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Saturday, 28 February 2015 16:29

Post Surgical Information

Pain control:

Immediately following surgery you will be taken to the recovery room where you will be motioned. Once stable you will be transferred to the orthopedic ward.

You will be set up with a button to press to administer pain relief through a machine called a PCA machine (Patient Controlled Analgesia) as well as given ketamine intravenously. 

The post-op protocol will vary slightly from patient to patient but generally you can expect your drain to be removed after 48 hours or once the ketamine infusion has been ceased. Once this is removed you can sit out of bed. The dressing will be reduced usually on the third day post-op in order to make movement easier. 

You will be visited by a physiotherapist who will prescribe exercises and to assist and supervise you with your rehabilitation and mobilisation.

 

Weight-baring:

Partial weight-bearing and the fitting of the lower prosthesis can take place as early as a few days after the second surgery. This is done under careful supervision of the team. It is now that the rehabilitation stage and gait training can begin.

This stage begins with weight loading using a specialised stump loader fitted onto the end of implant. You will begin the loading stage by doing five minutes of loading three times a day where you are required to push down through the loader to reach a designated weight using a set of scales. This weight and time of loading will increase slowly throughout a few days. 

 

Gait Training:

Once you can comfortably weight load at a weight of half your body weight (this is done by loading using a stump loader onto a set of scales) you will be fitted with a light leg and gait training can commence. 

During the gait training and loading period some muscle soreness is to be expected as the muscles are being used in new and different ways and will need time to adjust and build up strength.

In order to ensure the implant is safely integrated into the bone you are required to only partial weight-bear for the first 12 weeks. This means walking with at least one crutch or walking stick for this time period.

While it is a very exciting time and the urge to push yourself is often enticing it is very strongly recommended you build up your walking slowly to avoid any injuries caused by going too hard too soon. 

 

Post-Op Care:

Care should be paid to the opening (stoma) through which the external adaptor passes out of the stump. There will be a small amount of discharge from the stoma. This amount varies from patient to patient and some have none at all.

With normal daily hygiene the risk of infection is very low.  Washing once a day in the shower, paying attention to the stump and stoma is all that is needed.

 

Safety System:

Excessive rotation such as pivoting and sharp twisting movements should be avoided as a general rule. However, if high levels of strain should occur, the safety shear pins in the external implant system will break to protect against a bone fracture occurring. The system yields and the bone remains undamaged. Safety is paramount and the system has been designed to protect the bone during any large strain or vigorous movements. The safety pins are easily exchanged by the prosthetist and in the near future there is the possibility they will be able to be replaced by the patient.

Published in Post Surgery
Saturday, 28 February 2015 15:16

Osseointegration Surgical Procedure

 

The implantation of the OGAP-OPL is performed in either a single surgery or over two stages depending on the patients existing conditions and suitability.

As no two osseointegration patients are identical, the surgical process will vary slightly from patient to patient depending on their condition and needs.

 

The first stage will generally involve:

  • The soft tissue is managed and redundant skin and soft tissue fat are removed in order to minimise the bone to skin distance. This leads to a reduced chance of complications. The muscle groups are rearranged to serve a functional purpose in operating the leg and the soft tissue facial layer is reorganised around the stem.
  • The bone residuum is reshaped and any bone spurs are removed.
  • The bone canal is prepared using a specialised instrument. The internal component of the implant is press fitted into the bone canal securing early stability and future bone ingrowth.
  • If there is a neuroma causing nerve pain the nerves involved will be addressed surgically by excision of the painful neuroma and deep positioning of the residual nerve into the muscle group to minimise future nerve issues.
  • The stump is refashioned in a cosmetic manner and the wound is closed in layers.

 

A period of six to eight weeks takes place after the first stage to allow for osseointegration. This is then followed by the second stage.

 

Involved in the second stage is:

  • The creation of a circular skin opening (the stoma) at the base of the stump. Through this opening the dual cone adaptor is connected to the internal stem, which is already integrated in the bone. The remaining components of the prosthesis can then be attached externally.

 

If the surgery is performed in a single stage, all of the above will take place during the one procedure.

 

Partial weight-bearing and the fitting of the lower prosthesis can take place as early as a few days after the second surgery. This is done under careful supervision of the osseointegration team. It is now that the rehabilitation stage and gait training can begin.

