Biomaterials and Tissue Engineering Research Unit, School of AMME, The University of Sydney, Sydney, NSW, Australia.
Faculty of Health and Medicine, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia.
J Orthop Trauma. 2019 Aug;33(8):e303-e308. doi: 10.1097/BOT.0000000000001488.
To examine periprosthetic bone remodeling among the recipients of 2 types of lower-limb osseointegrated systems, the Integral Leg Prosthesis (ILP) and the Osseointegration Prosthetic Limb (OPL) type A, over a >24-month period.
Retrospective cohort study.
Private hospital, with a specialized osseointegration unit.
Twenty-eight patients with transfemoral lower-limb amputations were fitted with osseointegrated systems. Of these patients, 15 received the ILP and 13 the OPL osseointegrated implant.
Radiographic measurements were taken at baseline (0.4 ± 0.5 years) and at follow-up (3.0 ± 0.8 years) after the osseointegration procedure.
Radiographic bone density, longitudinal bone coverage, and bone width outcomes were measured in inverse "Gruen zones." Bone remodeling was evaluated by comparing changes between baseline and follow-up measurements.
Radiographic bone density decreased in all zones among both ILP and OPL groups. Cortical bone thickness increased among the OPL group in zones 3 (P < 0.05) and 5 (P < 0.05). Distal bone coverage of the ILP implant decreased by 2.3% (P < 0.01) and 4.1% (P < 0.05) of the total implant length on the medial and lateral sides, respectively.
Decreased bone density with increased periprosthetic cortical thickness suggests a change in the bone architecture for the OPL group. The findings of this study raise concerns for the long-term success of the ILP implant. Radiographic analysis of x-rays seems to be a useful tool for clinicians to evaluate bone remodeling around osseointegrated prosthesis.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
研究 2 种下肢骨整合系统（Integral Leg Prosthesis [ILP] 和 Osseointegration Prosthetic Limb [OPL] 型 A）的受植者在 >24 个月的时间内的假体周围骨重塑情况。
回顾性队列研究。
设有专门骨整合单元的私人医院。
28 例股骨下端截肢患者接受了骨整合系统的安装。其中 15 例患者接受了 ILP，13 例患者接受了 OPL 骨整合植入物。
在骨整合手术后的基线（0.4±0.5 年）和随访（3.0±0.8 年）时进行影像学测量。
在反向“Gruen 区”测量影像学骨密度、纵向骨覆盖和骨宽度结果。通过比较基线和随访测量值之间的变化来评估骨重塑。
ILP 和 OPL 两组所有区域的影像学骨密度均下降。OPL 组在区 3（P<0.05）和区 5（P<0.05）的皮质骨厚度增加。ILP 植入物的远端骨覆盖在内外侧分别减少了 2.3%（P<0.01）和 4.1%（P<0.05）的总植入物长度。
OPL 组的骨密度降低和假体周围皮质骨厚度增加表明骨结构发生了变化。本研究结果对 ILP 植入物的长期成功提出了担忧。对 X 光片进行影像学分析似乎是临床医生评估骨整合假体周围骨重塑的有用工具。
治疗性 3 级。有关证据水平的完整描述，请参见作者说明。
