Response Summary: osseointegration
Ted Trower
Description
Collection
Title:
Response Summary: osseointegration
Creator:
Ted Trower
Date:
3/19/2003
Text:
My original posting was:
The web site for Dr Branemark's manufacturer, Integrum
<URL Redacted> , has added a video clip of two AK amputees walking
on their prostheses. I found myself surprised that the gait of these two
amputees was not much different from that of an amputee wearing a
conventional prosthesis. Apparently the missing musculature has a more
profound effect than I had believed, and limb-to-socket instability has
less. To view the video, go to the web site, click on the link Patient
information, and then the link to the video. I would be most interested
in others prosthetists reaction to viewing this clip.
Responses follow:
==============================================
They look like they have been laterally trunk shifting for a long time. I
would send them to Bob Gailey for 10 gait training sessions, then look
again. I don't think there is a cause and effect relationship with the
osseointegration method.
--------------------------------------------------------------------------------------------
Thank you for sharing this website. If you don't mind an observation from
a student, it appears from the gait of the first patient (male) that they
haven't achieved adduction of the femur with osseointegration. I bet a
standing X-ray would show an abducted femur. By coming off the distal end
of the femur, the foot is placed too far medially. When this patient
walks, the gluteus medius is not on stretch (and demonstrates the gluteus
medius gait). Some sort of tapered wedge needs to be integrated into the
system to outset the foot and thereby bring the femur into
adduction. Long's line is from the head to the femur to the heel of the
foot. They have simply missed the line. If I'm bold enough I will drop
them an e-mail. What do you think?
--------------------------------------------------------------------------------------------
I am a senior Prosthetist practicing at the Roehampton Rehabilitation
Centre, Queen Mary's Hospital, London, UK.
We are fortunate enough to be one of the first centres outside of Sweden to
pilot trans-femoral osseointergration. We currently have 11 patients who
have completed the treatment program, all with varying degrees of success.
As a clinician at the centre I am privileged enough to witness these
patients, discuss their progress with various members of the Osseo team and
to have learnt 1st person the advantages and disadvantages of this
procedure. The program first started at Roehampton about 4 years ago and
therefore the first set of Osseo patients have been fully ambulating on
their Osseo prosthesis for about 2 years now. All these patients are 'NHS'
and there is a strict protocol within the centre with respect to the
suitability of the patient both medically, psychologically and socially.
At our annual conferences (BAPO) there is always a paper session/clinical
forum held by our centre's clinical manager (who is over-seeing the Osseo
program) to update colleagues who are interested on the progress and
findings so far with the program.
As years go by, more objective and subjective data has been collected and
relayed back to the profession.
Your observation regarding gait is not at all unfair. There are
complications regarding the alignment of an Osseo prosthesis, such as the
fact that there is no facility to allow any 'shift' of the prosthesis with
respect to the Osseo abutment/pin. Also, as you stated, there is no longer
a socket with which to influence stump position and hence alignment.
However, an extensive and regimented physio package is an integral part of
the Osseo program in order to limit/minimise any deviations.
While I am no expert on the osseo procedure or in fact responsible for the
program, the fact that we are carrying out trials at our centre allows me to
at least have an understanding of the program and it's
complications/benefits.
If you have any specific questions or are interested in the Osseo program I
would be more than happy to help if I can, and if I can not I would be more
than happy to ask the team members to assist.
==============================================
Thank you to all who responded.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
The web site for Dr Branemark's manufacturer, Integrum
<URL Redacted> , has added a video clip of two AK amputees walking
on their prostheses. I found myself surprised that the gait of these two
amputees was not much different from that of an amputee wearing a
conventional prosthesis. Apparently the missing musculature has a more
profound effect than I had believed, and limb-to-socket instability has
less. To view the video, go to the web site, click on the link Patient
information, and then the link to the video. I would be most interested
in others prosthetists reaction to viewing this clip.
Responses follow:
==============================================
They look like they have been laterally trunk shifting for a long time. I
would send them to Bob Gailey for 10 gait training sessions, then look
again. I don't think there is a cause and effect relationship with the
osseointegration method.
--------------------------------------------------------------------------------------------
Thank you for sharing this website. If you don't mind an observation from
a student, it appears from the gait of the first patient (male) that they
haven't achieved adduction of the femur with osseointegration. I bet a
standing X-ray would show an abducted femur. By coming off the distal end
of the femur, the foot is placed too far medially. When this patient
walks, the gluteus medius is not on stretch (and demonstrates the gluteus
medius gait). Some sort of tapered wedge needs to be integrated into the
system to outset the foot and thereby bring the femur into
adduction. Long's line is from the head to the femur to the heel of the
foot. They have simply missed the line. If I'm bold enough I will drop
them an e-mail. What do you think?
--------------------------------------------------------------------------------------------
I am a senior Prosthetist practicing at the Roehampton Rehabilitation
Centre, Queen Mary's Hospital, London, UK.
We are fortunate enough to be one of the first centres outside of Sweden to
pilot trans-femoral osseointergration. We currently have 11 patients who
have completed the treatment program, all with varying degrees of success.
As a clinician at the centre I am privileged enough to witness these
patients, discuss their progress with various members of the Osseo team and
to have learnt 1st person the advantages and disadvantages of this
procedure. The program first started at Roehampton about 4 years ago and
therefore the first set of Osseo patients have been fully ambulating on
their Osseo prosthesis for about 2 years now. All these patients are 'NHS'
and there is a strict protocol within the centre with respect to the
suitability of the patient both medically, psychologically and socially.
At our annual conferences (BAPO) there is always a paper session/clinical
forum held by our centre's clinical manager (who is over-seeing the Osseo
program) to update colleagues who are interested on the progress and
findings so far with the program.
As years go by, more objective and subjective data has been collected and
relayed back to the profession.
Your observation regarding gait is not at all unfair. There are
complications regarding the alignment of an Osseo prosthesis, such as the
fact that there is no facility to allow any 'shift' of the prosthesis with
respect to the Osseo abutment/pin. Also, as you stated, there is no longer
a socket with which to influence stump position and hence alignment.
However, an extensive and regimented physio package is an integral part of
the Osseo program in order to limit/minimise any deviations.
While I am no expert on the osseo procedure or in fact responsible for the
program, the fact that we are carrying out trials at our centre allows me to
at least have an understanding of the program and it's
complications/benefits.
If you have any specific questions or are interested in the Osseo program I
would be more than happy to help if I can, and if I can not I would be more
than happy to ask the team members to assist.
==============================================
Thank you to all who responded.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
Citation
Ted Trower, “Response Summary: osseointegration,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/220878.