Published in Surgery

The Osseointegration Group of Australia team consists of experts in a variety of fields each with a vast experience of working with amputees. They understand that every situation and patient is unique and with a combined team approach work together to assess and determine the best possible treatment for you.

They care for you emotionally and physically from the first meeting and offer support and expert guidance through all stages of the osseointegration process from choosing to undergo surgery, to the surgery itself, through to the after care in pain management, physiotherapy and prosthesis adjustments.

 

Meet the team:

  • Jennifer Martin - Acute Care Nurse; Nurse Unit Manager, Macquarie University Hospital
  • Sarah Benson - Physiotherapist, Macquarie University
  • Cathy Howells – Physiotherapist
  • Dr Ajay Kumar - Anaesthetist
  • Mitchell Grant - Patient Advocate
  • Shona Wilmot - Osseointegration Australia Coordinator
Published in Information
Tuesday, 17 February 2015 15:42

The OGAP-OPL Implant

The Osseointegration Group of Australia Osseointegration Prosthetic Limb (OGAP-OPL) implant is made up of several components. The components can be divided into an inner (endo) module and an external (exo) module.

The endo module, a titanium stem, is directly implanted into the bone.

The implant surface is made of highly porous titanium, which allows initial stability and long term bone integration (ingrowth). This technology has been successful in clinical use world wide for more than 30 years in joint replacement surgery. The biocompatibility of the titanium implant allows the bone to grow inside the surface of the prosthesis, which makes the bone and implant structure one solid unit. This is known as osseointegration.

A dual adaptor connects the internal implant to the external prosthesis. This adaptor has a highly polished smooth surface to minimise soft tissue friction. It is also coated with a titanium niobium, which has antibacterial properties. The dual adaptor passes through a small opening in the skin at the end of the stump known as the stoma. Externally the adaptor is fixed to a torque control safety device which further connects to the prosthetic limb.

Taking on and off the prosthesis is very easy and takes less than ten seconds. Due to the solid fixture to the bone it accurately connects in the exact spot each and every time you attach the prosthesis. This device can be used with all types of prosthetic knee units and lower limb prosthetic componentry.

Gone are the days of fiddling around with time consuming and cumbersome suction, socks and liners.

 

Published in Information
Tuesday, 17 February 2015 15:15

History Of Osseointegration

Osseointegration is derived from the Greek ‘osteon’ meaning bone, and the Latin ‘integrare’, which means to make whole. It is defined as the direct contact between living bone and the surface of a synthetic, often titanium based, implant. 

Osseointegration’s original application was in bone and joint replacement surgeries and not only has it dramatically enhanced these surgeries and their outcomes but now it is also used to vastly improve the quality of life for amputees.

Sir John Charnley pioneered Hip Replacement surgery in 1962. His design and approach involved fixing the replacement prosthesis to the bone, which he based on a dental practice of using bone cement. His revolutionary technique is still used today.

The concept of osseointegration in dentistry first started in 1965 with Professor Per-Ingvar Branemark who threaded trans-oral titanium implants into the mandible and maxilla (the bones of the upper and lower jaw) to act as anchorage for dental prostheses.

In 1990, based on a successful technique developed by his father, Brånemark performed the first transcutaneous femoral intramedullary prosthesis on an above knee amputee with an A 12-cm screw-fixation titanium threaded device.

A non weight-bearing period of six to 12 months was applied to allow proper osseointegration.

Clinically osseointegration for amputees has been used since 1995, utilising a skeletally integrated titanium implant that is connected through an opening in the stump (stoma) to an external prosthetic limb.  The traditional suction prosthesis is no longer required and perfect fit is achieved via a torque controlled knee connector.

This allows for direct contact to the ground, which provides greater stability, more control and minimises energy exerted.

 

Spongiosa Metal

There is a large debate in the orthopaedic community between using Screw Fixation or Fit and Fill Principle in the absence of bone cement. To date clinical data from hip arthroplasty has shown superior results with the press fit implants compared to those replaced using screw fixation. This is because press fit implants allows for much earlier mobilisation, better fixation and long term stability of the implant.

In 1982 ESKA Implants Lübeck/Germany, now Orthodynamics, pioneered a 3D macro porous surface structure that allowed for ingrowth between the bone and implant surface.

These images show the process of bone ingrowth into the spongiosa metal.

 

After the successful osseointegration results of the Spongiosa metal in hip and knee arthroplasty, Orthodyamics produced the OGAP-OPL implant in 1990. This implant was first implanted into the femoral canal of a young man who had lost his leg in a motorcycle accident.

