Press-Fit Osseointegration for the Transfemoral Amputee

The current worldwide standard rehabilitation strategy for amputees is to use a socket prosthesis. These attach to the extremity by squeezing, compressing, or pulling on the amputee’s skin, which causes pain, and dermatologic infections. Because the socket must be both airtight and rigid, patients also have sweating and trouble fitting when they gain or lose weight. Transfemoral amputees also often have poor biomechanics within their socket. These issues lead to frequent periods of disuse or abandonment of their prosthesis. Osseointegration is a reconstruction procedure in which a metal implant, most often titanium, anchors into the patient’s skeletal residuum, and connects to an external prosthetic limb via a transcutaneous adapter. Press-fit osseointegration techniques are currently the most commonly utilized. Following osseointegration, amputees nearly always report significantly improved prosthesis wear time, proprioception, mobility, and quality of life. Because there is a permanent opening in the skin (called a “portal”), there is a risk for infection, which requires operative intervention in around 5% of patients currently. This case illustrates a typical approach to reconstructing a transfemoral amputee. Her pre-presentation experience is representative of many patients, her surgical reconstruction is routine as far as osseointegration goes, and her postoperative improvement is both dramatic and predictable.