Periprosthetic osseointegration fractures are infrequent and management is familiar

Aims Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees. Methods A retrospective review identified 518 osseointegration procedures which were undertaken in 458 patients between 2010 and 2018 for whom complete medical records were available. Potential risk factors including time since amputation, age at osseointegration, bone density, weight, uni/bilateral implantation and sex were evaluated with multiple logistic regression. The mechanism of injury, technique and implant that was used for fixation of the fracture, pre-osseointegration and post fracture mobility (assessed using the K-level) and the time that the prosthesis was worn for in hours/day were also assessed. Results There were 22 periprosthetic fractures; they occurred exclusively in the femur: Two in the femoral neck, 14 intertrochanteric and six subtrochanteric, representing 4.2% of 518 osseointegration operations and 6.3% of 347 femoral implants. The vast majority (19/22, 86.4%) occurred within 2 cm of the proximal tip of the implant and after a fall. No fractures occurred spontaneously. Fixation most commonly involved dynamic hip screws (10) and reconstruction plates (9). No osseointegration implants required removal, the K-level was not reduced after fixation of the fracture in any patient, and all retained a K-level of = 2. All fractures united, 21 out of 22 patients (95.5%) wear their osseointegration-mounted prosthetic limb longer daily than when using a socket, with 18 out of 22 (81.8%) reporting using it for = 16 hours daily. Regression analysis identified a 3.89-fold increased risk of fracture for females (p = 0.007) and a 1.02-fold increased risk of fracture per kg above a mean of 80.4 kg (p = 0.046). No increased risk was identified for bilateral implants (p = 0.083), time from amputation to osseointegration (p = 0.974), age at osseointegration (p = 0.331), or bone density (g/cm2, p = 0.560; T-score, p = 0.247; Z-score, p = 0.312). Conclusion The risks and sequelae of periprosthetic fracture after press-fit osseointegration for amputation should not deter patients or clinicians from considering this procedure. Females and heavier patients are likely to have an increased risk of fracture. Age, years since amputation, and bone density do not appear influential

Single-stage osseointegrated reconstruction and rehabilitation of lower limb amputees: the Osseointegration Group of Australia Accelerated Protocol-2 (OGAAP-2) for a prospective cohort study.

IntroductionLower limb amputations have detrimental influences on the quality of life, function and body image of the affected patients. Following amputation, prolonged rehabilitation is required for patients to be fitted with traditional socket prostheses, and many patients experience symptomatic socket-residuum interface problems which lead to reduced prosthetic use and quality of life. Osseointegration has recently emerged as a novel approach for the reconstruction of amputated limbs, which overcomes many of the socket-related problems by directly attaching the prosthesis to the skeletal residuum. To date, the vast majority of osseointegration procedures worldwide have been performed in 2 stages, which require at least 4 months and up to 18 months for the completion of reconstruction and rehabilitation from the time of the initial surgery. The current prospective cohort study evaluates the safety and efficacy of a single-stage osseointegration procedure performed under the Osseointegration Group of Australia Accelerated Protocol-2 (OGAAP-2), which dramatically reduces the time of recovery to ∼3-6 weeks.Methods and analysisThe inclusion criteria for osseointegrated reconstruction under the OGAAP-2 procedure are age over 18 years, unilateral transfemoral amputation and experiencing problems or difficulties in using socket prostheses. All patients receive osseointegrated implants which are press-fitted into the residual bone. Functional and quality-of-life outcome measures are recorded preoperatively and at defined postoperative follow-up intervals up to 2 years. Postoperative adverse events are also recorded. The preoperative and postoperative values are compared for each outcome measure, and the benefits and harms of the single-stage OGAAP-2 procedure will be compared with the results obtained using a previously employed 2-stage procedure.Ethics and disseminationThis study has received ethics approval from the University of Notre Dame, Sydney, Australia (014153S). The study outcomes will be disseminated by publications in peer-reviewed academic journals and presentations at relevant clinical and orthopaedic conferences

Osseointegrated Prosthetic Limb for the treatment of lower limb amputations : Experience and outcomes.

