Leading the Way for Bone-anchored Prostheses

In January, the American Academy of Orthotists and Prosthetists (the Academy) established the Bone-Anchored Prosthetics Society (BAPS) to create a clinical home where prosthetists are well informed and prepared to care for patients using bone-anchored devices. Its mission statement emphasizes this commitment: The Bone-Anchored Prosthetics Society is dedicated to advancing clinical care for individuals with bone-anchored prostheses. The Society focuses on investigating, educating, and cultivating best practices for clinicians through research, publications, and educational events. BAPS aims to facilitate interdisciplinary communication and collaboration among all stakeholders involved in this innovative field. Osseointegration (OI) is a process in which a biocompatible material, most commonly titanium, becomes securely anchored within bone. This technology has transformed the landscape of medical devices and has gained significant attention within the medical profession. Despite its current prominence, the fundamental principles of OI have been understood for over 80 years. In the mid-20th century, researchers made a pivotal discovery while observing that screws implanted in the femur bones of rabbits were much more securely fixed after 16 weeks than at the time of insertion. This innovative concept was first applied to dentistry by Per-Ingvar Brånemark, MD, PhD, who sparked considerable interest among Swedish residents, as he integrated this technology into his dental practice. Due to the success of his innovation, a woman with bilateral transfemoral amputations approached Brånemark with the hope of adapting his dental OI procedure to her leg prostheses. Recognizing the potential impact, he successfully performed the procedure in 1990. He would go on to entrust this technology to his son, Rickard Brånemark, MD, PhD, who subsequently founded Integrum in 1998. Integrum remains dedicated to providing bone-anchored prosthetic systems to people with amputations worldwide. After three decades of innovation and research, OI procedures have revolutionized the field of prosthetics but have only recently been introduced in the United States. Just a short while ago, individuals seeking this treatment had to travel internationally for the procedure, funding the surgery without the assistance of their insurance provider. Today, a growing number of physicians across the United States offer OI prosthetic implant procedures, and with the Food and Drug Administration (FDA) approval of the OPRA Implant System for individuals with transfemoral amputations, insurance companies are more likely to provide coverage for OI surgical intervention and its associated prosthetic components. As a result of the success of OI in the United States, several other implant systems are in various stages of the FDA approval process and are currently being utilized with special FDA exemptions. Over the past century, sockets have evolved in their designs, materials, and suspension strategies, but even the best-fitting sockets pose inherent limitations and challenges for wearers, greatly impacting the quality of an individual’s life. These challenges can be particularly pronounced in more complex limb presentations, such as those involving short femurs, scar tissue, and hypersensitivity. As OI has gained traction in the prosthetic community, patients frustrated by the limitations of traditional socket options have increasingly turned to bone-anchored systems for the promise of enhanced functionality, biomechanical normalcy, and improved comfort. While there are undeniable risks associated with OI procedures, information is now readily available to help patients make informed decisions about their care. Nonetheless, the rising adoption of OI in the United States has not been matched by corresponding research, literature, or manufacturer guidelines, creating a sense of uncertainty for both prosthetists and patients. This gap has led to bone-anchored prosthetics being considered the Wild West of prosthetic technology. Despite the advancements in percutaneous OI, many prosthetists view bone-anchored prosthetics as daunting and unfamiliar and are concerned with how this technology challenges the traditional billing methods associated with conventional socket designs. The complexities and ambiguities of this segment of prosthetic care underscore the need for a dedicated professional organization, such as the BAPS, for prosthetists who are currently engaged in OI treatment and for those simply seeking to deepen their clinical knowledge. The Society recognizes that while the advancements in OI may seem intimidating, they do not need to be. Bone-anchored prosthetic devices represent a valuable clinical option for prosthetists that can greatly improve the quality of their patients’ lives. Moreover, the Bone-Anchored Prosthetics Society aims to advocate for the individual practitioner and to define the critical role prosthetists play in managing the care of those who have undergone OI procedures. To help facilitate dissemination of knowledge regarding bone-anchored prosthetics, following is a summary of the events and initiatives we have participated in or plan to engage with in the near future. Academy Unconference: June’s Unconference was a virtual event featuring an emergent agenda shaped by participant input. Attendees suggested session topics during registration and were prepared to speak on their topics, registered participants voted on the most compelling topics, and a final agenda was created based on the votes. At the event, a diverse cohort of 17 individuals from various disciplines engaged in lively discussions, leading to a follow-up webinar in October due to high interest. The topics presented at the Unconference were: What Should O&P Clinicians Consider Before Treating Clients Fitted with a Bone-Anchored Prosthesis Discussion Leader: Laurent Frossard, PhD, YourResearchProject, Brisbane, Australia Weighing the Risks and Benefits: A Patient’s Perspective Discussion Leader: Leslie Wilson, PhD, University of California San Francisco Future Research & Knowledge Gaps–Knowing What We Don’t Know: Uncovering Uncharted Terrain Discussion Leader: Brian Kaluf, CP, FAAOP, director, Salt Lake City Research Hub, Ottobock Reimbursement for the Treatment of Bone-Anchored Prostheses Discussion Leader: Kimberly Hoyt, CP, vice president, Noticeability State of the Science Conference: A gathering took place in Chicago in July, with BAPS involvement and representation by Matthew Garibaldi. Upcoming Events: An organized session is planned at the 2025 Academy Annual meeting in Atlanta. The Society is sponsoring a roundtable discussion with leading experts on prosthetic alignment and component considerations for the bone-anchored prosthetic patient. This will hopefully lead to further discussion and collaboration as we look to advance the field with more published data in these areas. The Bone-Anchored Prosthetics Society continues to be a vital force in advancing the care and innovation in prosthetics, creating a collaborative space for professionals dedicated to enhancing the lives of those with bone-anchored prostheses. It hosts monthly meetings to discuss case studies and ongoing research, fostering an active environment for members of varying experience levels. Members also engage in homework to deepen their understanding and contribute to discussions. Interested in joining BAPS? Reach out to Tracey Maranto at tmaranto@oandp.org to learn more about membership opportunities and upcoming events. Matthew Garibaldi, MS, CPO, is the director at UCSF Orthotic and Prosthetic Centers, California, and cochair of the Academy’s Bone-Anchored Prosthetics Scientific Society. Glen Thompson, MS, CPO, is business development manager at Integrum, and cochair of the Academy’s Bone-Anchored Prosthetics Scientific Society. Academy Society Spotlight is a presentation of clinical content by the Scientific Societies of the Academy in partnership with The O&P EDGE.

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