Osseointegrated Joint Replacement Connected to a Lower Limb Prosthesis: A Proof of Concept Study with 7 Cases - The 36th Annual Meeting of the Israel Orthopaedic Association 2016, November 30-2 December, 2016, David InterContinental, Tel Aviv, Israel

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¹School of Medicine, University of Notre Dame, Australia
²The Australian School of Advanced Medicine, Macquarie University, Australia
³Osseointegration Clinic, Norwest Private Hospital, Australia
⁴Tissue Engineering and Biomaterials Research Uni, The University of Sydney, Australia

Osseointegrated implants are a suitable alternative for prosthetic attachment in individuals with a lower limb amputation, who are unable to wear a socket. However, the small bone-implant contact area, reduced muscular leverage, osteoporosis, and joint arthritis contraindicates osseointegrated implant use in amputees with osteoporosis and a very short residuum. We aim to report on the feasibility and safety of combining Total Joint (Hip/Knee) Replacement with an osseointegrated implant for prosthetic attachment.

We retrospectively reviewed all seven cases of transfemoral (n=3) and trans-tibial (n=4) amputations who underwent osseointegration with joint replacement in 2012-2014. In a 2-stage procedure, a custom-made prosthesis was connected to a total hip replacement (THR) and a total knee replacement (TKR) and a stoma was created. Clinical outcomes were assessed at baseline and 24-44 months follow-up using standard measures of health-related quality-of-life, ambulation and activity level including the Questionnaire for Transfemoral Amputees (Q-TFA) and 6-minute walk test.

Four patients aged 35-77 years. There were no major complications and two cases of superficial infection. All patients showed improved Q-TFA and SF-36 scores. Three patients who were wheelchair-bound at baseline became community ambulators, and the four others patient exhibited improved ambulation.

This proof-of-concept case-series presents the first report of combining osseointegration and joint replacement. It indicates this procedure is feasible and potentially a safe and effective alternative for this patient group.