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Techniques to Remove Press-Fit Osseointegration Implants.

Germane Ong1, Jason Shih Hoellwarth2, Kevin Testworth3

  • 1Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, New South Wales, Australia.

JBJS Essential Surgical Techniques
|March 7, 2024
PubMed
Summary
This summary is machine-generated.

Transcutaneous osseointegration for amputees (TOFA) removal can be challenging due to robust bone integration. This article details safe and effective techniques for removing press-fit osseointegration implants when necessary.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Rehabilitation Medicine

Background:

  • Transcutaneous osseointegration for amputees (TOFA) significantly improves quality of life and mobility compared to socket prostheses.
  • Implant removal may be necessary due to infection, aseptic loosening, or fracture, though osseointegration implants are rarely removed for periprosthetic fractures.
  • Removal of deeply integrated TOFA implants can be challenging, even when portions are loose or the implant is fractured.

Purpose of the Study:

  • To demonstrate safe and effective techniques for removing press-fit osseointegration implants.
  • To provide guidance on managing complications associated with osseointegration implants.
  • To highlight the importance of preserving bone stock and minimizing iatrogenic injury during implant removal.

Main Methods:

  • Procedures are performed with patients in a supine position, with careful consideration for tourniquet use to minimize bone thermal exposure.
  • Implant removal techniques progress from conservative (slap hammer, wire-assisted) to aggressive (extended osteotomy) as needed.
  • Trephine reaming is discouraged due to potential bone damage and difficulty removing dual cone interfaces; osteotomy is preferred.

Main Results:

  • Most infections associated with TOFA do not necessitate implant removal, often resolving with antibiotics or limited debridement.
  • Revision osseointegration is generally successful in restoring mobility, with patients often achieving similar performance levels post-revision.
  • Reimplantation is typically feasible after a 6-12 week decontamination period involving antibiotics.

Conclusions:

  • Press-fit osseointegration implant removal requires careful technique to preserve bone integrity and facilitate potential revision surgery.
  • Non-surgical management or less invasive procedures are preferred for infections unless severe and recalcitrant.
  • Minimizing thermal injury and bone loss during removal is crucial for successful outcomes, whether for revision osseointegration or conversion to a socket prosthesis.