Osseointegrated Implants in Patients with Peripheral Vascular Disease: A Case Series of 4 Patients

Peripheral vascular disease (PVD) is the primary cause of lower extremity amputations in developed countries. Over the past decades, advancements in peripheral vascular surgery have helped salvage many limbs otherwise destined for amputation. Nevertheless, intervention through vascular surgery alone is not sufficient in many cases and additional reconstruction through orthopedic surgery is often required. Several studies exist in the literature showing the beneficial effects of osseointegration in lower limb amputees. However, no study to date has been published regarding the use of osseointegrated implants in vascular amputees. This study is a case series of 4 patients who suffered from PVD and received an osseointegrated implant as part of the treatment regime.

All patients were unilateral trans-tibial amputees (TTA) who suffered limb loss due to PVD and received a press-fit osseointegrated implant. Outcome measures included descriptive observations, the Questionnaire for persons with a Trans-Femoral Amputation (QTFA), Short Form Health Survey 36 (SF-36), K-Levels, Six Minute Walk Test (6MWT) and Timed Up and Go (TUG). Adverse events recorded included infection, revision surgery, fractures, implant failures and death.

At follow-up, there were no reports of implant failure or revision surgeries. The values of all outcome measures were consistent with reported values from other osseointegration studies and showed significant improvements compared to pre-operative levels. A single mild superficial infection event was recorded, which was treated successfully with oral antibiotics.

Although this case series represents a minor fraction of the osseointegration patient cohort, the implications of using osseointegration to retain a functional knee joint is significant for patients in terms of mobility, quality of life and even survival. These results suggest that osseointegration may be considered as an alternative method to help PVD patients maintain a higher activity level after amputation, which in turn improves their chances of survival and quality of life.