Endo-Exo Pty Ltd ( Australia). I receive Royalty ... connected to a prosthetic limbâ. Newman ... K1: Ability to use a prosthesis for ambula on on level surfaces at.
DEXA Scan
ASAMI 2016
Brisbane Munjed Al Muderis MB ChB, FRACS, FAOrthA
Chairman of the Osseointegration Group of Australia
Adjunct Clinical Associate Professor, School of Medicine, Sydney
University of Notre Dame Australia,
Macquarie University
Mandetory Disclosures Current Financial Consultant Agreements: Global Orthopaedic (Australia) AQ Implants (Germany) Amplitude (France) Lima Orthopaedic (Italy) Corin (United Kingdom) Endo-Exo Pty Ltd ( Australia)
I receive Royalty Payment for design contribution from: Global Orthopaedic (Australia) AQ Implants (Germany) Amplitude (France) IO Implants ( Australia)
Objectives and hypothesis The primary objective of this presentation is to introduce the Osseointegration Group of Australia Accelerated Protocol (OGAAP) and to evaluate the bone menial density changes after osseointegration surgery for amputees.
The Effect of Amputation Amputation of an extremity results in major changes in a person’s function, body image, and quality of life. It is estimated that less than 50% of amputees return to work, and the average time to return to work exceeds one year. Over 90% of bilateral above-knee amputees eventually end up confined to a wheelchair due to the difficulty of mobilising with dual socket.
We Have Been Trying For Six Centuries Ambroise Paré (1510-1590) Despite extensive research regarding socket design and manufacturing problems persist.
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Socket Skin Interface Problems Skin friction: Heat, rash, ulcers, blisters, perspiration, chafing, infections and general discomfort. Mobility and fit: Pistoning leads to energy loss, time spent donning and doffing, reduction of ipsilateral proximal joint movement, lack of rotational control, diurnal variation of the residuum leading to poor fit and lack of stability, Diminished proprioception: profound the lack of stability.
What About a Revolutionary Solution? Eliminate all socket problems Lower energy consumption Increase proximal joint ROM Allow more stability Restore proprioception Improve back pain
Osseointegration “Structural and functional connection between the macro-porous surface of implants and living bone tissue percutaneously connected to a prosthetic limb”
Newman, Michael; Takei, Henry; Klokkevold, Perry, eds. (2012). Carranza's Clinical Periodontology (in English). St. Louis, Missouri: Elsevier Saunders.
Distribution Per Year AMPUTATION LEVELS 300
Transhumeral
250
NUMBER OF CASES
248
Trans@bial
200
Transfemoral
181
169
Total
150
125
90
100 73 43 46
50 0
64 41
25 26 0 0 1
1
2010
0 0
6
6
2011
0 1
2012
16 0 3
2013
1
2014
3
2015
3
2016
DEXA Scan
Total Number With DEXA Scans
Standard AKA n:20
Short AKA n:15
BKA n:11
One Bilateral
K-Scores Of PaCents Before And AFer Surgery
K0: No ability to ambulate. Prosthesis does not enhance mobility. K1: Ability to use a prosthesis for ambula8on on level surfaces at fixed cadence (household ambulator). K2: Ability for ambula8on and traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces. (community ambulator). K3: Ability for ambula8on with variable cadence (community ambulator and may have exercise ac8vity that demands prosthe8c use beyond simple locomo8on). K4: Ability for prosthe8c ambula8on that exceeds basic ambula8on skills, exhibi8ng high impact, stress, or energy levels (child, ac8ve adult, or athlete).
K-Scores Of PaCents Before And AFer Surgery
pre op k-score 0 1 2 3 4
Pre 17 1 13 13 2
post op Post 0 0 15 26 5
K-Scores Of PaCents Before And AFer Surgery
Increased 31
Unchanged 15
Decreased 0
StaCsCcs: p = 0.0030, Very Significant when comparing Pre and Post Pre Post
Pa8ents who couldn't do the 14 0
Table: Wheelchair and walking-assisted paCents who could not aVempt Timed Up and Go test
t-test: p-value less than 0.0001 (this difference is considered to be extremely staCsCcally significant) Confidence interval = 95%
Graph for AKA Pre and Post op
t-test (95% CI) AKA Pre Spine vs AKA Post Spine AKA Pre Femur OP vs AKA Post Femur OP AKA Pre Femur CONT vs AKA Post Femur CONT
p-value
significance 1 no 0.5104 no 0.83 no
Graph for BKA Pre and Post op
t-test (95% CI) BKA Pre Spine vs BKA Post Spine
p-value
significance 0.586 no
BKA Pre Femur OP vs BKA Post Femur OP
0.8112 no
BKA Pre Femur CONT vs BKA Post Femur CONT
0.3814 no
t-test: Pre short vs pre standard: p-value = 0.0255 (staCsCcally significant) Post short vs post standard: p-value = 0.2469 (not staCsCcally significant)
t-test Post short vs Post standard: p-value = 0.4036 (not staCsCcally significant)
t-test: Pre short vs pre standard: p-value = 0.0002 (extremely staCsCcally significant)
t-test: post 2Y short vs post 2Y standard: p-value = 0.0880 (not quite staCsCcally significant but almost)
t-test: Post 1Y short vs Post 1Y standard: p-value = 0.1879 (not staCsCcally significant)
Post short vs Post standard, P = 0.2912 (not staCsCcally significant)
Conclusion Osseointegra8on surgery improve the quality of life of amputees There has been significant improvement in the K Levels, TUG and the 6 MWT. BMD showed improvement on the affected side for all the pa8ents Long term follow-up is needed to confirm these early promising results
Thank You
