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Szpital na Klinach is the only one in Poland and one of the few centers in the world that performs osseointegration procedures in people after limb amputation. In January this year. The hospital performed the first osseointegration procedures in the country in two patients after amputation of the shin. For the operated patients, the procedures are an opportunity to change the quality of life and to make everyday functioning more efficient without the need to use a traditional funnel prosthesis.
About osseointegration
Osseointegration is a modern method of prosthesis involving the implantation of an intraosseous implant (endoprosthesis), which is then attached directly to the external elements of the prosthesis (exoprosthesis). In practice, this means that after performing such a procedure, it is possible to eliminate the need to use a funnel prosthesis, the use of which is associated with excessive abrasions, skin ulcerations, pain or the formation of painful neuromas.
Thanks to endoprosthesis, patients also have the opportunity to increase the range of their movements, improve mobility, gait and sitting comfort. Osseointegration also allows the operated persons to feel the differences between the surfaces and to sense where the prosthesis is located without having to look at it. to a level close to physiological, because the bones and muscles at the endoprosthesis are actively used, thanks to which the patient becomes stronger and also increases his mobility. The nature of the implant also allows for a better range of motion compared to traditional prostheses.
The possibility of improving the quality of life of patients is one of the key values for which we have decided to launch a medical program in the field of osseintegration treatments. It turns out that biocompatible prosthetic implants integrated with the bone allow not only to improve physical fitness, but also increase mental well-being. The operation requires a well-trained team and excellent operator skills, but behind each of them lies the joy and satisfaction of our patients who, thanks to osseointegration, have a chance for a better quality of life. – says Joanna Szyman – president of the Neo Hospital Group, which includes Szpital na Klinach.
Who can undergo implantation procedures?
Patients who have undergone amputation of the lower limbs as a result of accidents as well as patients with a conflict in the area of a funnel prosthesis with insufficiency and instability of supply are qualified for the operation. As emphasized by the attending physician, specialist in the field of orthopedics and traumatology, Dr. Wojciech Piwek:
Compared to procedures performed at the level of the thigh, osseointergation at the level of the lower leg is a more complicated operation and requires greater planning precision, because we move around in smaller and more complex spaces. The indications for prosthesis in this place are also more limited due to the fact that the lower leg can be prosthesed with conventional socket prostheses, which often turn out to be sufficient. In the case of medically important indications, the so-called anastomotic conflicts, painful neuromas, or intolerance to the conventional prosthetic resurfacing of the stump.
An additional innovation introduced by the hospital in January this year. it is also possible to perform osseointegration treatments in one step.
What does the osseointegration procedure look like?
In most cases, osseointegration procedures are performed in two stages. In the first operation, the pin is mounted in the bone, while in the second step, the surgeon fixes the connecting module between the external and internal prostheses. However, in patients with good bone quality and anatomical conditions, it is possible to perform a one-step procedure. Both osseointegration procedures at the level of the shin bones performed in January at Szpital na Klinach were single-stage operations.
The decision to perform the procedure in one stage is always made intraoperatively. The undoubted advantage of the one-stage procedure is the reduction of surgical interventions, and thus the minimization of the risk of perioperative complications. In addition, patients are less burdened with anesthesia, certainly feel less stress, as well as recover faster and return to their daily activities faster. – says the attending physician, specialist in the field of orthopedics and traumatology, Dr. Łukasz Kawik.
Among the benefits mentioned by the patients themselves after osseointegration procedures, the most common are the ease of application of the prosthesis, good load transfer, correct sensation and restoration of deep feeling through direct contact and load transfer to the bone tissue.
Advantages of osseointegration in numbers
According to research results published in 2021. at JBJS Open Access by researchers at the Hospital for Special Surgery (HSS) in New York City, leg amputees who receive bone anchored prostheses report a high level of satisfaction compared to those who receive conventional funnel prostheses. As noted by Dr. Horst Aschoff – one of the few specialists in the world who has been dealing with the topic of osseointegration for over 15 years:
Due to the direct, skeletal connection of the prosthesis to the limb, amputees report major improvements in functionality, comfort, balance, proprioception, and even emotional connection with the limb.
The Human Amputation Questionnaire was used for the study, and researchers also collected data on a range of quality of life indicators, including patient-reported functional activity, mental health, pain and self-image, as well as adverse events such as serious infections, fractures at the implant site and other complications. The researchers found that the results improved significantly throughout the study period. Prosthetic mobility increased from 49,7 to 81,4 and prosthetic problems decreased from 46,4 to 9,1. Patients also experienced a significant improvement in implant function, as measured by 2-minute and 6-minute walk tests. The bone bonding of the implant was so strong that patients were able to return to physical activity quickly, including vigorous, strenuous exercise such as jogging within six months to one year after surgery. As Dr. Horst Aschoff emphasizes:
The increase in the results confirmed in the scientific study certainly confirms the benefits of osseointegration, but does not necessarily reflect what we actually see in the day-to-day hospital. Smiles on people’s faces, expressions of gratitude for how much their lives have changed are the actual evidence of patients who, thanks to osseointegration treatments, managed to improve the quality of life and even completely change it.