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Osseoperception in transcutaneous osseointegrated prosthetic systems (TOPS) after transfemoral amputation: a prospective study

  • Orthopaedic Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

A Correction to this article was published on 17 December 2021

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Abstract

Background

Endo-exo prosthetics (EEP), which belongs to the transcutaneous osseointegrated prosthetic systems (TOPS), provides an alternative bone-anchored rehabilitation method for transfemoral amputees. It led to the question of whether transmitted forces from prosthetic feet are perceptible by osseoperception resulting in proprioceptive feedback of ground conditions.

Objectives

The following hypotheses emerged for our trial with the null hypothesis: EEP fitting after transfemoral amputation does not influence osseoperception. Alternative hypothesis 1: EEP patients achieve better osseoperception results than transfemoral amputees fitted with socket prosthesis. Alternative hypothesis 2: EEP carriers achieve comparable results with regards to their osseoperception as non-amputees.

Methods

N = 25 patients with EEP (mean age = 50,6 ± 9,4, male/female = 15/10) N = 25 patients with socket prostheses (mean age = 52,6 ± 13,1, male/female = 19/6) and N = 25 healthy volunteers were included in the experimental case–control study. In three blinded test modules (V1, V2, V3), the participants had to identify different degrees of shore hardness (c) of different materials (rubber balls (shore = 5–25c), foam cushions (shore = 5–30c), foam mats (shore = 5–30c) with their prosthetic foot (or a personally defined foot in healthy volunteers) without footwear and had to rank them into the correct order according to their tactile sensation and the degree of hardness. A maximum of 10 points could be scored per run.

Results

This experimental observational study included N = 75 participants. The mean age for the entire cohort was 42.8 ± 16.6 years and the BMI was 26.0 ± 4.8. Our results show a significant level of differences in tactile osseoperception between all groups (p < 0.001). A correlation between the mean values of V1-3 and the PMQ2.0 as well as the mean values of K-Level and the prosthesis wearing time per day showed for PMQ (r = 0.387, p = 0.006) and K-level (r = 0.448, p = 0.001) which is a moderate effect according to Cohen.

Conclusion

Our study results suggest that the EEP treatment can lead to an improvement in tactile sensory perception via the bone-anchored implant, which can lead to an increase in quality of life and improved gait safety.

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Author notes

  1. Marcus Örgel, Mohamed Elareibi, Alexander Ranker, and Marcel Winkelmann are equally responsible for the completion of the manuscript.

Authors and Affiliations

  1. Department of Trauma, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Marcus Örgel, Mohamed Elareibi, Tilman Graulich, Christian Krettek, Claudia Neunaber, Horst-Heinrich Aschoff & Marcel Winkelmann

  2. Department of Physical Medicine and Rehabilitation, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Alexander Ranker

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Contributions

All authors contributed to the study conception and design. [MÖ]; methodology: [MÖ], [ME], [AR], [MW]; formal analysis and investigation: [MÖ], [ME]; writing—original draft preparation: [MÖ], [MW], [ME]; writing—review and editing: [MÖ], [TG], [CN], [AR]; resources: [MÖ], [H-HA], [TG]; supervision: [CK], [MW].

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Correspondence to Marcus Örgel.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Due to the retrospective data collection ethical approval was given as a waiver (No. 8894_BO_S_2020) and consent was granted by the Ethics Committee of Hannover Medical School.

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Consent to participate was obtained from all individual participants included in the study.

Consent to participate

Due to the retrospective data collection ethical approval was given as a waiver (No. 8894_BO_S_2020) and consent was granted by the Ethics Committee of Hannover Medical School.

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Örgel, M., Elareibi, M., Graulich, T. et al. Osseoperception in transcutaneous osseointegrated prosthetic systems (TOPS) after transfemoral amputation: a prospective study. Arch Orthop Trauma Surg 143, 603–610 (2023). https://doi.org/10.1007/s00402-021-04099-1

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