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Frossard, Laurent A.(2014)Are bone-anchored prostheses about to revolutionise the world of pros-thetics? InAustralian Orthotic Prosthetic Association (AOPA) Congress, 2014-10-09- 2014-10-10.

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Are bone-anchored prostheses about to revolutionise the world of prosthetics?

2014 AOPA Congress Page 1 of 5

ARE BONE-ANCHORED PROSTHESES ABOUT TO REVOLUTIONISE

THE WORLD OF PROSTHETICS?

Frossard Laurent (1,2, 3)

(1)

Queensland University of Technology, Brisbane, Australia (2)

University of the Sunshine Coast, Maroochydore, Australia (3)

Marie-Enfant Rehabilitation Center, Canada

Frossard L. Are bone-anchored prostheses about to revolutionise the world of prosthetics?

Australian Orthotic Prosthetic Association (AOPA) Congress. 2014. Melbourne, Australia.

p 2

Biography

Dr Laurent Frossard is currently an adjunct

Professor of Biomechanics at the QUT and

USC as well as the Chief Scientist Officer at

YourResearchProject. As project leader and

active researcher, his expertise in

Biomechanics relates to the development of

biomechanical tools and improvement of

basic knowledge of the locomotion and

rehabilitation of individuals with lower limb

loss fitted with osseointegrated implant and

socket. He is one of the very few

independent experts in the clinical benefits

of bone-anchorage prostheses. His academic

track record includes over 100 publications,

multiple grants, several supervisions of

postgraduate students and international

collaborations.

Abstract Individuals with limb amputation fitted with

conventional socket-suspended prostheses

often experience socket related discomfort

leading to a significant decrease in quality of

life. Most of these concerns can be

overcome by surgical techniques enabling

bone-anchored prostheses. In this case, the

prosthesis is attached directly to the residual

skeleton through a percutaneous implant.[1, 2]

The primary aim of this study is to present

the current advances in these surgical

techniques worldwide with a strong focus on

the developments in Australia. The

secondary aim is to provide an overview of

the possible critical changes that may

occurred in the world of prosthetic following

these developments in bone-anchored

prostheses.

The current advances will be extracted from

a systematic literature review including

approximately 40 articles. The outcomes

measured will include the estimation of the

population worldwide as well as the

complications (e.g., infection, loosening,

fractures, breakage) and the benefits (e.g.,

functional outcomes, health-related quality

of life).[3-20]

The population of individuals fitted with a

bone-anchored prosthesis is approximately

500 worldwide. Publications focusing on

infection are sparse. However, superficial

infections are common (80%) while the rate

of deep infection is estimated between 6 to

20%. Loosening and preprosthetic fractures

are fairly uncommon. Breakage of

percutaneous parts occurs regularly mainly

due to fall. All studies reported a significant

improvement in functional level and overall

quality of life.

Several commercial implants are in

developments in Europe and US.[21-28]

The

number of procedures is consistently

growing worldwide. This technique might be

primary way to fit a prosthesis to young and



active amputees by 2025. Interestingly,

Australia is currently on the leading country

worldwide in terms of range of procedures

and level of amputation, choice of implants,

rapid population growth, developments of

governmental reimbursement schemes, etc.

These developments in bone-anchored

prostheses could be potentially a game

changer in the field of prosthetics. The

fitting requirement (e.g., fall prevention) is

challenging the use of K-level

classification.[9, 10, 13, 14, 17, 20, 29-40]

It is

unclear, if the bottom line of prosthetists

would be affected due to the lack of socket

manufacturing. However, clearly prosthetists

could play in key role in referral and follow

up on patients, particularly in safe fitting of

the prosthesis[34]

, replacement of

percutaneous parts and prevention of

superficial and deep infection.

References 1. Branemark, R., P.I. Branemark, B.

Rydevik, and R.R. Myers,

Osseointegration in skeletal

reconstruction and rehabilitation: a

review. J Rehabil Res Dev, 2001.

38(2): p. 175-81.

