Osseointegration: An Alternative for Prosthetic Users
For some amputees, life can revolve around adjusting your prosthetic socket or at times dealing with rubbing and pinching. But thanks to developments in prosthetic technology, amputees who have had a hard time dealing with external prostheses can now enjoy a broader range of movement and potentially a more natural gait pattern through a bone implant procedure called osseointegration.
A semi-permanent prosthetic
Amputees who choose to undergo osseointegration surgery no longer need to deal with prosthetic sockets. That’s because the metal that is inserted into the bone of a leg or arm and penetrates through the skin is designed to attach directly to a prosthesis through a connector.
Osseointegration, while still rare in the United States, has been in development in Sweden since the early 1990s. The procedure is popular in Europe and Australia.
One of the first U.S. patients to undergo osseointegration surgery is George Kocelj. He had his surgery in 2016. Before that, Kocelj mainly used a wheelchair because his external prosthesis—specifically prosthetic sockets—didn’t work on him. This made him a great candidate for the procedure.
Cristopher Rowles, a retired Los Angeles Police Department officer, traded his traditional artificial leg for an osseointegrated prosthesis around the same time as Kocelj. His decision to opt for osseointegration was driven by years of unsuccessful prosthetic use. He recounts the times when he would be walking with his prosthetic leg, and the leg would suddenly detach, causing him to fall to the ground. He believes his old prosthetic system puts him at risk of further injury.
The version of osseointegration surgery performed on Rowles is not yet fully approved by the U.S. Food and Drug Administration (FDA), but it is allowed on a case-by-case basis. As of this writing, the only FDA approved osseointegration technology in the U.S. is the OPRA (Osseoanchored Prostheses for the Rehabilitation of Amputees).
Advantages of Osseointegration
After the surgery, Rowles reported that it only takes him thirty seconds to take his prosthetic leg on and off. He also said that he enjoys going to the gym five days a week and that driving with his new leg is more comfortable.
In 2011, doctors from the Radboudumc AOFE Clinic in The Netherlands sought to find out how orthopedic osseointegration improved the quality of life and gait of 22 patients.
The study found that osseointegration increased a patients’ prosthesis use to 101 hours per week, compared to only 56 hours when they were using a traditional prosthetic system incorporating the use of a prosthetic socket. Their walking speed also increased by 32 percent because walking with an osseointegration prosthesis cost 18 percent less energy. Best of all, the patients reported improved overall quality of life, rating it at 62 from 39 on a 100-point scale.
While osseointegration seems to be the next step for prosthetic technology, it’s not without its downsides.
First, the osseointegration procedure in the US is expensive, especially in an environment where traditional prostheses can set patients back by thousands of dollars. A Minnesota resident reportedly had to raise $18,000 through crowdfunding to pay for his osseointegration surgery while Rowles’ medical bills were covered by his workers’ compensation program.
Second, there are post-surgical health risks. The most significant health risk is the potential for infection at the site where the prosthesis meets body tissue. Although the overall infection rates have decreased since the procedure was first introduced, infections are still common.
Then there’s the issue of time. Getting fitted for an osseointegrated prosthesis after undergoing the procedure can be lengthy. Rowles’ prosthesis was custom-made in Australia; his medical team in Los Angeles worked closely with the Australian team to get his prosthesis completed.
A bionic future
If the trajectory of prosthetic technology development is any indication, a bionic future is already on the horizon. Experts say we can expect neuroelectric or myoelectric lower extremity prostheses, which will allow prosthetic users to control an artificial limb with electric signals transmitted through the muscle.What do you think of osseointegration? Have you had the procedure? Please share your experiences with us.