March 27, 2020

What to expect after Osseointegration surgery?

Written by Dr Matija Krkovic

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Rehabilitation phase

Post operatively patients will be admitted to a ward in Addenbrooke’s hospital, Cambridge, where they will be seen by a physiotherapist, experienced with osseointegration procedures. Postoperative X-rays will be taken when the patient is comfortable. Depending on the stability of the stem, they will be advised on whether they will be partial or full weight bearing after the second stage. At this point patients will not be able to wear socket prosthesis anymore.

Patients with above-knee amputations will be advised to remain non-weight bearing for 6-12 weeks. The estimated length of stay per patient is 1-2 days and this can extend to a few days in bilateral amputees or patients who were wheelchair bound for a prolonged period of time. Patients will be discharged home with regular follow up appointments at The London Prosthetic clinic, Pace Rehab and with Mr Matija Krkovic.


Physiotherapy

Following standard and established early post-operative osseointegration early mobility protocols, there is likely to be a need for continual physiotherapy over the following months. This will either be provided from The London Prosthetic clinic or Pace Rehabilitation clinics in Buckinghamshire or Manchester.  Where possible, local specialist physiotherapy support may be identified and provided closer to home. Bespoke programs of physiotherapy support will be discussed prior to surgery.

Follow up

Patients will be followed up clinically at 6 weeks post operatively, then at 3, 6 and 12 months and then annually after that. At all appointments X-rays will be checked and compared for any sign of infection or stem loosening. All patients will be seen at Addenbrooke’s hospital, Clinic 1.

Functional and life quality scores will be collected during clinic appointments at 6 and 12 months postoperatively and then annually. These include:

  1. 6 min walking test and
  2. Timed up and go test will be performed by Pace Rehab
  3. SF-36,
  4. EQ-5D-5L,
  5. Amputee mobility predictors assessment tool (AMPnoPRO),
  6. Questionnaire for transfemoral amputees(Q-TFA)
  7. Duration of prosthetic leg use per week and
  8. Toronto Extremity Scoring System.


3D computer assisted gait analysis will be included in standard postoperative follow up for all osseointegrated patients. There will be two sessions postoperatively. The first; 6 months post osseointegration procedure and the second; 2 years post operatively allowing us to independently review patient’s individual performance post osseointegration surgery.

Managing Complications

Complications can occur in any surgery and osseointegration is no different. Some complications are more common than others. Any complication will be reviewed clinically in face to face consultations unless otherwise agreed. Antibiotics will be prescribed, if required at the time of consultation. In case of more severe infections patients will be admitted to hospital for closer monitoring and intravenous antibiotics if deemed necessary.


According to the Australian Osseointegration group on reviewing 50 patients, the results showed that the complications were as followed:

  1. Stump soft tissue refashioning was performed in ten patients to avoid impingement, skin irritation and infection.
  2. 21 patients experienced one or more infections, of whom 13 responded to oral antibiotics alone, five to intravenous antibiotics and three required surgical soft tissue debridement of infected soft tissues.
  3. Four patients sustained periprosthetic fractures as a result of falls, three of whom were previously wheelchair-bound with severe osteoporosis.
  4. Revision of the implant was required in two patients; one due to failure of osseointegration as a result of an undersized device , and the other as the result of an implant fatigue failure at 3.5 years.

It is our understanding of the current NHS arrangement that patients with complications (infection, periprosthetic fracture,...) are eligible for the NHS treatment but the NHS is not responsible for replacement of an existing implant in case of implant malfunction, infection or loosening.

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