2. Aschoff, H.H., R.E. Kennon, J.M.

Keggi, and L.E. Rubin,

Transcutaneous, distal femoral,

intramedullary attachment for above-

the-knee prostheses: an endo-exo

device. J Bone Joint Surg Am, 2010.

92 Suppl 2(Supplement 2): p. 180-6.

3. Hagberg, K., E. Hansson, and R.

Brånemark, Outcome of

percutaneous osseointegrated

prostheses for patients with unilateral

transfemoral amputation at two-year

follow-up. Archives of Physical

Medicine and Rehabilitation,

2014(0).

4. Tsikandylakis, G., O. Berlin, and R.

Branemark, Implant Survival,

Adverse Events, and Bone

Remodeling of Osseointegrated

Percutaneous Implants for

Transhumeral Amputees. Clin

Orthop Relat Res, 2014: p. 1-10.

5. Branemark, R., O. Berlin, K.

Hagberg, P. Bergh, B. Gunterberg,

and B. Rydevik, A novel

osseointegrated percutaneous

prosthetic system for the treatment of

patients with transfemoral

amputation: A prospective study of

51 patients. Bone Joint J, 2014.

96(1): p. 106-113.

6. Van de Meent, H., M.T. Hopman,

and J.P. Frolke, Walking ability and

quality of life in subjects with

transfemoral amputation: a

comparison of osseointegration with

socket prostheses. Arch Phys Med

Rehabil, 2013. 94(11): p. 2174-2178.

7. Berlin, Ö., P. Bergh, M. Dalen, S.

Eriksson, K. Hagberg, S. Inerot, B.

Gunterberg, and R. Brånemark,

Osseointegration in transfemoral

amputees: the gothenburg

experience. Journal of Bone & Joint

Surgery, British Volume, 2012. 94-

B(SUPP XIV): p. 55.

8. Jacobs, R., R. Brånemark, K.

Olmarker, B. Rydevik, D. Van

Steenberghe, and P. Branemark,

Evaluation of the psychophysical

detection threshold level for

vibrotactile and pressure stimulation

of prosthetic limbs using bone

anchorage or soft tissue support.

Prosthetics and Orthotics

International, 2000. 24(2): p. 133-

142.

9. Frossard, L., N. Stevenson, J.

Smeathers, D. Lee Gow, S. Gray, J.

Sullivan, C. Daniel, E. Häggström,

K. Hagberg, and R. Brånemark,

Daily activities of a transfemoral

amputee fitted with osseointegrated

fixation: continuous recording of the

loading for an evidence-based

practice. Kinesitherapie Revue, 2006.

6(56-57): p. 53-62.



10. Frossard, L., K. Hagberg, E.

Häggström, D.L. Gow, R.

Brånemark, and M. Pearcy,

Functional Outcome of Transfemoral

Amputees Fitted With an

Osseointegrated Fixation: Temporal

Gait Characteristics. JPO Journal of

Prosthetics and Orthotics, 2010.

22(1): p. 11-20.

11. Hagberg, K., R. Branemark, B.

Gunterberg, and B. Rydevik,

Osseointegrated trans-femoral

amputation prostheses: Prospective

results of general and condition-

specific quality of life in 18 patients

at 2-year follow-up. Prosthetics and

Orthotics International, 2008. 32(1):

p. 29 - 41.

12. Hagberg, K. and R. Branemark, One

hundred patients treated with

osseointegrated transfemoral

amputation prostheses-rehabilitation

perspective. J Rehabil Res Dev,

2009. 46(3): p. 331-44.

13. Lee, W., L. Frossard, K. Hagberg, E.

Haggstrom, and R. Brånemark,

Kinetics analysis of transfemoral

amputees fitted with osseointegrated

fixation performing common

activities of daily living. Clinical

Biomechanics, 2007. 22(6): p. 665-

673.


Smeathers, E. Haggstrom, K.

Hagberg, J. Sullivan, D. Ewins, D.L.

Gow, S. Gray, and R. Branemark,

Monitoring of the load regime

applied on the osseointegrated

fixation of a trans-femoral amputee:

a tool for evidence-based practice.

