Osseointegration
The term Osseointegration is derived from the Greek word for bone, osteon, and the Latin word integrare, meaning to integrate or make whole. It refers to the direct surgical attachment or connection of metal or plastic implants to bone, without any sort of fibrous tissue involvement. Types of osseointegration surgery include dental and orthopaedic, although here we are obviously only concerned with the orthopaedic type, as it relates to implantation of prostheses used for attachment of artificial limbs.
Advantages
- The prosthesis can feel like a more natural extension of the limb because of its direct attachment.
- Reports of more responsiveness, better control, as forces are applied directly to the prosthesis rather than through an interface.
- Improved proprioception / awareness of limb position.
- Lighter prosthesis weight due to less components.
- Problems such as pain or discomfort, sweating, volume change and skin breakdown, are eliminated due to the absence of a prosthetic socket.
- Speed / ease of prosthetic attachment / removal.
Disadvantages / Risks
- Risk of infection around the bolt / skin interface, which is effectively a permanent open wound.
- Risk of bone fracture through the shaft and proximal to the end of the prosthesis.
- A second surgery, with potentially a long recovery as the bone grows around the prosthesis.
- Potential delays in prosthetic fitting while waiting for the prosthesis / bone interface to gain sufficient strength.
- The prosthetic shaft could become unthreaded and loosen.
Links and Other Resources
- Osseointegration Group of Australia
www.osseointegrationaustralia.com.au
Provides a wealth of information, including videos, and a resource for amputees considering this type of surgery.
The group also provides videos of the surgical and post-operative period, which are also hosted on YouTube:
Some Papers from Queensland Research
- Innovations of health services and economic evaluation of bone-anchored prosthesis using osseointegration: The Queensland Artificial Limb Service’s experience
https://eprints.qut.edu.au/115907/7/115907.pdf - Frossard, L., G. Merlo, T. Quincey, B. Burkett, and D. Berg, Development of a Procedure for the Government Provision of Bone-Anchored Prosthesis Using Osseointegration in Australia. PharmacoEconomics - Open, 2017: p. 1-6. DOI: 10.1007/s41669-017-0032-5
http://rdcu.be/s99d
https://eprints.qut.edu.au/107652/1/Art-QALS-Policy%20QLD%20experience-ePrint-03.pdf - Frossard L, Berg D, Merlo G, Quincey T, Burkett B. Cost-comparison of socket-suspended and bone-anchored transfemoral prostheses. JPO: Journal of Prosthetics and Orthotics. 2017. (29) 4, p 1-11. DOI: 10.1097/jpo.0000000000000142
http://journals.lww.com/jpojournal/Abstract/publishahead/Cost_Comparison_of_Socket_Suspended_and.99964.aspx
https://eprints.qut.edu.au/110461/1/2017%20Art-PROT-JPO-Cost%20comparison-ePrint%2004.pdf - Frossard, L., G. Merlo, B. Burkett, T. Quincey, and D. Berg, Cost-effectiveness of bone-anchored prostheses using osseointegrated fixation: myth or reality? Prosthetic and Orthotics International, 2017.
http://journals.sagepub.com/doi/10.1177/0309364617740239
https://eprints.qut.edu.au/114520/1/Art-QALS-Cost%20Effectiveness-ePrint-06.pdf