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:
- 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
- Stage 1: Implant
- 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
- Research at University of Colorado to improve scope
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.