Cleveland Clinic orthopedic and plastic surgeons are using osseointegration, which attaches prosthetic limbs directly to bone without a traditional socket, for patients with limb loss who cannot succeed with conventional prosthetics, the health system detailed in an Nov. 3 article.
The approach anchors a metal implant inside the residual bone and extends it through the skin to connect to an external prosthesis. Lukas Nystrom, MD, a Cleveland Clinic orthopedic surgeon, said the direct connection transfers force from the skeleton far more efficiently than a socket. Sockets lose energy through soft tissue and can cause friction, skin breakdown and fit problems.
The technique upends a core orthopedic principle: sealing implants away from the outside environment. Instead, surgeons build a stable skin-implant interface designed to prevent deep infection, a principle dental implants already use, Dr. Nystrom said.
Cleveland Clinic targets patients who have failed a socket prosthesis or are unlikely to succeed with one, including those with very short residual limbs. Active infection rules a patient out, and the team generally avoids the procedure in smokers. Surgeons assess limb shape and soft tissue rather than relying on body mass index alone.
Surgeons perform the procedure in two stages roughly two to three months apart. A gradual weight-bearing protocol follows over the first three months, with psychologists, social workers, physical therapists and prosthetists supporting patients. Infection at the skin-implant interface remains the central risk, though superficial infections generally respond to oral antibiotics.
Steven Schulz, MD, a Cleveland Clinic plastic surgeon, said pairing osseointegration with nerve procedures such as targeted muscle reinnervation could produce prostheses with sensory feedback. “This is the first step toward the future of prosthetics,” Dr. Schulz said.
Sweden first introduced the technique for lower-extremity amputations in the 1990s, and it has since expanded worldwide as implant design and surgical technique advanced.
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