Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Prosthet Orthot Int. 2021 Feb;45(1):76-80. doi: 10.1177/0309364620953985.
Osseointegration is a relatively new technique for prosthetic limb attachment that offers various improvements for patients with amputation and facilitates joint preservation. We present a case of implant loosening during rehabilitation in a patient with transtibial amputation that was successfully managed through a combination of measures, aiming to promote re-osseointegration of the implant.
Not much is known about structured management of adverse events after osseointegration. Septic or aseptic loosening is currently regarded as implant failure, prompting removal and possible re-implantation at a later stage. The objective of this case report was to evaluate the feasibility of salvaging a loosened implant.
Case report.
A novel treatment approach was employed to enable renewed osseointegration of the implant. First, the bone-implant interface was disrupted and renewed through axial rotation and distal repositioning of the implant. Afterwards, extracorporal shockwave therapy and antibiotic treatment were administered. Prosthetic rehabilitation was then started anew. Regular follow-up x-rays and clinical evaluations were conducted, including standardized outcome tests.
These combined measures led to a successful re-osseointegration of the implant. In a 21-month follow-up, the patient regained a stable and secure gait pattern, using his prosthesis every day for 15 hours and scoring above average on standardized outcome measures.
This represents the first report of implant salvage after failed primary osseointegration. As the associated risks of this novel treatment are very low, investigations are warranted to evaluate this approach on a larger scale.
骨整合是一种用于假肢附着的新技术，为截肢患者提供了各种改进，并有助于关节保护。我们报告了一例在胫骨截肢患者康复过程中发生植入物松动的病例，通过综合措施成功地进行了管理，旨在促进植入物的重新骨整合。
对于骨整合后的不良事件的结构化管理知之甚少。目前，感染或无菌性松动被认为是植入物失败，需要在后期取出并可能重新植入。本病例报告的目的是评估挽救松动植入物的可行性。
病例报告。
采用了一种新的治疗方法来实现植入物的重新骨整合。首先，通过轴向旋转和植入物的远端重新定位，破坏和更新骨-植入物界面。然后，进行体外冲击波治疗和抗生素治疗。然后重新开始假肢康复。进行了定期的随访 X 光和临床评估，包括标准化的结果测试。
这些综合措施导致植入物的成功重新骨整合。在 21 个月的随访中，患者恢复了稳定和安全的步态，每天使用假肢 15 小时，在标准化的结果测量中得分高于平均水平。
这是首例报道在初次骨整合失败后进行植入物挽救的病例。由于这种新治疗方法的相关风险非常低，因此有必要进行调查，以更大规模地评估这种方法。
