Bone Anchored Amputation Prosthesis: a new surgical system in the rehabilitation of the amputation: osseointegration

The amputations, traumatic or resulting from carcinological surgery,are often close to the articulation situated above, with problemsof cicatrisation and short stub. It is often difficult to obtain anoptimal rehabilitation among these patients by prosthesis. A prosthesisanchored directly to the level of the bone could be a functionallygood solution for these patients.The prosthesis anchored to the bone according to the concept ofosseointegration was developed by Per-Ingvar Brånemark in Göteborg(Sweden). Osseointegration was initially used in dental andmaxillofacial reconstructive surgery (29 000 cases carried out inmaxillofacial surgery in the world). In a multidisciplinary approach,osseointegration has been used since 1990, initially in Sweden thenin England, for the direct anchoring of the prosthesis of amputationin the skeleton in precise indications, limited to patients havingproblems of adaptation with their prosthesis and particularly shortstubs. The team is composed of orthopaedic surgeons, physiotherapistsand prosthesists. The surgical protocol is carried out in twostages at 6 month intervals with a progressive restarting of workload. Once in place, the prosthesis is directly anchored in the bone,freeing the articulation above, improving mobility, propioception inwalking, stability and comfort. The patients (150 Swedish casesbetween 1 year and 15 years of follow-up), showed an increasedfunction, and a facility using the prosthesis. Increased sensory possibilitieswere noted (osseoperception), improving the function andphysiological acceptance. Complication from infection is to befeared, one notes resolvent surface infections, and one failure bymajor infection. There was no fracture of implant. Osseointegrationis done today with 95 % success rate, provided there is rigorousselection of patients.