Osseointegration

Osseointegration, or bone anchoring, is an advanced approach to limb restoration that prioritizes the quality of life for people with certain types of amputations by improving their prosthetic comfort and maximizing function.

The Ohio State University Wexner Medical Center in Columbus, Ohio, is one of only a few locations in the United States that has built and focused a comprehensive program around osseointegration to restore the lives of people who need or have had an amputation – whether from combat-related injuries, traumatic accidents or cancer or other diseases.

We’re reimagining how prosthetic devices work for the hundreds of people with amputations who we care for every year. Our Limb Restoration Program team, which includes surgeons, rehabilitation specialists and mental health providers, will guide you from surgery through recovery.

What is osseointegration?

Osseointegration is the process of bone growing into a specially designed metal implant. It is the same process that has been used successfully for decades in dental implants. In the arms and legs, osseointegration allows a prosthetic device to be directly attached to the bone in the amputated limb. This can improve the stability, comfort and function of the artificial limb.

With the number of people living with limb loss increasing, more amputees are seeking alternatives to traditional, socket-based prosthetic devices due to their limitations and complications. Osseointegration can help people who’ve had poor experiences with prostheses. It can also give those who haven’t previously been candidates for a prosthetic limb the ability to walk or use their arms or hands again.

Osseointegration can be performed in one or two stages, depending on the implant and surgical technique used. Surgeons place a metal implant in the remnant limb, and then either simultaneously or during another surgery shape the remaining limb to provide a smooth, tailored fit for the prosthetic device to anchor to the metal implant.

Who is a candidate for osseointegration?

Osseointegration surgery is for people who’ve experienced an amputation and either aren’t a candidate for a traditional artificial limb or who haven’t experienced the desired results from other prosthetic devices.

While osseointegration is most commonly used for above-the-knee amputations, it can also be used on these parts of the body:

• Thigh (femur bone)
• Lower leg (tibia)
• Upper arm (humerus)
• Thumb

Ohio State is one of only a few places in the country offering thumb osseointegration. Our hand and upper extremity care surgeons give function back to people who’ve lost their thumb, allowing them to sense force and grip.

Other factors might play a role in whether you’re a candidate for osseointegration. Those include:

• Your overall health
• The density and integrity of the remnant bone where the implant will be anchored
• History of bone infections

How is osseointegration surgery performed?

Osseointegration techniques can vary, and the surgery can be part of an amputation or done alongside other procedures. Your surgeon will discuss procedure steps during your preoperative visits, but generally, osseointegration often requires multiple procedures followed by a series of physical therapy and follow-up visits.

Preparing for osseointegration surgery

You’ll need X-rays and other imaging done to give us exact measurements to create a customized implant that fits directly into your bone.

The night before surgery, you’ll be asked not to eat or drink since you’ll be under general anesthesia. You’ll also have to prepare to stay in the hospital for a few days.

During osseointegration surgery

The process for using the OPRA Implant System, a common implant used in osseointegration, involves:

• Stage 1 – Your surgeon will shape soft external tissues and create space within the bone to receive the implant, which can vary in material, length and style, such as a rod, screw or tripod. The surgeon will position the implant, trim and shape tissues, and close and cover the incision. Surgery time can vary from two to five hours, and you’ll be in the hospital for one to three days.
• Stage 2 – This surgery happens at least a few months after the first surgery. In this stage, the second part of the device, which is called an abutment, is placed into the bone anchor and screwed into place. The abutment then sticks out of the skin at the site. You’ll be in the hospital for three to five days following this surgery.

Recovery from osseointegration surgery

Our Limb Restoration Program team will guide you through every step of recovery, including wound dressing, infection prevention and movement restrictions. After your second procedure, you’ll begin rehabilitation. We know a team approach to rehab provides the best outcomes. During recovery, you may work with a:

• Physiatrist (a physical medicine and rehabilitation doctor)
• Physical therapist
• Occupational therapist
• Rehab psychologist or other mental healthcare provider
• Nurse case manager
• Prosthetist

Recovery and rehab time frames are different for every person, depending on a variety of factors, but generally, people can bear weight on the artificial limb six weeks after the second surgery and walk without assistance 12 weeks after the surgery.

What are the benefits of osseointegration?

Osseointegration allows our amputation experts to reimagine just what function and comfort can mean for those we treat. The benefits of osseointegration surgery can include:

• Overall improved quality of life
• Better mobility and control
• Increased sensory function and feelings of connectedness (osseoperception) with limb
• Little to no pressure on residual limb
• Prevention of complications associated with socket prosthetics, such as sores, chafing, sweating, other skin problems and the need for revision
• More natural, smoother gait
• Increased stability and strength
• Easier to put on and take off prosthesis
• Longer wear time with prosthesis
• Ability to use other advanced amputation techniques, such as targeted muscle reinnervation (TMR), to further improve function

What is the success rate of osseointegration surgery?

Success rates of osseointegration surgery are quite high, with the overwhelming majority of people experiencing improvements in their lifestyle, both subjectively and objectively. The limb restoration team will discuss the specific benefits that you can anticipate during your evaluation.

Risks of osseointegration surgery

Just like with any surgical procedure, there can be risks, such as complications with anesthesia. Although rare, other risks of osseointegration include:

• Infection
• Implant loosening over time
• Fracture

Fractures are rare because there’s a fail-safe mechanism between the implant and prosthetic device that causes the artificial limb to detach in cases of severe fall – similar to how skis break away.