5 Years Of Lower Limb Osseointegrated Prostheses: Anticipating The “Who, What, And When” Of Poor Outcomes
Grant G. Black, BA1, Anna M. Vaeth, BS1, Yunchan Chen, BS1, Albert Y. Truong, MD1, Taylor J. Reif, MD2, S. Robert Rozbruch, MD2, David M. Otterburn, MD1.
1Weill Cornell Medicine, New York, NY, USA, 2Hospital for Special Surgery, New York, NY, USA.
PURPOSE: Osseointegrated prostheses are a novel alternative to socket-suspended prostheses, especially when the latter are complicated by poor fit, soft tissue damage, or pain. However, osseointegrated prostheses can also lead to post-operative issues that rely on plastic surgery intervention. Little is known about the timeline of or risk factors for these complications as few centers currently perform the procedure.
METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Fisher’s exact test and unpaired t-tests were performed (alpha=0.05).
RESULTS: 70 patients met our study criteria: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. Indications for amputation were trauma(56), prior surgical complication(7), cancer(4) and other(3). Postoperative complications included soft tissue infection(26), osteomyelitis(5), neuroma(6), limb fracture(4), soft tissue revision(7), and hardware failure(2). Statistically significant correlations existed between increased age at implantation and neuroma development, decreased time from amputation to implantation and limb fracture, obesity and soft tissue infection, and female gender and soft tissue infection. Decreased surgeon experience was significantly associated with increased risk of osteomyelitis and neuroma. Subgroup analysis by amputation indication or level did not affect outcomes. Hypertension(15) and tobacco use(27) did not correlate with any complications.
CONCLUSION: Certain modifiable factors (BMI, timing of surgery) and unmodifiable factors (age, gender) correlate with increased risk of complications following lower limb osseointegration. These results can aid surgeons in better selecting appropriate candidates and anticipating post-operative outcomes.
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