Osseointegration – Rehabilitation

Patient at 4 months after insertion of bilateral below knee bone-anchors. He is practicing using his new prosthetic limbs.

Rehabilitation generally involves 3 phases.  You will be given specific information on your rehabilitation program after surgery and will be guided through the protocol by our rehabilitation team within the PPU at the Royal Free and by our rehabilitation partners.

Phase 1 involves the loading of a static weight by standing on a bathroom scale using a loading device attached to your implant. Loading takes place over a 20-minute period twice a day. This may commence as soon as the next day after surgery and continues until you achieve 50% of your bodyweight or 50 Kg. You will begin loading at 5 Kg, but the speed with which you reach your targets, and the speed with which you will be advanced through the protocol will be determined by your bone quality which will have been measured pre-operatively with a DEXA scan. It will also be influenced by our impressions of the quality of your bone intra-operatively.

Phase 2 applies only to above knee amputees and involves getting fitted with a light leg for gait training. You will start taking your first steps aided by parallel bars and (when it is safe) you will progress to using two crutches.

Phase 3 involves the fitting and alignment of your definitive prosthesis. Once fitted, you will be allowed to walk with two crutches for 6 weeks, followed by one crutch for another 6 weeks then unaided thereafter. This is necessary to minimise the risk of falls and to prevent premature overloading of the implant.

You should avoid performing high impact activities for the first 12 months post-surgery. If you look after your implant, we anticipate that it will provide you with reliable service for many years.

Ongoing Aftercare

At 3-4 months after surgery most patients will have completed their rehabilitation and will be walking without any assistive devices. However, it is important that you visit your prosthetist and physiotherapist regularly as you will continue to improve your gait and balance over time. Your prosthetist will also instruct you on how the safety mechanism works and how to correctly replace it should it break in a fall or accident.

Significant discharge from the stoma site following surgery is very normal and will usually lessen 3-6 months after your surgery. Females, patients with a short residual limb and patients who are obese are expected to have higher levels of secretion from the skin-implant interface (stoma) than others. This natural secretion is normally golden or clear in colour. To prevent dripping, you may wish to apply a split gauze dressing around your transcutaneous adaptor and gently tape this gauze to the metal components to hold it in place. Warm salt water baths can also be helpful to reduce the amount of discharge.

Daily cleaning: Once you leave the hospital, you should begin showering daily. Use your hands to gently wash the stump with soap and water. Ideally, use a hand-held shower head to rinse off your stoma daily. We also recommended that you use a very basic soap that does not contain perfumes or moisturisers. To remove dried blood and discharge from the metal components, you may wish to use a toothbrush while showering. To aid healing, you should aim to keep your stoma dry and uncovered for as long as possible – each day. Swimming in a salt water pool or the ocean is highly recommended. However, you should rinse your percutaneous opening after swimming, especially in rivers or public pools.

Know your components: The osseointegrated prosthesis is designed to become a permanent extension of your skeletal structure and you should learn how each component is designed to function. The team will explain how each component works, including any regular maintenance and services required.  As you increase your activity levels, the components may gradually become loose and you may need to re-tighten them – every 3 months. Our rehabilitation partners can supply you with the necessary kit to allow you to do this yourself – if you wish. However, you will need to purchase this kit yourself.

Infection management: Despite a significant reduction in infection rates after the introduction of single-stage surgery, infection remains a major risk associated with this procedure. If you suspect that you have an infection (pain, redness, fever or unusual discharge), please contact the team immediately. Describe your condition in as much detail as possible and send photos to the team to assist with the diagnosis. Avoid taking random swab cultures around the stoma skin area and do not begin any antibiotic treatments until you know what type of infection you are treating. The team will guide you on the best route of management.

Support network: Osseointegration surgery is a lifelong commitment. Relimb™ is part of an international osseointegration network which is constantly training new clinicians from centres across the glove. The network endeavours to provide all OI patients around the world with local support. Therefore, if you have any questions or concerns, simply reach out to any member of the osseointegration network.

Book an appointment

For more information, a quotation or to book an appointment, please contact our dedicated enquiries team who are available Monday – Friday from 8am – 6pm on 020 7317 7751 or rf.privateenquiries@nhs.net.