Physio Facts - Osseointegration - The Journey and What Rehab Entails
Osseointegration is becoming more widely accepted and used in the UK and is an excellent option for some amputees who struggle with sockets. In this blog I will try and explain the journey you will go on when you embark on osseo and what the rehab entails.
To begin with most our patients start their osseo journey at one of our osseo open days. This is a free of charge consultation held at our Dorset Orthopaedic clinics with the Prosthetic and Surgical team to discuss osseo and whether you would benefit from it. This allows you to understand the surgical process, the rehab involved, approximate costings and the time it will take from surgery to full weight bearing.
If you decide that osseo is for you then you will then need a consultation at the surgical hospital in London, tests will be undertaken to determine whether you are a suitable candidate for osseo and you will thoroughly discuss the surgery and subsequent rehab. Quotes for costs will be drawn up and you will also have a pre-surgery meeting with your Prosthetist and Physio at one of the Dorset Orthopaedic clinics. This allows us to take baseline measures, run you through the rehab protocol in detail and give you your pre-surgery exercises and stretches.
Once your surgery is booked in we will finalise all your rehab dates, we will also have a Plan B block of rehab pencilled in in case you are on the slow loading protocol instead of the fast loading protocol. What protocol you end up on largely depends on how your surgery goes and how the surgical team find your bone density so we do not know for sure which protocol you will be on until after the surgery. For the most part our patients end up on the fast loading protocol which is approximately 3 months from surgery to full weight bearing and unrestricted walking. However it is worth bearing in mind that everyone is different and it is subject to change depending on your progress.
Amputee standing by the balance bars
For now we will focus on the fast loading protocol. The week following surgery, anything from 2-7 days post-op you will begin your loading. You will spend 3 hours, spread out over the day, with your Physio, where we will do two loading sessions, begin your post-op exercises and stretches and use manual therapy to reduce the swelling and improve scar mobility. For a period of approximately two weeks (this depends on your weight) you will be wheelchair based and load through a special loading ‘foot’ onto a set of scales, each day you will increase the weight put through the implant which helps the bone re-form and hold the implant in place.
Once you have reached the desired loading weight you can be fitted for your prosthesis and begin partial weight bearing using elbow crutches. You will spend 5 days of 4 hours a day with your Physio learning how to walk, be given a new set of exercises and work on your strength and fitness. You then spend 6 weeks on elbow crutches following a set timetable of walking and standing time. During this time you will come back into clinic every other weeks for check ups.
After your 6 weeks on crutches you then spend 5 days of 4hours a day with your Physio to move onto walking with one stick, upgrade your exercises and focus on gait re-education. A further 6 weeks is spent using one stick until you spend another 5 days with your Physio to go to full weight bearing and really test out your walking skills over various terrain and surfaces.
After your full weight bearing week you are free to walk as much as you wish, however, one of the common after effects of osseo surgery at this stage is discomfort around the implant where the muscle is attached to the bone. This usually surfaces around the 3 months post-op mark and is due to the muscles having to start working again to move your leg and the attachment to the bone being stretched. This is usually managed with continuing exercise, stretching the muscles and steroid injections.
Osseo patients report to have more sensation and awareness of the surface underneath their feet, have exceptional control of their prosthesis and enjoy the freedom it allows them to have without a socket. We will be with you every step of the way to guide your osseo rehab journey and the online osseo group resources are a great form of support. If you are thinking of osseo please feel free to contact our clinic for more information to discuss whether it is the right option for you.