Prosthet Orthot Int, 2008. 32(1): p.

68-78.

15. Hagberg, K., E. Haggstrom, M.

Uden, and R. Branemark, Socket

versus bone-anchored trans-femoral

prostheses: hip range of motion and

sitting comfort. Prosthet Orthot Int,

2005. 29(2): p. 153-163.

16. Rubin, L., L. Kennon, J. Keggi, and

H. Aschoff, Surgical management of

trans-femoral amputation with a

transcutaneous, press-fit distal

femoral intra-medullary device:

analysis with minimum 2 year

follow-up. Journal of Bone & Joint

Surgery, British Volume, 2012. 94-

B(SUPP XXI): p. 95.

17. Frossard, L., R. Tranberg, E.

Haggstrom, M. Pearcy, and R.

Branemark, Fall of a transfemoral

amputee fitted with osseointegrated

fixation: loading impact on residuum.

Gait & Posture, 2009.

30(Supplement 2): p. S151-S152.

18. Nebergall, A., C. Bragdon, A.

Antonellis, J. Karrholm, R.

Branemark, and H. Malchau, Stable

fixation of an osseointegated implant

system for above-the-knee amputees:

titel RSA and radiographic

evaluation of migration and bone

remodeling in 55 cases. Acta Orthop,

2012. 83(2): p. 121-8.

19. Tillander, J., K. Hagberg, L.

Hagberg, and R. Branemark,

Osseointegrated titanium implants

for limb prostheses attachments:

infectious complications. Clin

Orthop Relat Res, 2010. 468(10): p.

2781-8.

20. Frossard, L.A., R. Tranberg, E.

Haggstrom, M. Pearcy, and R.

Branemark, Load on osseointegrated

fixation of a transfemoral amputee

during a fall: loading, descent,

impact and recovery analysis.

Prosthet Orthot Int, 2010. 34(1): p.

85-97.

21. Shevtsov, M.A., O.V. Galibin, N.M.

Yudintceva, M.I. Blinova, G.P.

Pinaev, A.A. Ivanova, O.N.

Savchenko, D.N. Suslov, I.L.

Potokin, E. Pitkin, G. Raykhtsaum,

and M.R. Pitkin, Two-stage

implantation of the skin and bone

integrated pylon (SBIP) seeded with



autologous fibroblasts induced into

osteoblast differentiation for direct

skeletal attachment of limb

prostheses. Journal of Biomedical

Materials Research Part A, 2013: p.

n/a-n/a.

22. Jeyapalina, S., J.P. Beck, K.N.

Bachus, O. Chalayon, and R.D.

Bloebaum, Radiographic Evaluation

of Bone Adaptation Adjacent to

Percutaneous Osseointegrated

Prostheses in a Sheep Model. Clin

Orthop Relat Res, 2014: p. 1-12.

23. Holt, B.M., K.N. Bachus, J.P. Beck,

R.D. Bloebaum, and S. Jeyapalina,

Immediate post-implantation skin

immobilization decreases skin

regression around percutaneous

osseointegrated prosthetic implant

systems. J Biomed Mater Res A,

2013. 101(7): p. 2075-82.

24. Jeyapalina, S., J.P. Beck, R.D.

Bloebaum, and K.N. Bachus,

Progression of Bone Ingrowth and

Attachment Strength for Stability of

Percutaneous Osseointegrated

Prostheses. Clin Orthop Relat Res,

2013: p. 1-9.

25. Shelton, T.J., J.P. Beck, R.D.

Bloebaum, and K.N. Bachus,

Percutaneous osseointegrated

prostheses for amputees: Limb

compensation in a 12-month ovine

model. J Biomech, 2011. 44(15): p.

2601-6.

26. Tomaszewski, P.K., N. Verdonschot,

S.K. Bulstra, and G.J. Verkerke, A

New Osseointegrated Fixation

Implant for Amputated Patients.

Journal of Biomechanics, 2012.

45(0): p. S322.

27. Tomaszewski, P.K., B. Lasnier, G.

Hannink, G.J. Verkerke, and N.

