In Hong Kong, there were more than 200 diabetic-related major lower extremity amputations annually. Up to three-quarters of patients undergoing lower extremity amputation have prosthesis-fit issues including development of skin ulcers or intolerable perspiration.
Osseointegration surgery for amputees refers to the implantation of a direct metal-to-bone anchorage in the appendicular skeleton as a platform to connect with an external prosthesis. This bypasses the traditional prosthetic-residuum interface and eliminates the prosthesis fitting problems related to skin and soft tissue. The indications are for amputees related to trauma or cancer causes who are not suitable for standard prosthesis.
Gait analysis of transfemoral amputees fitted with an osseointegrated fixation was different compared with conventional socket users in the cadence (2% quicker), the duration of the gait cycle (3% shorter), support phases (6% shorter), and swing phases (1% longer). For clinical outcome, Branemark (N=55) and Hagberg (N=39) reported improvement in the questionnaire for Person with a Transfemoral Amputation (Q-TFA) and the Short-Form (SF)-36 at 2 years after the second stage compared with pre-operation.
Safety of the osseointegrated implants had been reported in several case series. Branemark reported a total of 101 complications in 55 transfemoral amputations (51 patients). 8 legs (5 patients) were complication-free. Superficial infections were the most common complications, which were treated with oral antibiotics.
There are currently two transfemoral amputations with osseointegration undergoing rehabilitation in Hong Kong. The first patient received a two-stage osseointegration surgery overseas and the second patient received a single-stage osseointegration surgery in Hong Kong. The first patient had soft tissue trimming surgery performed for soft tissue redundancy one year after the index surgery. Both patients noted improvement in their mobility and prosthetic usage compared to socket prostheses.
In conclusion, osseointegration, since its early inception over 3 decades ago, appears to be gaining greater acceptance due to the continuous refinement of surgical techniques and implants. The problem of infection, which was a significant hindrance to the widespread use of this technology previously, will gradually improve with a better understanding of the technology and future research.
