Osseointegration amputation prostheses on the upper limbs

Abstract

BACKGROUND: The osseointegration programme for upper extremity amputation started in Sweden in 1990, when a titanium fixture was first implanted into a thumb. This method has since been used for transhumeral and below-elbow amputation. The treatment involves two surgical procedures. During the first a titanium fixture is surgically attached to the skeleton, and a second procedure six months later involves a skin penetrating abutment to which the prosthesis is attached. OBJECTIVES: To describe the osseointegration procedure for surgery, prosthetics and rehabilitation. METHODS: Patients with short stumps and previous problems with prosthetic fitting were selected. From 1990 to April 2010, 37 upper limb cases were treated and fitted with prosthesis: 10 thumbs, 1 partial hand, 10 transradial and 16 transhumeral amputations. Of these, 7 patients are currently not prosthetic users. RESULTS: Patients indicated that function and quality of life had improved since osseointegration. CONCLUSION: Osseointegration is an important platform for present and future prosthetic technology. The prosthetic situation is improved due to the stable fixation, freedom of motion and functionality. CLINICAL RELEVANCE: The two-stage osseointegration procedure has the potential to change the rehabilitation strategy for selected upper limb amputees. The method eliminates the need for a socket and the prosthesis will always fit. The stable prosthetic fixation and increased freedom of motion generates improved function. Specially designed components and rehabilitation procedures have been developed.