Transcutaneous bone-anchoring prosthesis with knee replacement: A novel treatment for amputees

Khemka, Aditya, Frossard, Laurent A., Lord, Sarah, Bosley, Belinda, & Al Muderis, Munjed (2015) Transcutaneous bone-anchoring prosthesis with knee replacement: A novel treatment for amputees. In XV World Congress of the International Society for Prosthetics and Orthotics (ISPO), 22-25 June 2015, Lyon, France.

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Over the last two decades, Transcutaneous Bone-Anchored Prosthesis (TCBAP) has proven to be an effective alternative for prosthetic attachment for amputees, particularly for individuals unable to wear a socket. [1-17] However, the load transmitted through a typical TCBAP to the residual tibia and knee joint can be unbearable for transtibial amputees with knee arthritis.


A. To describe the surgical procedure combining TKR with TCBAP for the first time; and

B. To present preliminary data on potential risks and benefits with assessment of clinical and functional outcomes at follow up


We used a TCBAP connected to the tibial base plate of a Total Knee Replacement (TKR) prosthesis enabling the tibial residuum and the knee joint to act as weight sharing structures by transferring the load directly to the femur. We performed a standard hinged TKR connected to a custom made TCBAP at the first stage followed by creating a skin implant interface as a second stage. We retrospectively reviewed four cases of trans-tibial amputations presenting with knee joint arthritis. Patients were assessed clinically and functionally including standard measures of health-related quality of life, amputee mobility predictor tool, ambulation tests and actual activity level. Progress was monitored for 6-24 months.


Clinical outcomes including adverse events show no major complications but one case of superficial infection. Functional outcomes improved for all participants as early as 6 months follow up.

Discussion & Conclusion

TKR and TCBAP were combined for the first time in this proof-of-concept case series. The preliminary outcomes indicated that this procedure is potentially a safe and effective alternative for this patient group despite the theoretical increase in risk of ascending infection through the skin-implant interface to the external environment. We suggest larger comparative series to further validate these results.

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ID Code: 89031
Item Type: Conference Paper
Refereed: Yes
Additional URLs:
Keywords: Osseointegration, Bone-anchored prosthesis, Implant, Amputation
DOI: 10.1177/0309364615591101
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OTHER MEDICAL AND HEALTH SCIENCES (119900) > Medical and Health Sciences not elsewhere classified (119999)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2015 [Please consult the author]
Deposited On: 13 Oct 2015 23:44
Last Modified: 24 Jun 2017 14:38

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