Orthopaedic oncologist Brock Lindsey discusses the Osseointegration Clinic at Johns Hopkins and answers commonly asked questions about the surgery, including what patients are eligible and the benefits over traditional prosthetic limbs. To refer a patient, please call 443-997-2663.
Really amputees of all kinds are good candidates for osteo integration. I think as part of our multidisciplinary process, we do an intake process that allows us to selectively choose how to best optimize each amputee, whether it be for device change or potential K for osteo integration. Then during that process, we're able to selectively choose which patient would be best. I think any time somebody is undergoing an amputation, whether it be in the acute setting or in the chronic setting. So patient that has been an amputee for years and years but continues to have problems or struggles with their amputation or their sockets. Um This is a good time to get orthopedics involved on the acute side. If we know that a patient is going to have an amputation problem, potentially a very short transfemoral amputation, that wouldn't be a good socket candidate or has soft tissue problems that we know we're going to have issues. That's a good time to get us involved because osteo integration can be a very good acute option for patients that have had chronic issues for years and years and continue to have issues. That's another time to get involved and then what we could do is bring together our team once again, whether it be through plastic surgery and nerve related transfers, like targeted muscle re innovation and RP uh to help with phantom limb pain as well as potentially offering osteo integration. At the same time, I think the major risk for osteo integration is obviously infection is going to be our biggest concern. I think that this style of surgical treatment for amputees has been around for quite some time in Europe. It's new in the United States. But we've learned a lot of things about osteo integration over those years. The biggest thing is the soft tissue envelope and how to handle that. And that's why we really involve multiple surgeons including both orthopedics and plastic surgery for that. Then the day to day care is also very important. And we go through that um you know, osteo integration hygiene and how to best take care of that. And as long as both the surgical team, as well as the patient is communicating very well back and forth. And we take very good care of this, it can be very successful despite that risk. But it's something we we definitely put at the forefront of our concerns. So probably the biggest benefit to osteo integration is the lack of sockets, mainly because we all know that sockets can be very difficult for patients with all their side effects of potentially sweating, constantly having to change them skin sores, just general uncomfortability as well as the difficulties in donning and doffing those. So that's a very large one. Another benefit is they get this sense of osteo perception where they can actually feel where the prosthesis is in space and especially for lower extremities, that helps them quite a bit for ambulation as well as being able to walk. It's much easier for these patients to walk in the lower extremity and the work of ambulation is drastically decreased. So potentially some patients that wouldn't even be able to ambulate now can especially with very high amputees patients that are not good candidates for socket. But we still have enough bone left to do an osteo integrated procedure, which can be quite small, as small as about 4.5 centimeters of bone remaining that will allow us to actually functional that patient and make him ambulating, which is excellent to see other benefits include for the upper extremity being able to use much more complicated prosthetics because they weigh more specifically with the myoelectric prostheses where previously with socket prosthesis, they would constantly fall off and then the sensors that are used for prosthetic control wouldn't contact the right areas. Osteo integration gives you that foundation for that kind of prosthesis to be on the patient and then be much more functional. The benefits of using a multidisciplinary team are actually quite expounding because if you look at amputation care from the orthopedic perspective, the plastic surgery perspective, the rehabilitation and physical medicine perspective and then the orthotics and the physical therapy, everybody comes at amputee care from a different angle. And when those people are communicating directly in front of a patient and addressing their issues or concerns as a team, it allows you to really optimize that process both from a speed as well as in an efficiency perspective and having really complicated conversations that a lot of times other teams don't have because they're so separate.
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