Amputees are
turning to a revolutionary procedure called osseointegration in order to find
increased stability and comfort with their prosthetic limbs. Instead of relying
on socket attachments, this innovative technology connects the artificial limb
directly into the bone for an enhanced attachment method that could be the
future for upper and lower extremity amputees alike. For amputees,
osseointegration offers a revolutionary new way to create an intimate
connection with their prostheses. This innovative technology involves
implanting metal anchors directly into the bone of amputated limbs – allowing
for an enhanced level of physical and psychological comfort as users are able to
sense that their artificial limb is now part of them. Not only does this
breakthrough technique give people back what they have lost but it also allows
them to excel far beyond previous limitations!
Is Osseointegration Right for You?
You
may consider exploring osseointegration if you:
·
Find your walking distance with a socket prosthesis is limited
·
Develop chronic skin problems with socket prostheses that prevent you
from wearing them regularly
·
Struggle with your socket prosthetic in general or don’t wear it as a
result
A study conducted
by the Radboudumc AOFE Clinic in 2011 of socket prosthetics
vs. osseointegration for lower-limb amputees helped solidify the
benefits of the procedure. The study found that in those with osseointegration:
·
Prosthesis use increased from 56 to 101 hours per week
·
Walking speed increased by 32% and used 18% less energy
·
Quality of life rating improved from 39 to 62 on a 100-point scale
However, this is an
intensive procedure with some risks involved, and the need for regular
maintenance that may make the procedure less appealing. Read on to learn more
about the potential pros and cons of this procedure and what you can expect.
Brief History
The first attempts
at osseointegration were begun in Sweden in the late 1950s by Dr. Brånemark
through the use of dental applications. This technique was then applied to
facial prostheses such as ears, noses, and hearing aids, as well as subsequent
joint replacements in the hand, and silicone prosthetic attachments for thumbs
and fingers.
Fast forward to the
90s. Brånemark’s team at the Sahlgrenska University Hospital and Integrum AB in
Gothenburg performed the first osseointegration procedures for both lower and
upper-limb amputees. Since then, thousands of amputees have undergone the
procedure in facilities all around the world.
How Does It Work? Process & Timeline
There are two
primary types of osseointegration procedures currently available for amputees.
OPRA was pioneered by Brånemark and his team in Sweden. A competing system
known as ILP has also been developed by Orthodynamics GMbH, Lübeck, Germany.
Some patients may
require more than one surgery. All osseointegration procedures require time for
the bone and residual limb to fully heal and strengthen around the metal
implant.
Screw shape
prosthesis (OPRA): This system uses a screw shape design and the implant length
within the body is relatively short (80mm). Patients will not be able to start
wearing a prosthesis on their abutment fully unsupported for 6-12 months.
Press fit
prosthesis (ILP): This system uses an alloy rod with a 3D tripod surface
structure with a longer implant length (140-180mm). The healing process is
quicker – some patients are able to start putting full weight on their
prosthesis as soon as 6 weeks.
During
rehabilitation you will learn to use your new prosthesis with the aid of
crutches. Rehabilitation can take 3-5 weeks, depending on the patient and
whether the surgery was for transfemoral or transtibial amputation.
Once you’re able to
fully support yourself with your new prosthesis, you can resume a
normally-active lifestyle with the exception of avoiding aggressive contact
sports. There are no issues with getting your abutment wet, so bathing and
swimming aren’t an issue.
Pros & Cons of Osseointegration
Osseointegration has both pros and
cons. It can change a life for the better, but it is also a major surgical
procedure with a long recovery time and rehabilitation.
Potential
Pros of the osseointegration procedure include:
·
Increased use of a prosthesis
·
More stability in walking and standing
·
Ability to walk longer distances
·
Avoiding the skin problems associated with socket prosthetics
·
Easy to remove and replace a prosthesis
Potential
cons of osseointegration include:
·
Surgical procedure with a potentially long recovery time
·
Need to regularly maintain and clean the interface between the skin and
implant
·
Risk of superficial skin infections or deep tissue infections
·
Potential for the abutment to bend or break
·
Limitations on participation in high impact sports
There is also the
potential for muscle pain in the first year. This is because your residual limb
needs time to strengthen around the abutment through regular use of your
prosthetic.
Osseointegration Prosthetics & Managing Your Abutment
Most prosthetics
companies now design prostheses designed for those who have undergone
osseointegration. Connection to the abutment is easy, and most amputees report
being able to attach or remove their prosthesis in 30 seconds.
There is some minor
care required for your abutment. The area of skin surrounding the abutment
(also known as a stoma) needs to be regularly cleaned.
Get More Resources on Osseointegration
We hope this guide
has provided you with some food for thought on osseointegration, but you likely
still have lots of questions.
For more
information, reach out to one of
our information specialists. They will be able to provide you
with personalized support and how to access any financial supports you may be
eligible for.
·
Osseointegration: Coming Soon to the United States?
https://www.amputee-coalition.org/inmotion_online/inmotion-29-05-web/40/
Nikki Grace-Strader & Solon Rosenblatt, MD. InMotion (September-October
2019, 40-43).
·
Osseointegration for Patients With Amputation in
the United States
https://www.amputee-coalition.org/inmotion_online/inmotion-27-06-web/43/
Richard J. O’Donnell, MD, and Rickard Brånemark, MD, PhD. InMotion (November-December
2017, 42-43).
·
Walter Reed National Military Medical Center
Osseointegration FAQs
https://tricare.mil/mtf/WalterReed/Health-Services/M_S/Osseointegration/Osseointegration-FAQs