Osseointegration: a pioneering procedure which offers new hope to amputees

Posted: 19/08/2019

Osseointegration is a revolutionary procedure for amputees which delivers significant benefits compared to conventional socket prostheses.

A traditional amputation involves use of a vacuum created between the residual limb and a socket to which the prosthesis is attached. Although some amputees find this sufficient to enjoy a good quality of life, it can lead to a range of problems with rubbing, discomfort and skin breakdown. This can inevitably cause a serious limitation in mobility, function and quality of life.

Osseointegration avoids these problems by dispensing with the socket entirely. The procedure involves a synthetic implant which is permanently anchored to living bone. There are currently two main types of system in use:

• Screw-shape prosthesis: this technique uses a titanium prosthesis with a screw design, derived from use in dental implants. The rehabilitation period is usually 6-12 months until full weight bearing is achieved;
• Press fit prosthesis: this system is derived from hip prostheses. In its original form, it makes use of a chrome cobalt molybdeen alloy rod, although newer models utilise titanium alloy rods. The rehabilitation period tends to be shorter, and earlier weight bearing is possible.

The procedure carries with it a range of major advantages. The direct contact between the implant within the bone and the external prosthesis allows a far greater duration of comfortable use. With a traditional amputation, significantly more energy is required for movement than for an able bodied person. This leads to a change in an individual’s natural gait and can cause long-term detrimental effects to the musculoskeletal system. For lower limb amputees, osseointegration allows the femur to remain in an anatomically natural position when weight bearing, which permits more freedom of movement, a normal loading of the hip joint and femur, and greater walking distance.

Osseointegration also allows greater osseoperception – perception of the position of the limb and its orientation in relation to the environment. Amputees report feeling more stable and secure on the ground, and are able to distinguish between different textures and types of surface.

While the procedure is currently more commonly performed on lower limb amputees, it has been successfully carried out on upper limb amputees.

A study looking into the benefits of osseointegration compared to traditional socket use (Walking ability and quality of life in subjects with transfemoral amputation: a comparison of osseointegration with socket prostheses, written by Van de Meent et al and published in the Archives of Physical Medicine and Rehabilitation, 2013) demonstrated that out of the study group of 22 transfemoral amputees who all previously suffered from socket related skin and residual limb problems, all had an improved outcome. Compared with socket prosthesis, all participants enjoyed significantly improved prosthesis use (average of 45% increase), walking distance (27% further on average) and prosthesis related quality of life.

Rosie Nelson, associate in the clinical negligence team said: “The benefits of this technique are impressive and wide-ranging. It is a fantastic option for amputees, particularly those who were previously very fit and active and want to return to being mobile as quickly as possible, with the fewest restrictions in doing the activities they previously enjoyed. It is also worth noting the cost saving implications of this technique. Not only are the costs of replacement sockets and fittings dispensed with; independence and mobility later on in life are more likely to be retained, and so costs associated with care and assistance are also reduced. One of our clients is currently looking into having this procedure performed.”

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