Skip to main content
SpringerLink
Log in

The Mangled Extremity: Osseointegration

  • Chapter
  • First Online:
The Mangled Extremity

  • 498 Accesses

Abstract

Patients with amputations often fail to tolerate conventional sockets resulting in complications that cause pain, skin breakdown, and improper prosthesis fit. Osseointegration allows direct attachment of an external prosthesis to the skeleton providing enhanced biomechanical advantage as well as rehabilitation potential to the patient. Multiple percutaneous implant systems exist with varying level of clinical use internationally. The purpose of this chapter is to review the history of osseointegration, osseointegration technique, implant examples, published research, and reported outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wright TW, Hagen AD, Wood MB. Prosthetic usage in major upper extremity amputations. J Hand Surg. 1995;20(4):619–22. https://doi.org/10.1016/s0363-5023(05)80278-3.

    Article  CAS  Google Scholar 

  2. Alfieri KA, Forsberg JA, Potter BK. Blast injuries and heterotopic ossification. Bone Jt Res. 2012;1(8):174–9. https://doi.org/10.1302/2046-3758.18.2000102.

    Article  Google Scholar 

  3. Krajbich JI, Pinzur MS, Potter BK, Stevens PM. Atlas of amputations and limb deficiencies: surgical, prosthetic and rehabilitation principles. 4th ed. 2004.

    Google Scholar 

  4. Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implant. 1990;5(4):347–59.

    CAS  Google Scholar 

  5. Aschoff H-H, Clausen A, Tsoumpris K, Hoffmeister T. Implantation der Endo-Exo-Femurprothese zur Verbesserung der Mobilität amputierter Patienten. Oper Orthop Traumatol. 2011;23(5):462–72. https://doi.org/10.1007/s00064-011-0054-6.

    Article  PubMed  CAS  Google Scholar 

  6. Potter BK, Burns TC, Lacap AP, Granville RR, Gajewski DA. Heterotopic ossification following traumatic and combat-related amputations. J Bone Jt Surg. 2007;89(3):476–86. https://doi.org/10.2106/jbjs.f.00412.

    Article  Google Scholar 

  7. Potter MBK, Forsberg LJA, Davis TA, et al. Heterotopic ossification following combat-related trauma. J Bone Jt Surg. 2010;92:74–89. https://doi.org/10.2106/jbjs.j.00776.

    Article  Google Scholar 

  8. Tintle LSM, Baechler LMF, Nanos CGP, Forsberg LJA, Potter MBK. Traumatic and trauma-related amputations. J Bone Jt Surg. 2010;92(18):2934–45. https://doi.org/10.2106/jbjs.j.00258.

    Article  Google Scholar 

  9. Tintle LSM, Baechler LMF, Nanos CGP, Forsberg LJA, Potter MBK. Reoperations following combat-related upper-extremity amputations. J Bone Jt Surg. 2012;94(16):e119. https://doi.org/10.2106/jbjs.k.00197.

    Article  Google Scholar 

  10. Brånemark R, Berlin O, Hagberg K, Bergh P, Gunterberg B, Rydevik B. A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: a prospective study of 51 patients. Bone Jt J. 2014;96-B(1):106–13. https://doi.org/10.1302/0301-620x.96b1.31905.

    Article  Google Scholar 

  11. Brånemark PI, Hansson BO, Adell R, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plastic Reconstr Surg Suppl. 1977;16:1–132.

    Google Scholar 

  12. Esposito M, Hirsch J, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants, (I). Success criteria and epidemiology. Eur J Oral Sci. 1998;106(1):527–51. https://doi.org/10.1046/j.0909-8836..t01-2-.x.

    Article  PubMed  CAS  Google Scholar 

  13. Håkansson B, Carlsson P. Skull simulator for direct bone conduction hearing devices. Scand Audiol. 1989;18(2):91–8. https://doi.org/10.3109/01050398909070728.

    Article  PubMed  Google Scholar 

  14. Murphy EF. History and philosophy of attachment of prostheses to the musculoskeletal system and of passage through the skin with inert materials. J Biomed Mater Res. 1973;7(3):275–95. https://doi.org/10.1002/jbm.820070319.

    Article  PubMed  CAS  Google Scholar 

  15. Mooney V, Predecki PK, Renning J, Gray J. Skeletal extension of limb prosthetic attachments–problems in tissue reaction. J Biomed Mater Res. 1971;5(6):143–59. https://doi.org/10.1002/jbm.820050612.

    Article  Google Scholar 

  16. Esslinger JO. A basic study in semi-buried implants and osseous attachments for application to amputation prosthetic fitting. Bull Prosthet Res. 1970;10(13):219–25.

    PubMed  CAS  Google Scholar 

  17. Hall CW. Developing a permanently attached artificial limb. Bull Prosthetic Res. 1974;22:144–57.

    Google Scholar 

  18. Hall CW, Cox PA, Mallow WA. Sketeal exension development: criteria for future designs. Bull Prosthetic Res. 1976;10:69–94.

    Google Scholar 

  19. Hall CW. A future prosthetic limb device. J Rehabilitation Res Dev. 1985;22(3):99. https://doi.org/10.1682/jrrd.1985.07.0099.

