Surgical technique of a bone-anchored prosthesis for transhumeral amputees.

OBJECTIVE

Fixating an arm prosthesis with a transcutaneous bone anchor provides a more comfortable and stable attachment than conventional socket-attached prosthetics. The objective is that bone anchoring will improve prosthetic usage, reduce prosthesis rejection, and aid to functions in daily life activities.

INDICATIONS

Subjects with transhumeral amputation or elbow disarticulation and insufficient functional effect of conventional socket-attached arm prostheses.

CONTRAINDICATIONS

Patients with local or systemic inflammatory processes, bone metabolism disorder, active use of chemotherapeutic or immunosuppressive medications and medically unexplained pain conditions in the respective residual arm.

SURGICAL TECHNIQUE

A cylindrical BADAL next (OTN Implants Germany, Rostock, Germany) humerus implant is transcutaneously inserted using a retrograde press-fit approach. The distal taper of the implant is connected to an adapter that serves as an abutment for the fixation of the postoperative load-set and arm prosthesis.

POSTOPERATIVE MANAGEMENT

Postoperative pain medication according to standard guidelines for shoulder surgery. Stoma care instructions before discharge from the hospital. Progressive loading at 6 weeks postoperatively using load plates of 100 g using in a compatible load set. Installation of an external arm prosthesis as soon as the weight of the arm prosthesis is reached.

RESULTS

In 4 individuals with median follow-up of 11 months, implant survival was 100%, prosthetic use improved from 0 h to an average 14 h per week, and no arm prosthesis rejection occurred. On a functional level, the 4 individuals improved from 0 to 5 on the patient-reported outcome measure (PROM) 33ADL PWP. This PROM measures 33 daily activities that can or can not be carried out with the prosthesis. No adverse events were reported.