Osseointegration (OI) for Amputees

Osseointegration is a surgical procedure that directly integrates a prosthetic limb with the remaining bone. Compared to traditional socket-based prosthetics, this approach can provide enhanced stability, support and functionality. Additionally, in some high-level amputation cases, the residual limb may be too short to support a standard socket-style prosthesis, which requires sufficient surface area to achieve a secure fit. While below-knee amputations typically allow for adequate suction and sealing, higher amputations near the hip can present challenges. For these reasons, osseointegration may be a particularly good option for transfemoral and transtibial amputees.

What does osseointegration involve?

Osseointegration provides a direct structural and functional connection between living bone and an artificial implant. The procedure begins with the surgical placement of a metal anchor directly into the bone of an amputated limb. The anchor will extend outward from the residual limb, and a prosthesis will be attached to the metal extension (abutment).

During the healing period, bone cells should grow and attach to the transdermal implant. Over time, the bone may remodel and strengthen around the implant, ensuring stability and long-term integration. This process is essential for the success of prosthetic limbs and other orthopedic devices.

What happens during osseointegration?

During osseointegration, the following multistep process takes place:

• Implant placement – A surgeon will place a biocompatible implant, typically made of titanium, into the remaining bone.
• Initial healing – As the body initiates a natural healing response, blood clots should form around the implant.
• Bone growth and attachment – Over several weeks to months, bone cells (osteoblasts) should grow and attach to the surface of the implant, gradually integrating it into the skeletal structure.
• Bone remodeling and strengthening – The bone should continue to remodel, strengthening the bond between the implant and surrounding bone, ensuring stability and load-bearing capability.
• Functional integration – Once fully integrated with the living bone, the implant can support a limb prosthesis or another orthopedic device, restoring function and stability.

What are the risks and possible complications of osseointegration?

While osseointegration is generally a safe and successful procedure, it carries certain risks and potential complications, such as:

• Infection – Bacteria can enter the surgical site and cause an infection, such as osteomyelitis, which may necessitate antibiotic treatment or implant removal.
• Implant failure – Incomplete integration or excessive stress on the implant can lead to loosening or failure over time.
• Bone fractures – Weak or insufficient bone structure may result in fractures around the implant site.
• Soft tissue irritation – The skin around the implant may become irritated or inflamed, especially in cases of through-the-skin (percutaneous) implants.
• Pain or discomfort – Some patients may experience chronic pain or sensitivity around the implant site.
• Prosthetic complications – If the implant does not integrate properly, it may not support the attached prosthesis effectively, leading to functional issues.
• Implant overload – Excessive mechanical stress, especially in weight-bearing applications, can weaken the integration and cause complications.

Proper surgical technique, careful patient selection and ongoing monitoring can help minimize these risks and improve the long-term success of osseointegration.

What to expect during recovery from osseointegration

Recovery from osseointegration is a gradual process that involves multiple stages to ensure proper healing and implant stability. These include:

• Initial healing – During the first few weeks after the implant is surgically placed in the bone, the patient may experience swelling, bruising and mild to moderate pain, which can be usually managed with over-the-counter or prescription pain relievers. The surgical site must be kept clean to reduce the risk of infection.
• Osseointegration phase – Over the next several months, the bone should gradually fuse with the implant, providing a strong foundation for the prosthetic attachment. During this time, patients may need to limit weight-bearing activities or use assistive devices to avoid placing excessive stress on the implant.
• Prosthetic attachment and rehabilitation – Once osseointegration is confirmed through imaging or clinical evaluation, the external prosthetic component will be attached. Physical therapy and rehabilitation can help the patient regain strength, mobility and coordination while adjusting to the prosthetic.
• Long-term maintenance – Regular follow-up appointments will be scheduled to monitor the implant, assess bone health and address any issues. The patient should closely follow all physician-provided care instructions to help prevent infection, irritation and mechanical complications.

Many amputees who have undergone osseointegration report experiencing osseoperception, a sensation that the prosthesis has become an actual part of their body. This phenomenon may help a patient overcome psychological hurdles that prevent them from regularly wearing their prosthesis.

How effective is osseointegration?

Osseointegration is effective for many patients, with success rates ranging from 80% to 95% depending on factors such as bone quality, surgical technique and post-operative care. When successful, osseointegration can provide a stable and durable connection between the implant and bone, allowing for improved mobility, comfort and prosthetic function compared to traditional socket-based prostheses. Long-term success depends on proper post-surgical care, rehabilitation and regular monitoring by the healthcare team.

Benefit from world-class care at Moffitt Cancer Center

Each year, approximately 12,000 limb amputations are performed in Florida. Moffitt is one of only three hospitals in the state—and the only dedicated cancer center—offering the OPRA™ Implant System, the first commercially available and most extensively studied osseointegrated prosthetic system. Moffitt’s highly skilled multidisciplinary team collaborates to assess patient suitability, perform the osseointegration procedure and provide comprehensive rehabilitation to optimize each patient’s outcome and quality of life. This advanced prosthetic option is transforming the lives of many patients who have undergone amputations, regardless of whether they have been diagnosed with cancer.

Known for its long history of surgical innovation, Moffitt is an outstanding choice for patients who require a complex limb salvage procedure. If you have questions about osseointegration, you can request an appointment with a specialist at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.