Will Osseointegration Render Sockets Obsolete?

Given the growing awareness and success of transfemoral osseointegration
around the world, should prosthetists who rely on fitting and fabricating
removable sockets for their livelihoods be worried? The answer is a resounding
“yes”— but only if you do not stay current with the latest
socket technology.

The data are hard to argue with. Osseointegration has proven that
anchoring an artificial limb on the intrinsic bone provides amputees with far
superior prosthesis performance.

  Randall Alley, BSc, CP, FAAOP, CFT
  Randall Alley

In the most comprehensive analysis to date, researchers in the
Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) study in
Sweden treated 51 patients with femur amputations and monitored their progress
for 2 years.

“For more than 9 out of 10 patients, this treatment leads to
improved function and enhanced quality of life,” Rickard
Brånemark, MD, MSC, PhD,
said when the study was first released.

Brånemark, one of the authors of the study and doctor of medicine
at Sahlgrenska University Hospital in Gothenburg, Sweden, pointed out that
attaching amputation prostheses directly to the skeleton using an implant has a
hopeful but as yet unachievable vision and development has been under way for
more than 20 years.

“Now, however, comes the international breakthrough for this
revolutionary treatment,” Brånemark said. OPRA results were further
examined and discussed at the recent Orthopaedic Surgical Osseointegration
Society’s International Conference held in San Francisco in February.

Room for hope

So why should prosthetists who rely on fitting removable sockets have
hope? Because revolutionary bone anchoring is possible not only with
osseointegration, but also with a removable socket. The High-Fidelity
Interface, which incorporates patent-pending bone anchoring technology, has
been on a parallel development path with osseointegration for years. Both
osseointegration and this interface design have approximately 200 patients

Whereas osseointegration uses an implanted rod to anchor the bone from
the inside, the High-Fidelity Interface uses longitudinal compression struts to
anchor the bone from the outside. Appropriate levels of compression are
achieved utilizing uniquely designed windows between the struts to manage the
gradual release of displaced soft tissue, enabling volume to safely escape. It
is this reduction of limb volume lying within the field of compression that
allows the management of undesirable motion of the underlying bone.

Both bone anchoring techniques offer advantages over conventional
sockets, including improved control, stability, gait, range of motion, comfort,
skin health, volume control and stamina. Recipients of both technologies also
report enhanced osseoperception, or the ability to feel the ground better,
since body weight and ground reaction force are absorbed more naturally through
the femur and into the hip.

More risk

Because osseointegration involves additional surgeries, it comes with
greater risks, including the possibility of infection through the stoma, the
potential for revision surgery, and cost. Osseointegration at the femoral level
also involves risk of fracturing or shattering the femur in a fall or while
performing high-impact activities. Whereas osseointegration is currently
approved in only a few countries and is not recommended for amputations due to
diabetes, bone anchoring interfaces are available to all amputees everywhere,
through local prosthetists who have been trained in implementation.
Prosthetists who are trained and outfitted with the right equipment can
integrate bone anchoring into their removable prostheses, and to stay current
as new research and best practices emerge.

As a news reporter from New Zealand recently said, “The technology
for prosthetic legs has advanced phenomenally in recent years, but the way the
legs are attached to the body hasn’t changed much since Napoleon’s
day.” With revolutionary advances in implanted and removable bone-anchored
prostheses, health care professionals and amputees alike can all be thankful
real progress is being made.

For more information:

Alley RD, Williams W, Albuquerque M, Altobelli D. Prosthetic sockets
stabilized by alternating areas of tissue compression and release. J Rehabil
Res Dev.

Hagberg K, Brånemark R. One hundred patients treated with
osseointegrated transfemoral amputation prostheses — rehabilitation
perspective. J Rehabil Res Dev. 2009;46:331-344.

Fourth International Conference: Advances in Orthopaedic
Osseointegration. Feb. 10-12. University of California, San Francisco.

Disclosure: Alley is the creator of the High-Fidelity Interface, XFrame
and CCI design.

For more information:

Randall Alley, BSc, CP, FAAOP, CFT is chief executive
officer of biodesigns, inc., a company specializing in advanced upper and lower
limb prosthetic systems, patient care and product development. He is an
international consultant and recipient of the Clinical Creativity Award from
the Academy of Orthotists and Prosthetists. Alley can be reached at

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