Transcutaneous osseointegration for amputees as a result of sepsis management: a case series of nine patients with a mean follow-up of 4 years

Background: Transcutaneous osseointegration following amputation (TOFA) is an alternative to standard prosthesis by directly anchoring a metal implant to the skeletal residuum. However, there is a paucity of data concerning whether TOFA is safe and reasonable for patients with lower limb amputation to manage complications of sepsis. The primary aim of this study was to record adverse post-TOFA events for nine patients (15 limbs) whose index amputations were performed to manage sepsis-related complications. The secondary aim was to compare the pre-and post-TOFA mobility and quality of life (QoL). Methods: A retrospective review of our practice’s prospectively maintained osseointegration database was performed. Patients with transfemoral and/or transtibial osseointegration for a limb in which the original amputation was performed to manage sepsis, at least two years prior to the study date, were included. This yielded nine patients with 15 osseointegrated limbs. Adverse events were antibiotics for infection or unplanned surgery. Outcomes were recorded using the SF-36 Health Survey and the Questionnaire for persons with a transfemoral amputation. Formal mobility evaluations included a 6-minute walk test and physician-determined K-levels. Results: The cohort had a mean age of 42.8 ± 6.5 (range: 35.0–52.4) years. The mean body mass index (BMI) was 27.2 ± 11.0 (18.4–54.5). Six patients (67%) underwent bilateral osseointegration, and three (33%) patients underwent unilateral osseointegration. Six patients (67%) representing 12 limbs (80%) had an uneventful course post-osseointegration. One (11%) patient had intravenous antibiotics to manage a superficial infection. One (11%) other patient had a periprosthetic femur fracture managed by open reduction internal fixation. No systemic complications, additional surgeries, or implant removals occurred. 75% (6/8) achieved K-level ≥ 2 post-osseointegration. There was no significant change in the 6-minute walk test. Conclusion: Lower limb osseointegration is a safe and effective rehabilitation option for patients whose amputations were a result of sepsis. Clinical significance: Further judicious use of TOFA for these patients seems highly merited.