Osseointegration is a procedure that many transfemoral and transtibial amputees are looking to when running into issues with socket prostheses. Many upper limb amputees are looking to this procedure as well for the potential of increased stability with their arm prosthesis.
The term osseointegration refers to a direct connection between human bone and an artificial implant. Osseointegration for amputees involves implanting a metal anchor directly to the bone of an amputated limb that extends out of the residual limb. A prosthesis is then attached to the metal extension (abutment).
Many amputees who have undergone osseointegration feel what is known as osseoperception – the sensation that their prosthesis is an actual part of their body. This helps many people overcome a psychological hurdle that prevents them from regularly wearing their prosthesis.
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 and 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.
The History of Osseointegration Surgery
Swedish professor Per-Ingvar Brånemark began the initial research into osseointegration in the 1950s. By the 60s he had established the basis for modern dental implants. In the following years, he would go on to pioneer many other osseointegration applications including facial prosthetics and prosthetic attachments for missing 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.
What Are The Pros and 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 the abutment (cleaned twice daily)
- Need to regularly take antibiotics to manage possible infection
- Potential for the abutment to bend or break
- Potential for decreased participation in sports vs. a socket prosthetic
There is also the potential for intense 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.
The Osseointegration Process and 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.
Osseointegration Prosthetics and 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 cleaned with soap twice a day to help prevent infection. Regular use of antibiotics is also required to help manage the risk of infection.
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 resources to help you determine if osseointegration is right for you, and how to access any financial supports you may be eligible for.
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