Verdonschot, Experimental

assessment of a new direct fixation

implant for artificial limbs. J Mech

Behav Biomed Mater, 2013. 21: p.

77-85.

28. Tomaszewski, P.K., M. van Diest,

S.K. Bulstra, N. Verdonschot, and

G.J. Verkerke, Numerical analysis of

an osseointegrated prosthesis fixation

with reduced bone failure risk and

periprosthetic bone loss. J Biomech,

2012. 45(11): p. 1875-80.

29. Vertriest, S., P. Coorevits, K.

Hagberg, R. Branemark, E.

Haggstrom, G. Vanderstraeten, and

L. Frossard, Static Load Bearing

Exercises of Individuals With

Transfemoral Amputation Fitted

With an Osseointegrated Implant:

Reliability of Kinetic Data. IEEE

Trans Neural Syst Rehabil Eng,

2014. In press.

30. Dumas, R., L. Cheze, and L.

Frossard, Loading applied on

prosthetic knee of transfemoral

amputee: comparison of inverse

dynamics and direct measurements.

Gait Posture, 2009. 30(4): p. 560-2.

31. Lee, W.C., J.M. Doocey, R.

Branemark, C.J. Adam, J.H. Evans,

M.J. Pearcy, and L.A. Frossard, FE

stress analysis of the interface

between the bone and an

osseointegrated implant for

amputees--implications to refine the

rehabilitation program. Clin Biomech

(Bristol, Avon), 2008. 23(10): p.

1243-50.

32. Frossard, L., J. Beck, M. Dillon, M.

Chappell, and J.H. Evans,

Development and preliminary testing

of a device for the direct

measurement of forces and moments

in the prosthetic limb of transfemoral

amputees during activities of daily

living. Journal of Prosthetics and

Orthotics, 2003. 15(4): p. 135-142.

33. Lee, W.C., L.A. Frossard, K.

Hagberg, E. Haggstrom, D.L. Gow,

S. Gray, and R. Branemark,

Magnitude and variability of loading

on the osseointegrated implant of

transfemoral amputees during



walking. Med Eng Phys, 2008. 30(7):

p. 825-833.

34. Frossard, L., E. Haggstrom, K.

Hagberg, and P. Branemark, Load

applied on a bone-anchored

transfemoral prosthesis:

characterisation of prosthetic

components – A case study Journal

of Rehabilitation Research &

Development, 2013. 50(5): p. 619–

634.

35. Frossard, L., L. Cheze, and R.

Dumas, Dynamic input to determine

hip joint moments, power and work

on the prosthetic limb of

transfemoral amputees: ground

reaction vs knee reaction. Prosthet

Orthot Int, 2011. 35(2): p. 140-9.


Sullivan, M. Uden, and M. Pearcy,

Categorization of Activities of Daily

Living of Lower Limb Amputees

During Short-Term Use of a Portable

Kinetic Recording System: A

Preliminary Study. JPO Journal of

Prosthetics and Orthotics, 2011.

23(1): p. 2-11.

37. Frossard, L.A., Load on

osseointegrated fixation of a

transfemoral amputee during a fall:

Determination of the time and

duration of descent. Prosthet Orthot

Int, 2010. 34(4): p. 472-87.

38. Frossard, L., D.L. Gow, K. Hagberg,

N. Cairns, B. Contoyannis, S. Gray,

R. Branemark, and M. Pearcy,

Apparatus for monitoring load

bearing rehabilitation exercises of a

transfemoral amputee fitted with an

osseointegrated fixation: a proof-of-

concept study. Gait Posture, 2010.

31(2): p. 223-8.

39. Helgason, B., H. Palsson, T.P.

Runarsson, L. Frossard, and M.

Viceconti, Risk of failure during gait

for direct skeletal attachment of a

femoral prosthesis: a finite element

study. Med Eng Phys, 2009. 31(5): p.

595-600.

40. Frossard, L., K. Hagberg, E.

Haggstrom, and R. Branemark,

Load-relief of walking aids on

osseointegrated fixation: instrument

for evidence-based practice. IEEE

Trans Neural Syst Rehabil Eng,

2009. 17(1): p. 9-14.

