National Conference Takeaways: Osseointegration in the U.S. – Today and Tomorrow

The 2023 National Conference boasted a variety of informative sessions covering topics relevant to the limb loss and limb difference community. Osseointegration is a procedure which is gaining popularity and giving hope to people who struggle with wearing a conventional socket. If you were unable to attend in person, learn more about the key takeaways from Osseointegration in the U.S. – Today and Tomorrow and discover if it may be right for you.

Speakers:  

• Jeffrey Cain, MD, Clinical Professor, University of Colorado, Department of Family Medicine 
• Jason Stoneback, MD, Associate Professor, Orthopedics, University of Colorado

Summary: Osseointegration is a surgical technique where a metal implant is attached directly to the bone, connected to a prosthetic device, and eliminates the traditional socket. For people who cannot tolerate a socket, it offers the potential for dramatic improvement in mobility and lifestyle. Our presentation will cover the history, research, risks, and benefits of osseointegration and help attendees better understand if osseointegration is a good choice for them.  

Key Takeaways from Dr. Jeffrey Cain:  

• Dr. Cain was in an airport crash and had both legs amputated below the knee  
• Implant that goes into the bone, the tissue grows around the implant  
• Lessons learned from dental implants  
• Benefits:
  • Direct skeletal attachment
  • Elimination of the socket
  • Osseoperception
  • Improved quality of life
  • Improved gait
  • Increased step count
• Surgical Challenges:  
  • Implant loosening/fractures  
  • Infection  
  • Stoma care  
  • Pain  
  • Expense  
  • Insurance
• Prosthetic Challenges:
  • Impact and torque limits  
  • Prosthetic alignment  
  • Osseoperception (hot, cold, vibration, etc.)  
  • Swimming (controversial)  
  • Metal abutment
• Two different kinds – screw fit and press fit. Screw fit is FDA-approved. The press-fit are in investigation now, expect to be FDA-approved in a year or two  
  • Screw fit – Integrum – Two stage surgery that is FDA-approved
• For people who can’t fit into a socket, this is a viable option  
• However, many people do get infections  
• Resources:  
  • Walter Reed National Military Medical Center  
  • Amputee Coalition osseointegration fact sheet
• If you are an above-knee amputee, he thinks this is a scientifically better way to get around.   
• If you have a socket and it’s working for you, osseointegration is not for you.

Key Takeaways from Dr. Jason Stoneback: 

• Traditional challenges with sockets  
  • Skin friction, soft tissue breakdown/wounds  
  • Volume fluctuations throughout the day  
  • Poor proprioception
• Replacing socket with bone-anchor prosthesis  
• A lot of nuances in ensuring an effective outcome  
• Femur pain, your muscles/skeleton isn’t working normally with a socket  
• Osseointegration realigns skeletal system  
• When you load your joints and are not aligned, you get arthritis earlier in life  
• Two stage technique
  • Stage 1: Implant  
    • 3 months in between stage 1 and stage 2  
  • Stage 2: create flap and skin graft skin to the end of the bone
• Rehab  
  • Stage 1: 3-6 months rest  
  • Stage 2: 3-6 months rest
• Press-fit (not FDA approved yet)  
  • Can be done in 1 stage  
  • 6 weeks after first surgery, then outpatient surgery to load the implant
• Right after surgery
  • PT  
  • Stoma care teaching  
  • Frequent follow up in first year  
  • Collaboration with local PCP/prosthetist
• Ensuring success  
  • Thorough assessment of patient goals  
  • Multi-disciplinary approach  
  • Dedicated program invested in long-term care and research of amputees with OI
• Who this is not for:  
  • Someone who does extreme sports!  
  • Kids  
  • Smokers  
  • Those with poor blood flow or on medication that impact blood flow (vascular disease, diabetes)
• Participants report greater participation in everyday activities, better balance, better confidence, better walking, less gait variability, better posture  
• Personalized medicine a key component of entire process  
• Future direction:  
  • Research at University of Colorado to improve scope
    • Diabetic candidate research  
    • Vascular disease candidate research

The 2024 National Conference is coming to the Hyatt Regency Atlanta, August 7-10 in Atlanta, Georgia. We would love to see you there! Discuss your experience with osseointegration or ask peers questions on AC Connect.