Radiographic bone changes in 12 participants with Intraosseous Transcutaneous Amputation Prosthesis (ITAP) over 11 years: A retrospective cohort study
Journal article, 2024
Background: Percutaneous Osseointegrated Implants (POI) influence the load transfer path to the host bone. In turn, mechanoregulatory processes (strain adaptive bone remodeling) drives periprosthetic bone changes which influence implant stability and fixation outcome. These bone changes have not yet been reported for the Intraosseous Transcutaneous Amputation Prosthesis (ITAP) clinical trial.
Objectives: This study will firstly standardise the zoning and reporting of periprosthetic bone change in POI radiographs. Secondly, it will retrospectively measure periprosthetic bone change from radiographs of 12 participants with an ITAP up to 11 years. Finally, the results will be qualitatively compared to those from participants with different POI designs.
Materials and methods: Twenty participants with unilateral transfemoral amputations received an ITAP in a two centre UK clinical trial in either 2008/09 or 2013/14. Participant radiographs from one centre were available (n = 12) over 11 years and have been collated and processed in a repeatable way. Transverse plane periprosthetic bone change measurements at three equidistant points along the implant stem were measured in AP and ML.
Results: Total median bone growth in AP was double that in ML (57.6 mm and 31.12 mm respectively). Median lateral and posterior bone change (1.44 mm and 1.09 mm) was greater than median medial and anterior (0.83 mm and -0.005 mm) bone changes respectively. The greatest change in radial bone growth was observed distally and the least proximally.
Conclusions: Bone changes were similar to some collared pressfit POI’s in the literature. We demonstrate the influence of stem design and mechanoregulatory remodeling in stable fixation, however, additional influences on periprosthetic bone change were inferred from the results and further investigations are necessary.
Clinical relevance: To identify ITAP design features and fixations that minimise endosteal resorption, thus promoting implant stability and contributing to clinical guidelines for rehabilitation and future design and fixation choices.
Objectives: This study will firstly standardise the zoning and reporting of periprosthetic bone change in POI radiographs. Secondly, it will retrospectively measure periprosthetic bone change from radiographs of 12 participants with an ITAP up to 11 years. Finally, the results will be qualitatively compared to those from participants with different POI designs.
Materials and methods: Twenty participants with unilateral transfemoral amputations received an ITAP in a two centre UK clinical trial in either 2008/09 or 2013/14. Participant radiographs from one centre were available (n = 12) over 11 years and have been collated and processed in a repeatable way. Transverse plane periprosthetic bone change measurements at three equidistant points along the implant stem were measured in AP and ML.
Results: Total median bone growth in AP was double that in ML (57.6 mm and 31.12 mm respectively). Median lateral and posterior bone change (1.44 mm and 1.09 mm) was greater than median medial and anterior (0.83 mm and -0.005 mm) bone changes respectively. The greatest change in radial bone growth was observed distally and the least proximally.
Conclusions: Bone changes were similar to some collared pressfit POI’s in the literature. We demonstrate the influence of stem design and mechanoregulatory remodeling in stable fixation, however, additional influences on periprosthetic bone change were inferred from the results and further investigations are necessary.
Clinical relevance: To identify ITAP design features and fixations that minimise endosteal resorption, thus promoting implant stability and contributing to clinical guidelines for rehabilitation and future design and fixation choices.
Author
Kirstin Ahmed
Chalmers, Electrical Engineering, Systems and control
Catherine Pendegrass
University College London (UCL)
William Aston
Royal National Orthopaedic hospital
Gordon Blunn
University of Portsmouth
Journal of Prosthetics and Orthotics
1040-8800 (ISSN)
Subject Categories
Orthopedics