1

Laurent Frossard (1, 2, 3)


Melbourne, Australia –10/10/2014

AOPA Congress 2014

(1) University of the Sunshine Coast, Autralia

(2) Queensland University of Technology, Australia

(3) Marie-Enfant Rehabilitation Center, Canada

http://www.chalmers.se/en/news/Pages/Thought-controlled-prosthesis-is-changing-the-lives-of-amputees.aspx


ePrin

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Context

Socket

Attachment

Socket

Socket

Context

Attachment

FixationSocket

Fixation

ePrin

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3

ITAP

Commercial fixationsIntegral Leg Prosthesis Orthodynamics Pty Ltd

UKILP

Dr Horst Aschoff

Lunow, C., K. Staubach, and H. Aschoff, [Endo-exo Femoral Prosthesis]. Zeitschrift Der Unfallchirug, 2010.

OLP

ITAP

Commercial fixations

Dr Munjed Al Muderis

Osseointegrated Prosthesis Limb Med-Italia Biomedica SRL, Italy

Sydney, Australia

http://www.osseointegrationaustralia.com.au/ePrin

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ILP/OPL

ITAP

Commercial fixationsOsseointegrated Prosthesis for Rehabilitation of

Amputees Integrum AB

SwedenOPRA

Dr Rickard Branemark

http://opraosseointegration.com/

ILP/OPL

ITAP


Nebergall, A., C. Bragdon, A. Antonellis, J. Kärrholm, R. Brånemark, and H. Malchau, Stable fixation of an osseointegated implant system for above-the-knee amputees. Acta Orthopaedica, 2012. 83(2): p. 121-128

OPRA

X-rays

ePrin

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ILP/OPL

ITAP


OPRA

Residuum post-op

OPRA

ILP/OPL

ITAP


Overview

ILP OPL OPRA

Interface fixation - bone Press-fit Press-fit Screw

ePrin

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6

OPRA

ILP/OPL

ITAP


Overview

ILP OPL OPRA


Nb of surgeries 2 2 2

Stage 1

Stage 2

OPRA

ILP/OPL

ITAP


Overview

ILP OPL OPRA


Nb of surgeries 2 2 –> 1 2

Stage 1

Stage 2

ePrin

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7

OPRA

ILP/OPL

ITAP


Overview

ILP OPL OPRA



Duration rehabilitation * 4 mth 4 mth 9-12 mth

* Estimation

Stage 1

Stage 2

2 months

OPRA

ILP/OPL

ITAP


Overview

ILP OPL OPRA




* Estimation

Stage 1

Stage 2

6 months

ePrin

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8

OPRA

ILP/OPL

ITAP


Overview

ILP OPL OPRA




Nb of years since first S1 * 8 2 15

* Estimation

OPRA

ILP/OPL

ITAP


Overview

ILP OPL OPRA




Nb of years since first S1 * 8 2 15

Nb of patients *100 80

500180

* Estimation

Most published and acknowledged

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Hagberg, K. and R. Branemark, One hundred patients treated with osseointegrated transfemoral amputation prostheses--rehabilitation perspective. J Rehabil Res Dev, 2009. 46(3): p. 331-44.

Screening -6 mth0 12 186

Exclusion criteria

Pre-op

Treatment with OPRA

• Diabetes• Smoking• Severe vascular disease• Peripheral vascular disease• Growing skeleton • Severe learning disability• Lack of compliance• Chemotherapy treatment• Inability to adhere program / pregnancy• Arteriosclerosis• Mental illness

Treatment with OPRA

Hagberg, K. and R. Branemark, One hundred patients treated with osseointegrated transfemoral amputation prostheses--rehabilitation perspective. J Rehabil Res Dev, 2009. 46(3): p. 331-44.

