Treatment Osseointegration

The treatment In short

Intake

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.
 

Surgery 1

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.
 

Surgery 2

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.
 

Rehabilitation

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

1. you experience problems with your socket prosthesis (perspiration, skin problems, pain)
2. your walking distance is limited because of your socket prosthesis
3. you can’t sit comfortably when wearing your socket prosthesis
4. your socket prosthesis often becomes loose during daily activities 
5. 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: kostenvanzorg@radboudumc.nl. 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.