Frölke Jan Paul, Atallah Robin
Radboudumc Nijmegen, Nijmegen, The Netherlands.
AOFE Clinics Oosterbeek, Oosterbeek, The Netherlands.
Oper Orthop Traumatol. 2025 Apr;37(2):133-141. doi: 10.1007/s00064-024-00882-6. Epub 2025 Jan 8.
Transcutaneous osseointegration prosthetic systems (TOPS) offer a stable skeletal attachment for artificial limbs post-extremity amputation, serving as an alternative to socket attachment. Press-fit osseointegration implants (OI) utilized in TOPS consistently enhance quality of life and mobility for amputees, particularly those experiencing socket-related issues. Despite notable benefits, late complications such as infection and implant loosening pose challenges unique to TOPS due to their percutaneous nature. Recent studies indicate a low risk of implant failure but highlight the prevalence of minor soft tissue complications. Successful TOPS implementation is hypothesized to rely on early osseointegration and effective drainage of fluid discharge from the stoma. Factors influencing implant survival encompass implant characteristics, bone quality, and host factors. Longitudinal follow-up data reveal changes in periprosthetic bone and soft tissue conditions over time, necessitating ongoing clinical management. Distal bone resorption, evidenced by X‑ray, may result from stress shielding or local osteitis, leading to stoma-related complaints and jeopardizing implant survival. Understanding these dynamics is crucial for optimizing TOPS outcomes and addressing evolving patient needs.
Purulent and bloody discharge from the stoma with pain and radiographic evidence of distal cortical resorption.
Complaints attributed to other pathologies, signs of progressive bone resorption or implant loosening.
We propose a unique innovative surgical approach to address symptomatic distal bone resorption in individuals undergoing treatment with press-fit transcutaneous osseointegration prosthetic systems (TOPS) following limb amputation. Distal bone resorption can lead to painful symptoms and compromise the effectiveness of TOPS, necessitating a stepwise intervention strategy. The protocol involves assessing cortical involvement through radiographs, followed by surgical debridement with assessment of potential implant loosening. The next step involves application of a two-part mirror-polished sleeve to mitigate local soft-tissue irritation and promote physiological drainage. Patient education is paramount, emphasizing the potential for limited pain relief and the risk of postoperative infectious complications. This protocol offers a structured approach to managing distal bone resorption in TOPS recipients, aiming to optimize treatment outcomes while ensuring informed patient consent.
Following surgery, the cement used to fixate the sleeve must harden and after 24 h the leg prosthesis can be clicked on again. With regard to the surgical wound, no special measures are necessary other than standard orthopedic postoperative wound care. In view of this revision surgical procedure, we recommend to continue antibiotics for 6 weeks with preference for clindamycin 3 × 600 mg/day.
Limited preliminary clinical data show promising results.
经皮骨整合假肢系统（TOPS）为肢体截肢后的假肢提供了稳定的骨骼附着，可作为接受腔附着的替代方案。TOPS中使用的压配式骨整合植入物（OI）持续提高截肢者的生活质量和活动能力，特别是对于那些有接受腔相关问题的患者。尽管有显著益处，但由于其经皮性质，感染和植入物松动等晚期并发症给TOPS带来了独特挑战。近期研究表明植入物失败风险较低，但突出了轻微软组织并发症的普遍性。成功实施TOPS被认为依赖于早期骨整合以及造口处液体排出的有效引流。影响植入物存活的因素包括植入物特性、骨质和宿主因素。纵向随访数据显示假体周围骨和软组织状况随时间变化，因此需要持续的临床管理。X线显示的远端骨吸收可能由应力遮挡或局部骨炎引起，导致与造口相关的不适并危及植入物存活。了解这些动态变化对于优化TOPS效果和满足不断变化的患者需求至关重要。
造口有脓性和血性分泌物，伴有疼痛且X线有远端皮质吸收的证据。
归因于其他病理情况的主诉、进行性骨吸收或植入物松动的迹象。
我们提出一种独特的创新手术方法，以解决接受肢体截肢后使用压配式经皮骨整合假肢系统（TOPS）治疗的患者出现的有症状的远端骨吸收问题。远端骨吸收可导致疼痛症状并损害TOPS疗效，因此需要采取逐步干预策略。该方案包括通过X线片评估皮质受累情况，随后进行手术清创并评估潜在的植入物松动情况。下一步是应用两部分的镜面抛光套筒以减轻局部软组织刺激并促进生理性引流。患者教育至关重要，要强调疼痛缓解可能有限以及术后感染并发症的风险。该方案为管理TOPS使用者的远端骨吸收提供了一种结构化方法，旨在优化治疗效果同时确保患者知情同意。
手术后，用于固定套筒的骨水泥必须硬化，24小时后可再次安装腿部假肢。对于手术伤口，除了标准的骨科术后伤口护理外无需采取特殊措施。鉴于此翻修手术，我们建议继续使用抗生素6周，首选克林霉素，3×600毫克/天。
有限的初步临床数据显示出有前景的结果。
