseointegration to improve the quality of life of amputees has been a more recent development which first started in Sweden in the 1990’s.

The advantages of Direct Skeletal Fixation (DSF) of a prosthetic limb compared to standard  methods for securing a prosthetic limb are enormous:

  • DSF using a bone-anchor, allows the mechanical axis of the residual limb to be as close to normal as possible. As a result, the amputee experiences fewer restrictions in the range of movement of the residual limb, more reliable control of the prosthesis attached to the residual limb and complete freedom from socket-related issues (e.g. ulcers, chaffing, sweating, slippage, smell and pain).
  • Once fully integrated, DSF systems also enable amputees to don and doff their prosthesis, quickly and easily while many users report greater feedback from their prosthesis – a phenomenon described as osseoperception. In some cases, experienced users are even able to distinguish between walking on grass versus carpet!
  • This highly innovative technique contributes to the amputees’ quality of life.

Initially, there were only a few centres and surgeons performing this type of surgery. However, since 2010, advances in our understanding of how the implants must perform and improvements in surgical technique and implant design have resulted in a massive increase in the number of amputees undergoing this treatment, worldwide.  Currently, there are three different types of implant which are routinely available for treatment, including OPRA (Swedish), OPL (Australian) and ILP (German).  These are the only bone-anchored implants which are CE-marked for use in Europe.  Your surgeon can discuss the relative merits of each type of implant during your consultation.

Group 20

Patient with a standard, socket-fitted prosthesis after left above knee amputation.

Conventional socket fitted prosthesis

In the UK, major limb amputations (above the wrist or ankle level) are relatively common. The most common cause for an amputation (usually lower limb) is peripheral vascular disease – usually as a result of smoking or diabetes (or both).

Trauma is another common cause – especially accidents involving motorcycles. Less commonly, patients undergo amputation for treatment of a cancer affecting the limb or after major infections (for example, meningitis), or for a congenital condition.

prosthetic socket is the device that joins your residual limb (stump) to the prosthesis. The socket is made just for you, according to the condition and shape of your residual limb.

Patients undergoing amputation for peripheral vascular disease are generally 60 years or older and male, while patients undergoing traumatic amputations are generally 30 years or older and also male.

Procedure

For a conventional Socket Fitted Prosthesis to work, the soft tissues around the residual bone must be immobilised by the socket. This allows any forces transmitted to the residual bone to be transmitted through the soft-tissues and into the prosthesis via the socket itself. This is achieved by ensuring that the socket is very tightly fitted to the residual limb and requires the input of a skilled prosthetist to create a bespoke residual limb socket that is unique to every amputee.

If the fitting is not tight, the prosthesis may rotate or become uncontrollable or unusable. However, the tighter the fit, the greater the chance of problems with sweating, skin irritation, chaffing, skin ulceration or pressure on painful neuromas. Moreover, the shape and volume of a residual limb changes virtually daily and certainly yearly. Therefore, most amputees need to have their socket refashioned at least once a year.

These are just a few of the reasons why amputees may seek help and advice from Relimb™ about possible surgical interventions for their residual limb.

Aftercare and rehabilitation

After osseointegration surgery, you will receive a combination of pain medications depending on your specific needs. This may include the use of a patient controlled analgesic device (PCA) or continued infusions of local anaesthetic through an in-dwelling catheter. Alternatively, you may be able to manage with oral medication alone (e.g. tramadol or oxycontin).

The aim is to try and convert you to oral analgesia as quickly as possible so that you can have a clear enough mind to allow you to commence your rehabilitation as soon as possible.

You will stay in hospital for a maximum of 3 – 5 days. However, exceptionally, some patients may feel able to go home on the same day as the surgery. All patients are unique in terms of their perception of pain and you will simply have to see how you feel on the day after your surgery.

After osseointegration surgery, you will receive a combination of pain medications depending on your specific needs. This may include the use of a patient controlled analgesic device (PCA) or continued infusions of local anaesthetic through an in-dwelling catheter. Alternatively, you may be able to manage with oral medication alone (e.g. tramadol or oxycontin).

The aim is to try and convert you to oral analgesia as quickly as possible so that you can have a clear enough mind to allow you to commence your rehabilitation as soon as possible.

You may stay in hospital for around 3 – 5 days. However, exceptionally, some patients may feel able to go home on the same day as the surgery. All patients are unique in terms of their perception of pain and you will simply have to see how you feel on the day after your surgery.