Screening -6 mth0 12 186

Pre-op

Inclusion criteria

• Socket-related problems• Inability to use a conventional prosthesis• Use of prosthesis limited significantly• Short residual limb• Dimension of residual bone• Quality of residual bone• Bilateral amputation• Understanding the risks of complications• Willing to comply with treatment protocol• Following the rehabilitation protocol• Acceptance of disability

K0 to K2

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Screening

Treatment with OPRA

Surgery

-6 mth0 12 186

Residuum pre-op

Screening

Treatment with OPRA

Surgery

-6 mth0 12 186

Stage 1 – Insertion medullar part

ePrin

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Screening

Treatment with OPRA

Surgery

-6 mth0 12 186

Stage 2 – Insertion percutaneous parts

Screening

Surgery

Treatment with OPRA

Vertriest S, Coorevits P, Brånemark R, Hagberg K, Brånemark R, Vanderstraeten G, Frossard L. Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: Reliability of kinetic data. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2014. Accepted minor revisions.

Rehab

-6 mth0 12 186

Load bearing exercises

Bone remodelling =

Right load +

Right time

ePrin

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Screening

Surgery

Treatment with OPRA

Frossard, L., D.L. Gow, K. Hagberg, N. Cairns, B. Contoyannis, S. Gray, R. Brånemark, and M. Pearcy, Apparatus for monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation: A proof-of-concept study. Gait and Posture, 2010. 31(2): p. 223-228

Rehab

-6 mth0 12 186

Load bearing exercises - Static

Screening

Surgery

Treatment with OPRA

Hagberg, K. and R. Brånemark, One hundred patients treated with osseointegrated transfemoral amputation prostheses - the rehabilitation perspective. Journal of Rehabilitation Research & Development, 2009. 43(3): p. 331-344

Rehab

-6 mth0 12 186

Load bearing exercises - Dynamic

ePrin

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13

Screening

Surgery

Treatment with OPRA

Rehab

-6 mth0 12 186

Walking aids

Frossard, L., K. Hagberg, E. Haggstrom, and R. Branemark, Load-relief of walking aids on osseointegrated fixation: instrument for evidence-based practice. NSRE, IEEE Transactions on, 2009. 17(1): p. 9-14

Rehab

Screening

Surgery

Treatment with OPRA

-6 mth0 12 186

Choice of components

Frossard, L., E. Haggstrom, K. Hagberg, and P. Branemark, Load applied on a bone-anchored transfemoral prosthesis: characterisation of prosthetic components – A case study Journal of Rehabilitation Research & Development, 2013. 50(5): p. 619–634.

Fitting

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Benefits

Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. Bone Joint J, 2014. 96(1): p. 106-113. Errata : Haddad, Bone Joint J: 2014, 96-B 106-113

Benefits

Health-related quality of life: SF 36

Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. Bone Joint J, 2014. 96(1): p. 106-113. Errata : Haddad, Bone Joint J: 2014, 96-B 106-113

Benefits

BenefitsHealth-related quality of life: SF 36

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Benefits

Benefits

Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. Bone Joint J, 2014. 96(1): p. 106-113.

Health-related quality of life: Q-TFA

Benefits

Benefits

Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. Bone Joint J, 2014. 96(1): p. 106-113.

Health-related quality of life: Q-TFA

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Benefits

BenefitsSitting

http://www.sahlgrenska.se/su/osseointegrationhttp://osseointeg.ning.com/profile/ErikAx

Benefits

Benefits

Lundberg, M., K. Hagberg, and J. Bullington, My prosthesis as a part of me: a qualitative analysis of living with an osseointegrated prosthetic limb. Prosthetics and Orthotics International, 2011. 35(2): p. 207-214

Body representationN=13

‘‘ The prosthesis (OI-prosthesis) is a part of me since it works so well, and you don’t have to think that it’s a problem and that it should be hard and so forth . . . it’s more like a substitute, my ¨pretend leg ¨ ’’

http://news.bme.com/tag/amputation/

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Benefits

Benefits

Hagberg, K., E. Häggström, S. Jönsson, B. Rydevik, and R. Brånemark, Osseoperception and Osseointegrated Prosthetic Limbs, P. Gallagher, D. Desmond, and M. MacLachlan, Editors. 2008, Springer London. p. 131-140

