Transtibial Osseointegration for Patients with Peripheral Vascular Disease: A Case Series of 6 Patients with Minimum 3-Year Follow-up

Muhammad Adeel Akhtar; Jason Shih Hoellwarth; Shakib Al-Jawazneh; William Lu; Claudia Roberts; Munjed Al Muderis

doi:10.2106/JBJS.OA.20.00113

Transtibial Osseointegration for Patients with Peripheral Vascular Disease: A Case Series of 6 Patients with Minimum 3-Year Follow-up

JB JS Open Access. 2021 Jun 23;6(2):e20.00113. doi: 10.2106/JBJS.OA.20.00113. eCollection 2021 Apr-Jun.

Authors

Muhammad Adeel Akhtar^{1

2

3

4

5}, Jason Shih Hoellwarth⁵, Shakib Al-Jawazneh⁵, William Lu⁶, Claudia Roberts^{2

5}, Munjed Al Muderis^{2

4

7}

Affiliations

¹ Trauma and Orthopaedic Department, Victoria Hospital Kirkcaldy, NHS Fife, Kirkcaldy, Scotland, United Kingdom.
² Norwest Private Hospital, Bella Vista, New South Wales, Australia.
³ University of Edinburgh, Edinburgh, Scotland, United Kingdom.
⁴ University of St Andrews, St. Andrews, Scotland, United Kingdom.
⁵ Australian School of Advanced Medicine, Macquarie University, North Ryde, New South Wales, Australia.
⁶ Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney, New South Wales, Australia.
⁷ School of Medicine, The University of Notre Dame Australia, Auburn, New South Wales, Australia.

Abstract

The management of peripheral vascular disease (PVD) can require amputation. Osseointegration surgery is an emerging rehabilitation strategy for amputees. In this study, we report on 6 patients who had PVD requiring transtibial amputation (PVD-TTA) and either simultaneous or subsequent osseointegration (PVD-TTOI).

Methods: Six patients (aged 36 to 84 years) with transtibial amputation and preexisting PVD underwent osseointegration between 2014 and 2016 and were followed for 3 to 5 years. Pre- and postoperative clinical and functional outcomes (pain, prosthesis wear time, mobility, walking ability, and quality of life) and adverse events (infection, fracture, implant failure, revision surgery, additional amputation, and death) were prospectively recorded.

Results: All patients' mobility improved following osseointegration. Three patients initially had required the use of a wheelchair, precluding baseline walking tests; the other 3 were classified as K level 1 or 2, with mean baseline Timed Up and Go (TUG) test = 14.0 ± 2.2 s and 6-Minute Walk Test (6MWT) = 262 ± 75 m. At the time of the latest follow-up, all patients were K level 2 or 3; mean TUG = 12.7 ± 7.2 s and 6MWT = 353 ± 148 m. Four patients wore their prosthesis ≥16 hours daily. Three patients had superficial soft-tissue infections. One other patient experienced recurrent infections 2.8 years after osseointegration requiring debridements and transfemoral amputation; the patient died 2 days following surgery from myocardial infarction caused by coronary atherosclerosis.

Conclusions: All 6 patients who underwent PVD-TTOI in this case series survived through 2 years. Patients who initially had used a wheelchair achieved and maintained independent, unaided ambulation until PVD-related impairments in the contralateral leg occurred in 1 patient. Patients previously using a traditional socket prosthesis reported improvement in mobility and quality of life. One patient's death underscores the importance of careful patient selection. However, marked improvement in the other 5 patients suggests cautious optimism that PVD-TTA is not an absolute osseointegration contraindication. Conscientious further investigation seems appropriate.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.