Osseointegration means integration with the bone. An implant, usually a porous titanium, is fitted directly into the bone and protrudes out of the end of the stump. This can then be used to attach your prosthesis directly to you rather than using a socket. The bone can then grow into the implant creating a network of bone, which under a microscope looks a little bit like a natural sponge.
You then have a hole at the end of your stump that gradually heals and a metal rod looks like it comes straight out your skin. You will always have a hole there, as the implant will gently move. Think of it a little like having your ear pierced and how the skin heals leaving the hole. This does mean that there is a risk of infection and you will always have to be mindful of keeping the implant clean and healthy.
The loading process begins post-op by very gradually increasing the body weight that goes through the implant. As it gets stronger and the pain reduces, you can continue to add a bit more weight to it. Initially you will be able to start walking with crutches but soon you’ll be able to fully weight bear through the implant and prosthesis.
This method of attaching a prosthetic is especially useful for those with very short above knee stumps, as it improves control and is more functional than a socket. It is also beneficial for those that have skin which cannot tolerate a socket, preventing them from being able to use a leg before. Being directly attached to bone, you will be able to feel the ground and have an increased awareness of where your prosthesis is and what you are walking on.
Additionally, it can provide a more comfortable solution for upper limb amputees as the weight of a prosthesis is carried more naturally rather than via a sleeve and sling around the back and shoulders.
From a rehab point of view, initially we are looking at reducing swelling and trying to promote healing of the wound site. We want to gradually increase weight bearing as it helps with bone healing and increases bone density. Once that part is out the way, it’s just like the rehab for any amputee or injury - improve strength, stability and mobility. Rehab is good for pre and post osseointegration surgery as you can prepare the muscles before and then continue to strengthen them after. The fitter you go into surgery the quicker you will recover and return to full function.
At Dorset Orthopaedic we have great links with the Australian Osseo group, and Professor Munjed Al Muderis holds regular UK consultation clinics that you can attend to see if Osseo is for you. At the moment, surgery is only available with this group in Australia but they organise everything for you, from airport transfers, to accommodation and rehab afterwards. We liaise regularly and closely with the Australian team so that when you come back to the UK you have the best post-op care possible. Hopefully in the future the surgery will become available in the UK, but then a visit to Australia would be pretty nice right?