Review Article

Technical Overview of Osseointegrated Transfemoral Prostheses: Orthopaedic Surgery and Implant Design Centered

[+] Author and Article Information
Andrii Maryniak

Center for Medical Education, Poznan University of Medical Sciences, Poznan, Poland

Brock Laschowski

Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada

Jan Andrysek

Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada

1Corresponding author.

ASME doi:10.1115/1.4039105 History: Received November 12, 2017; Revised January 16, 2018


Bone-anchored prostheses represent a promising solution to numerous medical complications associated with conventional socket-suspended prostheses. The following technical overview was constructed for prospective engineers and orthopaedic surgeons interested in osseointegrated implants for transfemoral prosthesis-residuum interfacing. Existing osseointegrated implants comprise different biomaterial compositions (i.e., titanium alloy vs. cobalt-chromium-molybdenum alloy) and mechanical designs (i.e., screw-fixated vs. press-fixated devices). Perioperative systems of osseointegration surgery include: preoperative assessments (i.e., alongside inclusion and exclusion criteria); intraoperative procedures; and postoperative rehabilitation (i.e., static loading and dynamic gait rehabilitation). The intraoperative procedures involve: transecting and reorganizing the residual musculature; embedding the implant into the femoral intramedullary cavity; and coupling the osseointegrated implant to an external prosthesis (e.g., robotic device). Postoperative clinical evaluations have demonstrated significant biomechanical, psychological, and physiological improvements in patients using bone-anchored prostheses compared to conventional socket-suspended prostheses. Nevertheless, bacterial infections surrounding the skin-implant biointerface, often resulting from Staphylococcus aureus or other coagulase-negative staphylococci, remain a relatively frequent medical complication, which can culminate in periprosthetic osteomyelitis and/or implant extraction. The technical overview concludes with discussions of: the recent FDA Humanitarian Use Device designations; financial analyses between bone-anchored and socket-suspended prostheses; and applications of vibrotactile osseoperception for augmenting walking and balance feedback control.

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