Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases

Khemka, Aditya, Frossard, Laurent, Lord, Sarah J, Bosley, Belinda, & Al Muderis, Munjed (2015) Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases. Acta Orthopaedica, 86(6), pp. 740-744.

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Abstract

Background and purpose — Osseointegrated implants are an alternative for prosthetic attachment in individuals with amputation who are unable to wear a socket. However, the load transmitted through the osseointegrated fixation to the residual tibia and knee joint can be unbearable for those with transtibial amputation and knee arthritis. We report on the feasibility of combining total knee replacement (TKR) with an osseointegrated implant for prosthetic attachment.

Patients and methods — We retrospectively reviewed all 4 cases (aged 38–77 years) of transtibial amputations managed with osseointegration and TKR in 2012–2014. The below-the-knee prosthesis was connected to the tibial base plate of a TKR, enabling the tibial residuum and knee joint to act as weight-sharing structures. A 2-stage procedure involved connecting a standard hinged TKR to custom-made implants and creation of a skin-implant interface. Clinical outcomes were assessed at baseline and after 1–3 years of follow-up using standard measures of health-related quality of life, ambulation, and activity level including the questionnaire for transfemoral amputees (Q-TFA) and the 6-minute walk test.

Results — There were no major complications, and there was 1 case of superficial infection. All patients showed improved clinical outcomes, with a Q-TFA improvement range of 29–52 and a 6-minute walk test improvement range of 37–84 meters.

Interpretation — It is possible to combine TKR with osseointegrated implants.

Impact and interest:

5 citations in Scopus
3 citations in Web of Science®
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ID Code: 91562
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: Osseointegration, Bone-anchored prosthesis, Amputation, Transtibial amputation, Below-Knee amputation
DOI: 10.3109/17453674.2015.1068635
ISSN: 1745-3682
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Orthopaedics (110314)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Exercise & Nutrition Sciences
Copyright Owner: Copyright 2015 Nordic Orthopaedic Federation
Copyright Statement: This is an open-access article distributed under the terms of the CC-BY-NC-ND 3.0 License which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is credited.
Deposited On: 03 Jan 2016 23:53
Last Modified: 05 Jan 2016 01:58

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