 

Published in Information
Monday, 16 February 2015 15:54

Osseointegration Information

Osseointegration is derived from the Greek ‘osteon’ meaning bone, and the Latin ‘integrare’, which means to make whole. It is defined as the direct contact between living bone and the surface of a synthetic, often titanium based, implant.

Osseointegration’s original application was in bone and joint replacement surgeries and not only has it dramatically enhanced these surgeries and their outcomes but now it is also used to vastly improve the quality of life for amputees.

Clinically osseointegration has been used since 1995, utilising a skeletally integrated titanium implant that is connected through an opening in the stump (stoma) to an external prosthetic limb.  The traditional suction prosthesis is no longer required and perfect fit is achieved via a torque controlled knee connector.

This allows for direct contact to the ground, which provides greater stability, more control and minimises energy exerted.

The Osseointegration Group of Australia Osseointegration Prosthetic Limb (OGAP-OPL) implant is modelled on the anatomy of the human body and takes the load back to the femur and the hip joint when walking. In a traditional socket prosthesis both the femur and hip joint are not loaded naturally which results in degeneration and atrophy of the bone and can lead to osteoporosis.

The OGAP-OPL is suitable for both above and below knee amputees and is implanted directly into the tibia or femur accordingly.

 

Advantages Of Osseointegration And The OGAP-OPL:

No Socket

  • Walking with the OGAP-OPL allows for natural loading of the hip joint and the femur which encourages bone growth, creates a more natural gait and requires less physical exertion
  • Any weight or fluid variations of the stump have no effect on fit or functionality
  • No bulky socket which results in a natural streamlined look in clothes 

 

Freedom of Mobility

  • Allows for full freedom of movement in activities ranging from walking to cycling, recreational activities and physical work
  • Muscular strength is developed freely minimising muscle wastage of the stump
  • Movement is not restricted by the protruding edges of a socket allowing for greater ease and comfort sitting, standing and walking
  • The direct connection between femoral bone, implant and knee enables free, natural pivoting movements.

 

Easy Attachment and Osseoperception

  • The knee prosthesis can easily be attached and removed with ease within just a few seconds
  • The patient regains their sense of proprioception, which is the unconscious perception of the position of the body, movement and spatial orientation in relation to the external environment. This means the patient regains the ability to feel the ground beneath them as they walk and can differentiate between different surfaces such as carpet, grass, tiles and uneven ground. This allows for safer and more confident movement even in unfamiliar areas or dim light.

 

Frequently Asked Questions:

What do I need to do?

Make an appointment with Professor Munjed Al Muderis and his team to discuss your situation.  You will need to be motivated and willing to work with our physiotherapists to build your muscle strength following the surgery. You can make an appointment by calling 1800 905 907 or +61 2 8882 9011 or book an appointment online

 

How soon after amputation can surgery be performed?

Each situation is unique and will be assessed in order to make the best decision for you.  The earliest that osseointegration surgery has been performed is within a year of the patient’s initial amputation. 

 

How much does it cost?

Australian Private Health Insurance covers most of the cost involved with OGAP-OPL prosthesis surgery. However, some items necessary for your treatment may not be covered under some health funds such as physiotherapy, medications or x-rays. This will vary from company to company and policy to policy. Please check with our staff and your fund for more details. 

 

Are there any disadvantages?

There will be a small amount of discharge from the stoma. The amount of discharge varies from patient to patient and some patients have none at all.

 

For more information on the surgical procedurethe implant and the history of osseointegration please view the other pages in the information section.

Published in Information

 

This video demonstrates the loading exercises required after an Osseointegration operation.

The patient featured is a below-the-knee amputee and had both Stage 1 and Stage 2 of Osseointegration surgery performed in one operation.

Published in Post Surgery
Tuesday, 10 February 2015 11:00

Osseointegration Patients - 9 and 15 months

 

This video demonstrates two patients, one 9 weeks post osseointegration surgery and the other 15 months post osseointegration surgery as performed by Professor Munjed Al Muderis.

Published in Post Surgery

 

This video demonstrates a patient 5 days after undergoing the Osseointegration procedure as performed by Professor Munjed Al Muderis. 

Published in Post Surgery

 

This video demonstrates a patient 4 months after undergoing Osseointegration surgery as performed by Professor Munjed Al Muderis.

Published in Post Surgery