Background

Over the last 10 years, OPRA Australia has had close links with the Branemark OsseoIntegration program Sweden and over the last 8 has been considering OsseoIntegration to enable direct skeletal fixation of limb prostheses. Significant consultation and discussion has taken place between the Swedish based program and Melbourne leading to the formation of the Branemark OsseoIntegration centre in Melbourne.
 

Patient selection

As part of the initial implementation for OsseoIntegration and as part of an international study, trans-femoral amputees who had failed to benefit from conventional socket based prosthetic systems were chosen and those who met the criteria outlined on the website were identified, interviewed and examined. X-rays and CT Scans using standardised techniques were obtained. As well as being physically suitable the initial candidates had to be close enough to easily logistically access the program and obviously be psychologically able to participate. After this the cases were discussed with the Swedish team and two choices made from whom informed consent was obtained after considerable discussion. One trans-femoral amputee in his 40s had an amputation due to an osteo-sarcoma and the second, a woman in her mid 30s, secondary to trauma.

Preoperative assessment

(5 October 2000)
 The two clients underwent a number of assessments including functional performance assessments as well as video and force plate data recording. This information will be used as part of the ongoing evaluation of the outcomes.

Surgical Outcomes

The surgery was carried out on the 5^th of October, 2000 in two surgical sessions, morning and afternoon, involving the Swedish and Australian teams. There was uncomplicated post surgical recovery and discharge home within a week of surgery. There have been periodic consultations with both amputees since and they are progressing well.

Initial rehabilitation process

One amputee has found it possible to be mobilised again on a new prosthetic system with allowance for the distal stump to avoid weight bearing. Although mobility is limited, as previously, it is important to keep activity levels up if at all possible. The other amputee as previously has found it impossible to wear a conventional socket system and is mobilising using crutches until the abutment is fitted.

Final Procedure

The stage 2 Surgery was successfully performed by the Australian OPRA surgical team under the supervision of Dr Rickard Branemark from Sweden. This occurred at the Alfred Hospital 22 March, 2001 on the original 2 clients.
It is anticipated that the next phase will commence in approximately 6 weeks.

Prosthetic Fitting and Rehabilitation

April 2001

After the  process of two-phase surgery, and  'conventional interim prosthesis' rehab,  the patients are now commencing to apply weight to their abutments in preparation for independent weight bearing and the connecting of a prosthesis.

They have been receiving treatment twice a day, seven days a week.  Their rehabilitation involves increasing weights to the abutments until they can tolerate their own body weight.  So far, they are both on schedule according to program protocol, without having any complications whatsoever.

 “It has been a long process and we’ve needed to be very patient as there are no short cuts, however with the expected outcome, it is worth however long it takes” the patient said.

(Neither patient is at the stage of fitting as yet - 30 June 2001)

July/August 2001

There are a number of phases:-

a) the static phase of loading and unloading initially occurred with gradual increase in weight through a short and then long pylon, The static loading phase was uncomplicated without any pain on or off loading of the implant.

b) the dynamic loading phase – this then involved the addition of a knee joint and articulated ankle joints to the long pylon with walking initially in rails then with axillary crutches progressing to single point sticks and then full independence.
The importance of intensive physiotherapy throughout all phases of the Osseointegration process, most particularly during the mobilisation phase and then with gait training cannot be under emphasised to gain the best functional outcome.

The two Melbourne Osseointegration cases were mobilised and walked (albeit without full weight bearing on the prosthetic side) on Monday the 6th of August 2001.

We will provide further information as they move through the mobilisation phases.

Ongoing Assessment
Please refer to OPRA Australia or contact by following this link.