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    Interventional procedure overview of direct skeletal fixation of limb prostheses using an intraosseous transcutaneous implant

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    What the procedure involves

    The procedure aims to surgically insert an OIP implant, producing a secure connection between the remaining bone and the implant for prosthetic attachment. The implant may be in 1 piece or modular with a separate small metal extension (called an abutment). 

    The advantages of DSF of an OIP implant are:

    • proper transfer of load from the prosthesis to the person's body

    • better function and mobility (such as walking)

    • improved comfort while sitting

    • better balance

    • fewer stump problems

    • increased prosthesis use, and

    • improved QOL.

    The potential problems are:

    • soft-tissue infection at the interface between the skin and the prosthesis

    • deep infection

    • fracture or loosening around the implant, and

    • implant failure.

    DSF of limb prostheses using an OIP implant is done under general or regional anaesthesia (depending on the level of amputation). It is usually done in 2 operations separated by a period of time. In the first stage, a metallic implant (with either an outer surface threaded like a screw or a press-fit design) is inserted into the medullary cavity of the residual bone. Then, healing components are attached to the implant to secure the bone graft during the healing period. The second stage of the procedure is done approximately 2 to 6 months later, after the implant has integrated into the bone (osseointegration) and the stump wound is completely closed and healed. It involves surgically removing the healing components and re-exposing the distal end of the implant. It is then attached to an abutment with an abutment screw or bridge component. The wound is closed with the abutment penetrating the skin. The external prosthesis can then be attached to the OIP implant using various components, depending on the level of amputation.

    The procedure may also be done in a single stage in which the 2 operations are done sequentially during a single session. But the 2-stage procedure is more common.

    A period of extensive physiotherapy and rehabilitation follows, and the load on the prosthesis is gradually increased until full weight-bearing is allowed a few weeks later.