Osseointegration may yield improvements for patients with transtibial amputations
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Results presented at the Limb Lengthening and Reconstruction Society Annual Scientific Meeting showed use of osseointegration may lead to subjective and objective improvements in patients with transtibial amputations.
Munjed Al Muderis, MB, ChB, and colleagues preoperatively and postoperatively collected SF-36 and modified questionnaire for persons with a transfemoral amputation surveys, physician examinations, and timed up-and-go (TUG) and 6-minute walk tests among 91 patients who underwent 102 consecutive, primary transtibial osseointegration procedures.
In his presentation, Al Muderis noted most patients who underwent transtibial osseointegration experienced an increase in prosthesis use, K-levels and improvement in SF-36 psychological scores. He added most patients also had improvements in the 6-minute walk test, but had a decrease in the TUG test.
“When we look at the complication rate, we do have 27 infections and we do have at least 35 cases of unplanned surgery,” Al Muderis said in his presentation, which received a second-place award from the Limb Lengthening and Reconstruction Society.
Among 17 implants that were removed, Al Muderis noted 14 were reimplanted. Despite a significantly higher complication rate in transtibial osseointegration compared with transfemoral osseointegration, Al Muderis said patients who underwent transtibial osseointegration had improved performance compared with patients who had a socket prosthesis.
“The implication of a successful outcome from osseointegration surgery, in general, and transtibial osseointegration surgery, in particular, can benefit the overall wider community of orthopedics, as well as surgery in the broader medical field,” Al Muderis, professor of orthopedics at Macquarie University in Sydney, told Healio Orthopedics. “With finding a happy medium between the soft tissue and the implant and the connection through the skin with bacterial colonization that does not cause infection, this can provide a major source for research and explore potential translation of this area of happy medium to other applications in medicine.”
Perspective
Back to TopS. Robert Rozbruch, MD
The positive experience with tibial osseointegration surgery shared by Munjed Al Muderis, MB, ChB, and colleagues is timely and important. Their findings were that in patients having difficulty with socket wear, a surgically made skeletal connection for a below knee prosthetic leg led to improved function and satisfaction for their patients. While there were some complications, these were manageable and were expected to decrease with increasing experience.
Osseointegration is mainly used for transfemoral amputees with socket wear difficulties. It is notable that many transtibial amputees, particularly those with short residual limbs and compromised soft-tissue – scars, atrophy, sensitivity to pressure – also have marked difficulty with socket wear. Osseointegration surgery creates a direct skeletal connection for the prosthesis and eliminates the socket with its problems of pinching, sweating, sores and instability.
We at Hospital for Special Surgery have also had positive experiences with this tibial procedure in 30 patients to date. Amputees start at different levels of function and, in general, transtibial patients have better function than transfemoral patients. With osseointegration surgery, all amputees have potential for improved control of their leg, energy transfer to the prosthetic and even a better sense of proprioception. Increased load directly to the bone may also improve local bone density to combat disuse osteopenia noted universally in amputees.
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Al Muderis M, et al. Transtibial osseointegration confers mobility benefits with limited complications. Presented at: Limb Lengthening and Reconstruction Society Annual Scientific Meeting; July 16-17, 2021; New York.
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