Orthopedics

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Complex Case Spotlight

Osseointegration Surgery Improves Connection Between Limb & Prosthesis

Permanent implant system in patient with transfemoral amputation increases comfort, mobility, and limb strength.

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Complex Case Spotlight

Osseointegration Surgery Improves Connection Between Limb & Prosthesis

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Muscle Reinnervation & Osseoanchored Prosthesis Implantation

In the initial surgery, the surgeons performed targeted muscle reinnervation to restore nerves to the patient’s thigh and reduce his pain and phantom limb syndrome symptoms. Then in the distal end of his residual femur bone, they implanted the titanium osseoanchored prosthetic system, and used a bone graft harvested from the femur’s intramedullary canal to allow the bone to fill the gap and grow into the implant.

Surgeons reinnervate the patient’s thigh muscles and implant the titanium connector.
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Attachment of Titanium Abutment to Osseoanchored Prosthetic Fixture

In the second surgery, surgeons attached a titanium abutment to the implanted osseoanchored prosthetic fixture through a skin aperture to allow a connection to the external prosthesis. A delicate soft tissue surgery and complex closure with skin graft around the metal abutment ensured proper tightening of the patient’s thigh musculature, fat, and skin, allowing it to heal down to the metal and bone and remove all gaps.

A new titanium abutment attaches to the implanted osseoanchored prosthetic fixture in the patient’s thigh.
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Fitting of Full Prosthetic Device

After a few months of healing, the patient was fitted for the full prosthetic device in May 2023. Physical therapy helped him gain strength and confidence and he began relying less on assistive devices. The technique, initially developed for dental implants, can be used for both upper and lower limb prosthetics, and may significantly expand the range of options after amputation due to bone tumors.

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At a follow-up, the patient tries on the full prosthetic system.
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The Foundations of Orthopedic Surgery: From the Hospital for Joint Diseases to NYU Langone

For a rich compilation of the history of orthopedics at our institution, see this recent issue of the Bulletin of the Hospital for Joint Diseases.