Techniques to Remove Press-Fit Osseointegration Implants

• DOI: 10.2106/jbjs.st.23.00017
• Publication Date: 2024-03-06T19:00:55Z
• Authors: Germane Ong; Jason Shih Hoellw...; Kevin Testworth; Munjed Al Muderis
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Subspecialty Procedures

Background: Transcutaneous osseointegration for amputees (TOFA) has proven to consistently, significantly improve the quality of life and mobility vast majority amputees, as compared with use a socket prosthesis 1,2 . As any implant, situations such infection, aseptic loosening, or implant fracture can occur, which may necessitate hardware removal. Although it eventually date no ever required removal in setting periprosthetic fracture. Since TOFA implants are designed facilitate robust bone integration, be challenging. Even cases portions loose, other areas remain strongly integrated resist Further, there an fractures, leaving residual portion place without interface extraction tool. outcomes revision not been primary focus publication, fact that necessary generally succeeds restoring similar documented 3–5 removal, preserving healthy tissue avoiding iatrogenic injury critically important. This article demonstrates several techniques remove press-fit we have found safe effective. Description: The procedure is performed patient supine position affected extremity prepared draped typical sterile fashion. tourniquet help reduce blood loss, but safer during create increased prolonged thermal exposure, reaming drilling. If patients clinically stable, withholding antibiotics until cultures obtained diagnostic yield. technique should proceed from conservative aggressive, necessary: slap hammer, thin wire-assisted extended osteotomy. Trephine discouraged because need difficulty removing dual cone along extensive damage often caused surrounding reaming, avoided osteotomy technique. Alternatives: It important emphasize most infections related transcutaneous do require removal; alone soft-tissue and/or limited debridement sufficient resolve infection cases. non-infectious indication (such loose implant) declines surgery, activity modification close observation reasonable. infectious very must maintained avoid potential osteomyelitis. suppressive (oral intravenous) severity infection. An alternative surgery manage implant-associated amputation above (within same bone, through-joint amputation, through femur transtibial osseointegration). considered only if tremendously compelling reason so, emergency amputate due life-threatening Rationale: Indications include persistent pain, deep recalcitrant retention, mechanical complications involving loosening breakage. following specific examples indications removal: cannot resolved oral intravenous soft achieved stable integration (aseptic loosening) causing fractured deformed concern Expected Outcomes: Most who suitable reimplantation after decontamination period local antibiotic depot antibiotics. duration 6 12 weeks. Following osseointegration, achieve levels performance they had prior Infection does appear associated risk mortality Patients decline able return prosthesis. Important Tips: treatable antibiotics, debridement. Consider these options before reflexively implant. Preserving stock optimal another conversion Living even infected, decontaminated Minimize by releasing using saline solution irrigation procedure. removed fully (rather than single clamshell-type osteotomy), attempt screw osteosynthesis preserve canal future osseointegration. Be gentle techniques. Elevating quickly violently cause propagating morbidity, splinter fragments. Carefully separating will loss condition revision. some cases, advised treat every involves first surgical stage culture acquisition, A separate second eradicated Many hammer fine wire techniques; reserved diligent attempts unsuccessful, order optimize integrity.