osseointegration for knee disarticulation amputee

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Posted By Hudson, Katherine on 11/15/2013 8:21:00 AM
Hi list,

Some advice please.

I have a knee disarticulation patient who is 18 months since traumatic
amputation. He successfully wears a distal end bearing socket with a
suction fit, microprocessor knee and carbon foot. He wears his
prosthesis all day, every day, walks unaided and functions at a high K3
level, working 5 days a week.

He has been referred by his orthopaedic surgeon privately (he is
insurance funded of course) for assessment for osseointegration. I do
not understand why.

From a prosthetic point of view these are my concerns:

- There is not going to be any functional gain.

- There is a history of infection (as initially he was
initially a transtibial level but had to be revised).

- Surgery is complicated by an IM nail for midshaft femur

- The prosthetic knee centre will then have to be set more
distal (resulting in a larger discrepancy between the anatomical and
prosthetic knee centre).

- There is potential for his stump level to be revised which
would see him loose capacity to fully end bear.

Does anyone know if osseointegration has been performed on a knee
disarticulation patient successfully? I could not find any case study of
this in my literature search.

Or has anyone had a patient functioning at such a high level undergo
osseointegration before at a transfemoral level? In my limited
experience with osseointegration I have only observed it to be
prescribed for patients where a socket was not able to be successfully
worn so offered large functional gains.

Thanks in advance,

Katherine Hudson
Prosthetist Orthotist

Melbourne, Australia

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