Osseointegrated Total Hip Replacement Connected To a Lower Limb Prosthesis: 3 Cases a Proof of Concept Study

Osseointegrated implants are an alternative for prosthetic attachment for individuals with transfemoral amputation unable to wear a socket. However, small bony-implant contact area, reduced muscular leverage, and osteoporosis discourage us from their application in transfemoral amputees with a short residuum and osteoporosis. We report on the feasibility of combining total hip replacement (THR) with an osseointegrated implant for prosthetic attachment.

We retrospectively reviewed 3 individuals with transfemoral amputations who underwent an osseointegrated implant combined with THR in our center. At baseline patients presented with significant flexion contractures of the affected hip joint. A 2-stage surgical procedure was performed 5-8 weeks apart. An osseointegrated femoral prosthesis was connected to the custom made THR prosthesis transferring the load directly to the pelvis through the acetabulum allowing the femoral residuum and the hip joint to act as weight-sharing rather than weight-bearing structure. Functional outcomes were assessed using the Short Form 36 (SF-36) health survey and the Questionnaire for Transfemoral Amputees (Q-TFA). Ambulation ability was measured using K-levels, Timed Up and Go (TUG) and 6-Minute Walk Test (6MWT).

All patients improved at follow-up for SF-36 and Q-TFA scores. All cases demonstrated improvement in their mobility. On functional testing they could cover more than 200 m in 6 minutes and performed TUG in less than 15 seconds. All patients had a pain-free hip and a normal range of motion at follow-up assessment. All patients had complete healing at the 3-month follow-up. No cases presented with granulation tissue. One case had 1 episode of superficial infection. Implants were stable and well aligned.

In this study, we demonstrated that it is possible to combine THR in combination with osseointegration in the presence of osteoporosis for the improvement of mobility in the very short transfemoral amputee.