Osseoperception

Benefits

Benefits

Hagberg, K., E. Häggström, S. Jönsson, B. Rydevik, and R. Brånemark, Osseoperception and Osseointegrated Prosthetic Limbs, P. Gallagher, D. Desmond, and M. MacLachlan, Editors. 2008, Springer London. p. 131-140

Doning and doffing

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Benefits

BenefitsHip range of movement

http://osseointeg.ning.com/profile/ErikAx

Tranberg, R., R. Zügner, and J. Kärrholm, Improvements in hip- and pelvic motion for patients with osseointegrated trans-femoral

prostheses. Gait & Posture, 2011. 33(2): p. 165-168

N=19 N=57

Benefits

Benefits

Frossard, L., K. Hagberg, E. Haggstrom, D. Lee Gow, R. Branemark, and M. Pearcy, Functional outcome of transfemoral amputees fitted with an osseointegrated fixation: Temporal gait characteristics. Journal of Prosthetics and Orthotics, 2010. 22(1): p. 11-20

Walking abilities and functional outcomes

N=12

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Risks

Infections

Risks

[1] Tillander, J., K. Hagberg, L. Hagberg, and R. Branemark, Osseointegrated Titanium Implants for Limb Prostheses Attachments: Infectious Complications. Clinical Orthopaedic Related Research, 2010. 468(10): p. 2781-2788

[2] Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. Bone Joint J, 2014. 96(1): p. 106-113.

Overview - Deep infectionsInclusion Follow-up

(2-3 yrs) (S2-2 yrs)

Reference [1] [2] [1] [2]

Number of participants in study 39 51 39 51

Definite implant infection / Deep implant infection 5% 11% 15% 6%

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Risks



Infections Overview - Deep infectionsInclusion Follow-up

(2-3 yrs) (S2-2 yrs)

Reference [1] [2] [1] [2]


Definite implant infection / Deep implant infection 5% 11% 15% 6%

Short course of antibiotics

Risks



Infections Overview – Superficial infectionsInclusion Follow-up

(2-3 yrs) (S2-2 yrs)

Reference [1] [2] [1] [2]


Local soft tissue infection in the skin penetration area / Superficial infection 17% 11% 29% 80%

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Risks



Infections Overview – Superficial infectionsInclusion Follow-up

(2-3 yrs) (S2-2 yrs)

Reference [1] [2] [1] [2]


Local soft tissue infection in the skin penetration area / Superficial infection 17% 11% 29% 80%

Cleaning

Risks

Pitkin, M., On the way to total integration of prosthetic pylon with residuum. Journal of Rehabilitation Research & Development, 2009. 46(3): p. 345-360

Infections Discharge

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Infections

Risks

Thompson M. Mechanical analysis of osseointegrated transfemoral implant systems. 2009. Master Thesis. Queen’s University Kingston, Ontario, Canada

Breakage

Activity of daily living

High-impact activities / Falls

Breakage

Infections

RisksTitel RSA and radiographic

Nebergall, A., C. Bragdon, A. Antonellis, J. Kärrholm, R. Brånemark, and H. Malchau, Stable fixation of an osseointegated implant system for above-the-knee amputees. Acta Orthopaedica, 2012. 83(2): p. 121-128

Loosening

N=55

1, 2, 5, 7, 10 years post-op

Strong bonding

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Risks vs Benefits

Benefits Risks

Future developments

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Future developments

Kang, N.V., C. Pendegrass, L. Marks, and G. Blunn, Osseocutaneous integration of an intraosseous transcutaneous amputation prosthesis implant used for reconstruction of a transhumeral amputee: Case report. The Journal of Hand Surgery, 2010. 35(7): p. 1130-1134.

