About OsseointegrationOsseointegration is used for permanent anchorage of artificial limbs to the remaining bone of a leg or arm. In a two-step surgical procedure, a metal (titanium) implant is inserted into the bone of the arm or leg. Part of the implant extends beyond the skin, enabling the prosthesis to be attached with a click safety adapter.
Advantages and disadvantages Osseointegration
AdvantagesAn osseointegrated prosthesis offers many advantages to individuals with an arm or leg amputation compared with a socket prosthesis (which fits over the stump of the amputated leg or arm). The attachment of the osseointegrated prosthesis is much more stable and provides a full range of joint movement, making walking much easier. An osseointegrated prosthesis does not cause pain or skin breakdown when used. Because the prosthesis is directly attached to the bone, the wearer feels as though their prosthesis is part of their own body by a process known as “natural osseoperception” (i.e. it feels as though it is their own leg or arm). Since 2009, the Radboud University Medical Centre (Radboudumc) in Nijmegen, the Netherlands, has been offering this highly innovative technique which significantly improves the quality of life of individuals with an amputation.
In 2011, the Radboudumc carried out a study of the first 22 patients to be given an osseointegrated prosthesis at their centre. Aspects of walking and quality of life with the osseointegrated prosthesis were compared with a socket prosthesis. It was found that prosthesis use increased from 56 to 101 hours per week, walking speed increased by 32% and walking required 18% less energy with the osseointegrated prosthesis. Prosthesis-related quality of life improved from 39 to 62 on a scale of 0 to 100.
Advantages of an osseointegrated prosthesis
- Increased prosthetic use
- Longer walking distances
- Full range of joint movement
- Better sitting comfort
- No skin problems
- Stable and safer standing and sitting
- A sense of the artificial limb belonging to the body
- Easy and quick attachment and removal
- Improved quality of life.
DisadvantagesOsseointegration is a safe treatment, and inflammation of the bone is rare. A disadvantage is that the area where the implant enters the skin (called the “stoma”) has to be cleaned twice daily with soap and water. This is comparable with brushing the teeth. In some cases, the skin around the stoma may become irritated. In the first year after implantation, intense muscle pain may be felt. This muscle pain disappears as soon as the stump muscles become fitter and stronger.
The treatment In short
After obtaining the agreement of your health insurance company to pay the costs, you should send us a request for an intake consultation. The intake consultation is to evaluate whether you are a suitable candidate for osseointegration and, if you are, to inform you about the osseointegration procedure. This will also include having an informative chat with someone who has been fitted with an osseointegrated prosthesis. If you prove to be a suitable candidate, you will be prepared and scheduled for surgery. The surgery will consist of two operations.
During the first operation, a metal implant will be inserted into the remaining bone of your leg or arm. If necessary, the length of the bone will we adjusted and the soft tissue around the bone corrected. After the first operation, you will stay in hospital and receive intravenous antibiotic treatment for 5 days. The first operation is nearly always carried out on a Monday and patients are discharged on a Friday. The second operation will be carried out 6–8 weeks after the first operation. During this period, you may not wear your socket prosthesis. Your prosthesis will remain at the hospital and will be prepared for osseointegration by our prosthetic technicians.
During the second operation, a small hole is made in the skin and the connecting part of the osseointegration prosthesis is inserted into the implant via this hole (also called a “stoma”). The second operation is short. If all goes well, you will be allowed home on the same day or the next day. Before going home, you will be given instructions on how to clean the stoma.
One week after the second operation, the rehabilitation programme will start. This involves daily visits (between 3 and 5 pm) to the Rehabilitation Department at the Radboudumc. You will learn, in a step-wise manner, how to attach the prosthesis and how to walk with crutches. If you have a below-knee amputation, you will complete the rehabilitation in 4 weeks. If your amputation is above the knee, you will be required to do exercises at home after the 4-week rehabilitation period, and will be able to walk without crutches in about 2–3 months.
Questions about osseointegration
What happens to the bone with an osseointegration implant?Most individuals treated with an osseointegration implant have weakened bone due to disuse osteoporosis (a condition causing weak, brittle bones due to lack of use). When a socket prosthesis is used, the bone is not loaded and the stump muscles are inactive. This may result in decreased muscle volume and weakened bone. With the osseointegration implant, the natural load of the bone is restored and the stump muscles are reactivated to stabilise the bone.
At the Radboudumc, bone-remodelling processes have been evaluated and the results show that the bone around the osseointegration implant becomes thicker and stronger.
Am I a suitable candidate for osseointegration treatment?You are a suitable candidate for osseointegration treatment when:
you don't smoke and
- you experience problems with your socket prosthesis (perspiration, skin problems, pain)
- your walking distance is limited because of your socket prosthesis
- you can’t sit comfortably when wearing your socket prosthesis
- your socket prosthesis often becomes loose during daily activities
- you have back pain because you do not stand or sit up straight or you limp when you walk.
Will my health insurance company pay for the costs of the osseointegration treatment?
In Europe, most health insurance companies reimburse osseointegration treatment. Before your first consultation with the Osseointegration Team at the Radboudumc, you will have to obtain the agreement of your health insurance company to cover the costs. Upon request, the Financial Department of the Radboudumc will send you a quotation for the osseointegration treatment: firstname.lastname@example.org. All European citizens pay the same price for osseointegration treatment at the Radboudumc. The price includes the implant, two operations involving two hospital stays of 5 days and 1 or 2 days and a 4-week rehabilitation programme.
Can I do everything with my osseointegrated prosthesis?
All daily activities can be carried out with an osseointegrated prosthesis, including having a bath, swimming (in the sea, a river, a lake, or a swimming pool), taking a sauna, cycling, sailing, etc.
Contact sports, including fighting, soccer and skiing, are not recommended. However, you may do these sports when not wearing your prosthesis.