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Osseointegrated prostheses

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Description

Transfemoral osseointegrated prosthesis.
Transfemoral osseointegrated prosthesis. [1]

A prosthetic limb, or prosthesis, is an assistive device utilized by individuals with congenital limb deficiencies or acquired amputations. Historically, patients have interfaced with a prosthesis through a socket, which is a cup-like structure that fits around the residual limb. Osseointegrated prostheses are prosthetic limbs that are attached directly to the remaining bone in the residual limb and do not require the traditional socket. Use of an osseointegrated prosthesis requires a surgical procedure during which a commercially pure titanium fixture is implanted into the bone, and an attached abutment penetrates the skin. Prosthetic components, such as knees, shanks, hands, and feet, then attach directly to the abutment. [1]

History

The principle of osseointegration using titanium implants was discovered by Per-Ingvar Brånemark in 1952[2] and has been in clinical use for prosthetic replacement of teeth since 1965. [3] The world leaders in osseointegration are a team headed by Rickard Brånemark in the Centre of Orthopaedic Osseointegration (COO) at Sahlgrenska University Hospital, Gothenburg, Sweden. This team has been using osseointegration in upper- and lower-limb prosthetic management since 1990. [2] As of 2008, more than 120 patients world-wide have undergone osseointegration prosthetic treatment. [1]

Benefits

Transhumeral osseointegrated prosthesis.
Transhumeral osseointegrated prosthesis. [1]

Osseointegrated prostheses offer many benefits to the patient. Users and researchers report the following advantages: [1][2][3][4]

  • Absence of fitting issues in the presence of fluctuating limb volume
  • Consistent and secure suspension
  • Improved body image relative to a traditional socket
  • Absence of sweating, chafing, and socket pressure issues
  • Improved range of motion
  • Lower perceived prosthesis weight
  • Increased control of prosthesis
  • Lack of need to regularly remake sockets due to wear and limb changes
  • Easier donning and doffing
  • Increased perception of prosthesis-environment interaction
  • Improved overall quality of life.

Challenges

Despite its many benefits, there are some challenges associated with osseointegration. The Brånemark procedure, which is the most successful implantation procedure, requires two surgeries with six months between surgeries, resulting in a large time investment by the patient. Additionally, a relatively long rehabilitation period is necessary in order to protect the implant site by slowly increasing loading and activity. The most serious challenge is the risk of infection. Although many improvements have been made via a strict rehab protocol, and risk can be controlled largely by antibiotics and good hygiene, the possibility of infection is still a reality. Infection at the implant site can lead to bone loss, loosening of the implant, or a revision amputation at a higher level. [2]

Current Research

Osseointegrated prosthetic limb treatment has not yet received FDA approval in the U.S., primarily due to infection risk. Several organizations, institutions, and government agencies in the U.S. have partnered together to tackle the current challenges, particularly infection prevention methods and rotation-resistant implant design. Work is underway at the University of Utah and the George E. Wallen Department of Veterans Affairs Medical Center, where antibiotic properties of frog skin are being investigated for their application to improving infection risk in osseointegration treatment. [2] A joint research group between the Providence VA Medical Center, and Brown University, Providence, Rhode Island, is investigating development of an environmental seal at the skin-implant interface by altering the titanium implant surface to promote dermal and epithelial growth. [5]

References

  1. 1.0 1.1 1.2 1.3 1.4 Hagberg K, Häggström E, Jönsson S,Rydevik B, and Brånemark R. Chapter 10 Osseoperception and osseointegrated prosthetic limbs, in Psychoprosthetics. London:Springer; 2008.
  2. 2.0 2.1 2.2 2.3 2.4 Fairley, Miki. Osseointegration: in the wave of the future?, O&P Edge. Epub Sept 2006.
  3. 3.0 3.1 Sahlgrenska International Care, Göteborg, Sweden
  4. Study finds osseointegrated leg prostheses improve quality of life., O&P Edge. Epub Sept 2010.
  5. Fairley, Miki. Osseointegration: infection solutions., O&P Edge. Epub Feb 2007.