It’s an exciting time in the field of external limb prosthetics. The adoption of osseointegrated prosthetic limb implants in Europe and Australia marks the beginning of a new chapter for Canadian amputees and the medical community that supports them.
Please note: The following information was originally published by Orthotics Prosthetics Canada, and is being shared with their permission.
Osseointegration (OI) refers to the direct structural and functional connection between living bone and the surface of a biocompatible metal implant. This technique provides a stable fixation between remodeled biological tissues and a titanium implant without stimulating rejection mechanisms. Osseointegrated prosthetic implants are a viable alternative to the traditional socket-based solutions that have been the foundation for prosthetic devices for centuries.
Although osseointegrated prosthetic surgeries are not yet being routinely performed in Canada, work is ongoing to bring these surgeries to Canada. Presently, a number of Canadian amputees are traveling abroad to undergo OI surgery, and then relying on the Canadian medical community for post-surgery care and ongoing support upon their return. As of November 2017, OPC is aware of 26 Canadian amputees who have undergone osseointegrated prosthetic implant surgery abroad.
Ask any limb amputee how they feel about their prosthesis’ socket system and you’ll probably quickly learn about the limitations of this man-made extension of their body. Although prosthetic limbs have evolved through major technological advancements in the last two decades, there are still limitations to their use. Discomfort and problems related to the fit of the socket are common and have shown to negatively impact the quality of life and mobility of the user.
The origins of osseointegration date back to the 1960s, when it was discovered that titanium implants could be used as a restoration for tooth loss. The long-term success of a series of clinical trials confirmed the advantage of the functional and structural connection between living bone and the titanium implant. Osseointegrated prosthetic implants differ from traditional socket-based solutions in that a titanium implant is inserted into the marrow space of the bone and exits through the residual limb’s skin with an abutment. The implant, which is called a “fixture”, integrates into the bone over time. The abutment exits through the amputee’s soft tissue and skin and allows a prosthesis to be attached directly to the abutment.
In most cases, the certified prosthetist will have an established relationship with the patient from their prior socket-based prostheses. The prosthetist knowledge and expertise will provide important insight regarding the potential advantages and/or disadvantages of osseointegrated prostheses. In collaboration with the physiatrist, the certified prosthetist should discuss with the patient whether osseointegration is a viable treatment option based on the patient’s profile, as well as their goals and expectations. If it is, a referral will be made to the OICT to initiate a preliminary assessment.
The certified prosthetist role during the preliminary assessment will be to provide insight into the current ability, desired goals and expected outcomes of the patient in comparison to expected outcomes with traditional socket-based prostheses. The certified prosthetist will be expected to provide their expert opinion on the success or failure of the current prosthetic socket, the abilities of the patient and whether proceeding with osseointegration would improve the patient’s quality of life.
Following the surgery, rehabilitation follows. During this stage, the certified prosthetist works closely with the patient to implement the terminal and abutment components in a way that incorporates OICT recommendations related to initial loading of the implant and gait rehabilitation. The certified prosthetist will be responsible for selecting and applying the prosthetic components to the abutment. All components will be adjusted by the prosthetist as required in order to ensure an optimal outcome. Also, all components will be assembled and statically aligned. This completed prosthesis will be a “training” prosthesis and may or may not be temporary depending on the outcome of this stage of the care continuum and the functional ability of the patient. Dynamic alignment will be provided once full loading of the prosthesis is attained and initial gait rehabilitation has begun. Throughout the rehabilitation stage, continuous support to the rehabilitation team is provided by the certified prosthetist with a focus on adjusting prosthetic componentry to optimize rehabilitation outcomes.
As the overall outcome of the patient is evaluated, the certified prosthetist will share their expert opinion on the functional ability of the patient relative to the componentry selected. Additionally, the prosthetist will recommend a follow-up schedule for maintenance of the components and ongoing evaluation of the patient.
Following successful rehabilitation and gait training with the osseointegrated prosthesis, the certified prosthetist will continue to work closely with the rehabilitation specialists and the patient to improve alignment and dynamic function of the prosthesis as the patient improves.
As osseointegrated prosthetic implants become more common, they have the potential to fundamentally improve the quality of life of amputees and shift the field of Canadian prosthetics. All team members supporting amputees will need continuing education on state-of-the-art developments as technology and treatments evolve and the number of surgeries performed increases in Canada.
Educating tomorrow’s prosthetists about this procedure is key. As a first step for current members of the prosthetics profession, an article with an overview of the procedure was published in the 2017 edition of our national publication, Alignment. Osseointegration Related to Limb Prosthetics in Canada, written by Tony van der Waarde, CP(c) is available for public viewing at this link: https://go.epublish4me.com/ebook/ebook?id=10094337#/78.