inMotion Magazine

September | October 2019 42 Medical conditions such as severe osteoporosis, diabetes, peripheral vascular disease, and smoking are all contraindications for the procedure. In the past, many insurance companies in the U.S. have declined coverage for osseointegration surgery because they considered it experimental or because it was only offered outside the U.S. However, increased experience with patients and new support from the medical literature is now changing this dynamic and some patients are finding insurance is now covering their surgery. History of osseointegration Osseointegration has been around for longer than most people realize. The first attempts at osseointegration were begun in Sweden in the late 1950s by Dr. Per-Ingvar Brånemark with dental applications. Brånemark and Dr. Bjorn Rydevik used the same technology for limb loss when they first developed a screw-in titanium implant to treat transfemoral amputations in 1990. Their OPRA device is implanted in a two-stage procedure. The first surgery places an internal implant in the bone and is followed six months later by a second surgery to connect to the terminal device. Full weight-bearing is allowed after an additional six months of rehabilitation. In 1999, Dr. Horst Aschoff in Germany developed a press-fit implant with a cobalt-chrome core and titanium overlay to promote osseointegration. His Integral Leg Prosthesis (ILP) device is similar to the most common artificial hip and knee joints used worldwide, allowing the option of a one- or two-stage osseointegration procedure and a more rapid rehabilitation process. Technology (continued) Photo courtesy of Solon Rosenblatt, MD. X-ray of a transfemoral above-knee amputee with an OI in the right femur. The OI eliminates the need for a prosthetic socket and gives the amputee a direct connection between the body and the prosthesis. The Integral Leg Prosthesis (ILP) and the Osseointegration Prosthetic Limb (OPL): The ILP implant was the first press fit implant for OI, developed in Germany in 1999. The stem is made of cobalt-chrome and it has a titanium onlay to promote osseointegration. The OPL line of implants, developed by the Osseointegration Group of Australia in 2010, has a stem made of titanium with a porous coating to promote osseointegration. Photo courtesy of osseointegrationaustralia.com.au.