    Article  CAS  Google Scholar 

  20. Andersson GB, Gaechter A, Galante JO, Rostoker W. Segmental replacement of long bones in baboons using a fiber titanium implant. J Bone Jt Surg Am. 1978;60(1):31–40. https://doi.org/10.2106/00004623-197860010-00005.

    Article  CAS  Google Scholar 

  21. Ling RSM. Observations on the Fixation of Implants to the Bony Skeleton. Clin Orthop Relat R. 1986;210(NA):80–96. https://doi.org/10.1097/00003086-198609000-00012.

    Article  Google Scholar 

  22. Tsikandylakis G, Berlin Ö, Brånemark R. Implant survival, adverse events, and bone remodeling of Osseointegrated percutaneous implants for Transhumeral amputees. Clin Orthop Relat Res. 2014;472(10):2947–56. https://doi.org/10.1007/s11999-014-3695-6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kang NV, Pendegrass C, Marks L, Blunn G. Osseocutaneous integration of an intraosseous transcutaneous amputation prosthesis implant used for reconstruction of a transhumeral amputee: case report. J Hand Surg. 2010;35(7):1130–4. https://doi.org/10.1016/j.jhsa.2010.03.037.

    Article  Google Scholar 

  24. Aschoff HH, Kennon RE, Keggi JM, Rubin LE. Transcutaneous, distal femoral, intramedullary attachment for above-the-knee prostheses. J Bone Jt Surg. 2010;92(Supplement & lowbar;2):180–6. https://doi.org/10.2106/jbjs.j.00806.

    Article  Google Scholar 

  25. Skalak R. Biomechanical considerations in osseointegrated prostheses. J Prosthet Dent. 1983;49(6):843–8. https://doi.org/10.1016/0022-3913(83)90361-x.

    Article  PubMed  CAS  Google Scholar 

  26. Hagberg K, Brånemark R. One hundred patients treated with osseointegrated transfemoral amputation prostheses–rehabilitation perspective. J Rehabil Res Dev. 2009;46(3):331–44. https://doi.org/10.1682/jrrd.2008.06.0080.

    Article  PubMed  Google Scholar 

  27. Hagberg K, Häggström E, Jönsson S, Rydevik B, Brånemark R. Psychoprosthetics. London: Springer-Verlag London Limited; 2008. p. 131–40. https://doi.org/10.1007/978-1-84628-980-4_10.

    Book  Google Scholar 

  28. Zaid MB, OʼDonnell RJ, Potter BK, Forsberg JA. Orthopaedic osseointegration. J Am Acad Orthop Surg. 2019;27:e977–85. https://doi.org/10.5435/jaaos-d-19-00016.

    Article  PubMed  Google Scholar 

  29. Sullivan J, Uden M, Robinson KP, Sooriakumaran S. Rehabilitation of the trans-femoral amputee with an osseointegrated prosthesis: the United Kingdom experience. Prosthetics Orthot Int. 2003;27(2):114–20. https://doi.org/10.1080/03093640308726667.

    Article  CAS  Google Scholar 

  30. Tillander J, Hagberg K, Hagberg L, Brånemark R. Osseointegrated titanium implants for limb prostheses attachments: infectious complications. Clin Orthop Relat Res. 2010;468(10):2781–8. https://doi.org/10.1007/s11999-010-1370-0.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hagberg K, Brånemark R, Gunterberg B, Rydevik B. Osseointegrated trans-femoral amputation prostheses: prospective results of general and condition-specific quality of life in 18 patients at 2-year follow-up. Prosthetics Orthot Int. 2008;32(1):29–41. https://doi.org/10.1080/03093640701553922.

    Article  Google Scholar 

  32. Muderis MA, Khemka A, Lord SJ, de Meent HV, Frölke JPM. Safety of osseointegrated implants for transfemoral amputees. J Bone Jt Surg. 2016;98(11):900–9. https://doi.org/10.2106/jbjs.15.00808.

    Article  Google Scholar 

  33. Forsberg, JA. Transhumeral Amputee Osseointegration Study (TAOS) FDA Early Feasibility Study IDE#G150155.

    Google Scholar 

  34. Hudak PL, Amadio PC, Bombardier C, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med. 1996;29(6):602–8. https://doi.org/10.1002/(sici)1097-0274(199606)29:6<602::aid-ajim4>3.0.co;2-l.

    Article  PubMed  CAS  Google Scholar 

  35. Cella D, Yount S, Rothrock N, et al. The patient-reported outcomes measurement information system (PROMIS). Med Care. 2007;45(5):S3–S11. https://doi.org/10.1097/01.mlr.0000258615.42478.55\.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Walter Reed National Military Medical Center, Department of Surgery Division of Orthopaedics, Bethesda, MD, USA

    Ashley B. Anderson & Jonathan A. Forsberg

  2. Uniformed Services University, Bethesda, MD, USA

    Ashley B. Anderson & Jonathan A. Forsberg

  3. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Jonathan A. Forsberg

Authors
  1. Ashley B. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan A. Forsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Raymond A. Pensy

  2. Hand Surgery Division Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA

    John V. Ingari

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Anderson, A.B., Forsberg, J.A. (2021). The Mangled Extremity: Osseointegration. In: Pensy, R.A., Ingari, J.V. (eds) The Mangled Extremity. Springer, Cham. https://doi.org/10.1007/978-3-319-56648-1_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56648-1_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56647-4

  • Online ISBN: 978-3-319-56648-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation