Osseointegrated prostheses for rehabilitation foll

Authors: Yan Li Rickard Brånemark

Publish Date: 2017/02/22

Volume: 120, Issue: 4, Pages: 285-292

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Abstract

The direct attachment of osseointegrated OI prostheses to the skeleton avoids the inherent problems of socket suspension It also provides physiological weight bearing improved range of motion in the proximal joint as well as osseoperceptive sensory feedback enabling better control of the artificial limbs by amputees The present article briefly reviews the pioneering efforts on extremity osseointegration surgeries in Sweden and the development of the OPRA Osseointegrated Prostheses for the Rehabilitation of Amputees program The standard implant design of the OPRA system and surgical techniques are described as well as the special rehabilitation protocols based on surgical sites The results of longterm followup for transradial transhumeral and thumb amputee operations are briefly reported including the prospective study of transfemoral amputees according to OPRA protocol The importance of refinement on implant designs and surgical techniques based on the biomechanical analysis and early clinical trials is emphasized Future aspects on osseointegration surgery are briefly described including novel treatment options using implanted electrodesDurch die direkte Anbringung osseointegrierter OIProthesen an das Skelett können die Probleme der Schaftprothesenversorgung vermieden werden Mit der OIProthese lassen sich eine physiologische Gewichtsbelastung ein verbesserter Bewegungsumfang des proximalen Gelenks und eine osseoperzeptive sensorische Rückkopplung erzielen was eine bessere Steuerung künstlicher Gelenke durch Patienten mit Amputationen ermöglicht Im vorliegenden Beitrag wird eine kurze Übersicht über die wegweisenden Leistungen in der Osseointegrationschirurgie der Extremitäten in Schweden und über die Entwicklung des OPRAProgramms Osseointegrated Prostheses for the Rehabilitation of Amputees gegeben Dabei werden das Standardimplantatdesign im OPRASystem und chirurgische Techniken sowie spezielle Rehabilitationsschemata je nach Operationsgebiet dargestellt Über die Ergebnisse der Langzeitnachbeobachtung nach Operation von Patienten mit transradialer transhumeraler und Daumenamputation einschließlich der prospektiven Studie an Patienten mit transfemoraler Amputation gemäß OPRAProtokoll wird kurz berichtet Die Bedeutung von Verbesserungen des Implantatdesigns und chirurgischer Techniken auf der Basis biomechanischer Analyse und früher klinischer Studien wird hervorgehoben Zukünftige Aspekte der Osseointegrationschirurgie einschließlich neuer Therapieoptionen unter Verwendung von implantierten Elektroden werden kurz beschriebenDespite the improvements in medical and surgical interventions for limb salvage procedures the amputation numbers remain high in the world due to the aging population civilian accidents local wars and terrorism attacks 1 2 Prostheses are aimed to enhance mobility independence safety and quality of life for amputees 3 Evidence of prosthesis usage can be dated back to ancient Egyptians The earliest documented functional lowerlimb prosthesis was unearthed in Italy probably from 300 BC The weightbearing part of the prosthesis was made of bronze and iron combined with a wooden/leather socket for connecting the residual limb 4 The material and technique evolved over centuries while the socket remains as a critical part for prosthesis connection The socket design however frequently places the residual limb under excessive stresses and pistoning vertical movements within the socket and results in skin irritation and ulcers which are often regarded as the major reasons for prosthesis rejection by amputees 5The direct attachment of an osseointegrated OI prosthesis to the skeleton avoids the inherent problems of socket suspension It also provides physiological weight bearing improved range of motion in the proximal joint and osseoperceptive sensory feedback thus enabling better control of the artificial limbs by amputees 6 7 8 The cumulative success rate of 92 at the 2‑year followup 9 and reports on the dramatic improvements of quality of life for transfemoral amputees 6 9 10 11 led to the approval of the Osseoanchored Prostheses for the Rehabilitation of Amputees OPRA device recently by the Food and Drug Administration FDA for rehabilitation of abovetheknee amputees The present article briefly reviewed the pioneering efforts on extremity osseointegration surgeries in Sweden and the development of the OPRA programIn the early 1960s the Swedish researcher PerIngvar Brånemark discovered in his microcirculation studies that his titanium chambers were firmly maintained in rabbit tibia without severe soft tissue reaction or loosening When the experiments were finished the titanium chambers could not be removed from the bone These unexpected findings gave PI Brånemark the idea that titanium implants could be used as a restoration option for tooth loss After successful animal experiments with intraosseous anchorage of dental prostheses 12 PI Brånemark completed the first human trial in an edentulous patient in 1965 The longterm success of a series of clinical trials confirmed the advantage of the functional and structural connection between living bone and the titanium implant which he later named “osseointegration” 13The application of osseointegration for amputee rehabilitation started in 1990s mainly based on the dental and craniofacial osseointegration experience and the biomechanical studies of PI Brånemark’s son Rickard Brånemark who later became the Chief Surgeon and Director of the Center for Orthopedic Osseointegration COO at Sahlgrenska University Hospital in Gothenburg Sweden R Brånemark and coworkers evaluated the biomechanics of boneanchored implants during healing after irradiation in experimental arthritis in rat rabbit dog and human 14 This experimental work became the basis for implant designs and rehabilitation protocols for extremity osseointegrations

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