Common Problems and History of Prosthesis Installation with Bone Combination Surgery

Frequently asked questions about prosthetic limbs installed through osseointegration surgery:

Is installing a prosthetic limb a single-stage or a two-stage surgery?

Most patients require only a single-stage surgery to have the implant installed. For more complex cases, the decision may be made to complete osseointegration in two stages, several months apart, if it is in the patient's best interest. Patients with very short residual limbs may also require lengthening before osseointegration. Even in a single-stage surgery, additional surgery can often be done while the implant is being installed.

What types of amputations can be osseointegrated?

People who have lost upper and lower limbs, and people who have lost fingers due to amputation, can undergo osseointegration even where the residual bone is very short.

What if I have diabetes?

Diseases such as insulin-dependent diabetes can negatively impact the healing process. Therefore, patients with diabetes and these conditions may be at higher risk for implant failure.

Is long-term antibiotic treatment required?

No. Antibiotics are a key part of the postoperative infection-reducing protocol, but are often not given long-term in patients without a history of recurrent infections.

What are the potential complications of osseointegration?

As with any surgery, osseointegration carries a certain degree of risk. Although proven to be a safe and effective treatment option, some patients may experience complications after osseointegration surgery.

Is osseointegration reversible?

Yes. The implant can be removed and the prosthesis fitted using a conventional socket.

History of osseointegrated prostheses

1500s: First documented use of prostheses

First socket prosthesis: The so-called Capua Leg, has been More than 2,300 years of history. It was made of bronze, held in place by rods and straps, and was probably crafted by an armorer. The first written record of the use of prosthetics comes from 16th-century France, where royal surgeon and field medic Ambroise Paré worked to fit soldiers who had lost upper and lower limbs after being injured in battle. According to records, one of the soldiers was an Army captain who wore one of Parley's robotic hands in combat.

After the 1500s: The evolution of socket-making techniques

During the 16th and 19th centuries, there were further developments in prosthetic technology. Since the late 17th century, the Dutch surgeon Pieter Verduyn has developed a hinged below-knee prosthesis that allows knee movement and also developed one of the first true flap amputations. Prosthetic limb technology emerged in the 19th and early 20thth: first with Pott's Angelsey Leg (c. 1800), then with Selpho's Selpho Leg (c. 1839). The mass amputations performed during the American Civil War (1861-1865) spurred massive development. In the 20th century, British aviator André Marcel Desoutter created the first aluminum prosthetic leg.

1940s: The beginning of osseointegration

The phenomenon of osseointegration, the ingrowth of bone onto the surface of artificial implants, was first discovered in animal models in 1940. It was pioneered by Swedish surgeon Per-Ingvar Brånemark, who performed the first osseointegrated dental implant in 1965. These first dental implants have been around for over 40 years.

1980 Era: The development of osseointegration

Throughout the 1970s and 1980s, osseointegration technology developed and became increasingly accepted by the scientific and surgical communities. This led to investigation of other potential applications of the technology.

1990: First osseointegration of amputees

1990 May 5By Rickard Brånemark, son of Per-Ingvar Designed andinstalled the first amputee osseointegrated implant. The patient is a 25-year-old woman who lost both legs above the knee in a tram accident when she was 15 years old. The surgery is done in two stages over a six-month period. It enables patients to walk using crutches and exercise by riding a bicycle. These first implants worked as intended for 23 years.

The 1990s: New applications of osseointegration

After the early success of Brånemark in 1990 Further clinical trials were conducted in the early 1990s, further developing applications for above-the-knee (transfemoral) amputees, and pioneering the use of osseointegrated implants for below-the-knee (transradial) and digital (thumb and finger) amputees. The experience of these first osseointegrated amputees was used to improve osseointegrated implant technology and the techniques used in osseointegrated surgery.

1998: Brånemark begins to develop standardized protocols for the two-stage osseointegration procedure, the osseointegrated implant itself and the patient's postoperative recovery process. This is called OPRA:An osseointegrated prosthesis for amputee rehabilitation. OPRA is based on the use of transosseous and screw-assisted implants.

1999: The first "press-fit" osseointegrated implant is installed in Germany, in an 18-year-old male with an above-the-knee amputation. This implant, known as an integral leg prosthesis (ILP), includes many innovations that benefit stability, weight bearing, and mobility.

After 2010:The next generation of compression implants is represented by osseointegrated prostheses (OPL), designed by Professor Munjed Al Muderis and colleagues. OPL is typically implanted in a single-stage surgery, providing amputees with shorter recovery times, and reflects the latest advances in biomechanical engineering and materials science, as well as additive manufacturing technologies that provide the best fit for each patient. To date, more than 1,000 patients have been successfully implanted with OPL.