BACKGROUND: Osseointegration has emerged over the past two decades as a dramatically different approach for the treatment of lower limb amputations, which involves direct attachment of the prosthesis to the skeletal residuum. This approach can address many of the socket-interface issues associated with socket prostheses which represent the current standard of care for amputees. The Osseointegrated Prosthetic Limb (OPL) is an osseointegration implant with a new design and improved features compared to other available implant systems. OBJECTIVES: To report on the experience and outcomes of using the OPL for osseointegrated reconstruction of lower limb amputations. MATERIALS AND METHODS: This is a retrospective study of 22 patients who received the OPL implant between December 2013 and November 2014. Clinical outcomes were obtained pre- and post-operatively, with results reported at the 1‑year follow-up. Outcome measures included the Questionnaire for persons with a Trans-Femoral Amputation (Q-TFA), Short Form Health Survey 36 (SF-36), Six-Minute Walk Test (6MWT), and Timed Up and Go (TUG). Adverse events were also recorded. RESULTS: Compared to the mean pre-operative values obtained while patients were using socket prostheses or were wheelchair-bound, the mean post-operative values for all four validated outcome measures were significantly improved. There were 15 episodes of minor infections in 12 patients, all of which responded to antibiotics. Soft tissue refashioning was performed electively on 6 patients. No other adverse events were recorded. CONCLUSIONS: The results demonstrate that osseointegration surgery using the OPL is a relatively safe and effective procedure for the reconstruction and rehabilitation of lower limb amputees

Zebra lines of pamidronate therapy in children

Background: Pamidronate therapy is increasingly used in children for the treatment of low bone mineral density and increased bone fragility resulting from a spectrum of conditions. The aim of the present study was to determine and describe the radiographic features associated with cyclical bisphosphonate therapy in the growing skeleton. Methods: A retrospective review of the radiographs of thirty-five children who had been managed with cyclical pamidronate was carried out. The physeal growth rates were estimated by measuring the band intervals on radiographs and the corresponding time intervals between the administered doses of pamidronate. Results: Metaphyseal bands, which we call zebra lines, were observed with band intervals that were dependent on the age of the patient, the rate of growth, and the dosing regimen. Epiphyseal and apophyseal bands were also observed in some patients. A distinction was made between Harris growth arrest lines and zebra lines. There was no evidence to suggest a deceleration in bone growth in children managed with pamidronate. Conclusions: The term zebra lines is proposed as a descriptive term for the characteristic pattern of metaphyseal banding seen on the radiographs of children receiving cyclical bisphosphonate therapy.M. Al Muderis, T. Azzopardi and P. Cund

Osseointegration as Treatment for a Knee Disarticulation Because of a Congenital Femoral Deficiency: A Case Report.

CASE: A 25-year-old woman underwent osseointegration surgery as treatment for an amputation that had been performed because of congenital femoral deficiency. The undersized custom-designed implant for the congenitally hypoplastic femur subsequently loosened, causing substantial pain and loss of function. The patient underwent revision surgery with a larger standard-sized osseointegration implant, and experienced no additional complications. CONCLUSION: This case demonstrates the possibility of stimulating a hypertrophic response in underdeveloped bone, which allows the subsequent insertion of a larger implant with greater stability. Similar procedures can be considered for the treatment of patients who had amputations because of congenital deficiencies, in order to produce improved outcomes and reduce the risk of additional complications

Osseointegrated Transtibial Implants in Patients with Peripheral Vascular Disease: A Multicenter Case Series of 5 Patients with 1-Year Follow-up

Item does not contain fulltextBACKGROUND: Osseointegration is an alternative treatment for amputees who are unable to wear or have difficulty wearing a socket prosthesis. Although the majority of limb amputations are due to vascular disease, such amputations have been perceived as a contraindication to osseointegration surgery. We report the outcomes of osseointegrated reconstruction in a series of 5 patients with limb amputation due to peripheral vascular disease. METHODS: Five patients with transtibial amputation and a history of peripheral vascular disease who received an osseointegration implant from 2014 to 2015 were followed for 12 months. Clinical and functional outcomes were assessed, including pain, the amount of time the patient wore the prosthesis, mobility, walking ability, and quality of life. Adverse events, including infection, fracture, implant failure, revision surgery, additional amputation, and death, were monitored and recorded. RESULTS: Five transtibial amputees (56 to 84 years of age) followed for 1 year after osseointegration surgery were included in this case series. The mobility of all patients was improved at the time of follow-up. Three patients were wheelchair-bound prior to the surgery but all 5 were able to walk and perform daily activities at the time of follow-up. Four of the 5 patients were pain-free at 12 months postoperatively, and all 5 were using the osseointegrated prosthesis. Two patients had a single episode of superficial soft-tissue infection. CONCLUSIONS: An osseointegrated implant may be considered a feasible alternative to the conventional socket prosthesis for patients with peripheral vascular disease. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.8 p