ITAP, Stanmore Implant, UKFixation

NHS

Clinical trial

Future developments

http://www.healio.com/orthotics-prosthetics/prosthetics/news/online/%7Bbf5a0e16-eb8c-4e89-aa8b-0e2941bc31fb%7D/researcher-announces-plans-for-fda-study-of-osseointegrated-implants

University of Utah - Orthopaedics DepartmentFixation

FDA

Clinical trial

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TeamsFixation

Future developments

http://www.chalmers.se/en/news/Pages/Thought-controlled-prosthesis-is-changing-the-lives-of-amputees.aspx

Neuromuscular control of prosthesis

Focus

Focus

TeamsFixation

Future developments

Accessible to population with diabetes

Challenges

K. Ziegler-Graham, E. J. MacKenzie, P. L. Ephraim, T. G. Travison, and R. Brookmeyer, "Estimating the prevalence of limb loss in the United States: 2005 to 2050," Arch Phys Med Rehabil, vol. 89, pp. 422-9, Mar 2008.eP

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Focus

TeamsFixation

Future developments

High impact activities

Challenges

http://www.tulsaworld.com/

Focus

TeamsFixation

Future developments

Accessible to low income countries

Challenges

http://projecthopeinthefield.blogspot.ca/2010_04_01_archive.htmlePrin

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Focus

TeamsFixation

Future developments

Pediatric applications

Challenges

http://www.dailymail.co.uk/news/article-1160954/With-pairs-legs-I-feel-10-feet-tall-The-boy-7-doesnt-let-double-amputation-hold-back.html

Australia : leader worldwide

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Clinical know-how

• 3rd largest population worldwide• largest population outside Europe

• Fastest growing population worldwide

OPRA500 cases15 years

≈33 cases/year

ILP/OPL80 cases2 years

≈40 cases/year

Population

Population


Clinical know-how

Several world firsts

• Broadest range of case-mix

Case-mix

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Population

Case-mix


Clinical know-how

• Only two countries where patients have 2 choices of implants

OPRA ILP OPL

• Only country where patients have 3 choices of implants

Choice

Population

Case-mix

Choice


• State (QLD) looking at fair and equitable reimbursement scheme

Support government

15K for kit Otto Bock prosthesis

Support

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Population

Case-mix

Choice

Support


Unique Clinical Outcome Registry=

Evidence-based treatment

Scientific expertise

Research

Population

Case-mix

Choice

Support

Research


• Biggest demand is in Australia

Heat + sweat=

Poor socket fit =

Poor quality of life

Demand Patients

Clinical know-how

Support government

QLDNT

Demand

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• BAP works!

• It is happening!

• It is happening now in Australia!

Just some thoughts!

Not yet!

Eligibility criteria

Exclusion

• Diabetes• Smoking• Severe vascular disease• Peripheral vascular disease• Growing skeleton

Safe

No major loss of incomeseP

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Soon, it might!

Eligibility criteria ChangeInclusion

• Diabetes• Smoking• Severe vascular disease• Peripheral vascular disease• Growing skeleton

Possible loss of incomes

Inclusion

Soon, it might!

• Revisiting the use of K-Levels for choice of componentso All patients = K4 regardless of

functional outcomes

• Manufacturing of purposely designed components (e.g., knee)o Larger ROMo Safer (e.g., fall)o Capitalising more on osseoperceptiono Better monitoring of ADL and usage

Developt

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Inclusion

Developt

Soon, it might!

• Before surgeryo Referral of patientso Participate to screening

• After surgeryo Fitting limb Minimise risks of fall Loading profile Fixing / Replacing fixation parts

o Primary care for infection prevention Diagnosis Treatment (e.g., Referral GP, surgeon)

CPO Role

Inclusion

Developt

Soon, it might!

• Assistance from supporting bodies:o E.g. QALS in QLD 23 hours $15K for componentsCPO Role

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Laurent Frossard (1, 2, 3)


Melbourne, Australia –10/10/2014

AOPA Congress 2014

(1) University of the Sunshine Coast, Autralia

(2) Queensland University of Technology, Australia

(3) Marie-Enfant Rehabilitation Center, Canada

Website

www.YourResearchProject.com

www.laurentfrossard.com

LinkedIn

www.ca.linkedin.com/pub/laurent-frossard/5/4b4/b59/

Google+

www.plus.google.com/#113083134851353167716/about

Facebook

www.facebook.com/YourResearchProjectePrin

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