Choosing osseointegration: Should prosthetists refer to the “20/20 dilemma”?

No Thumbnail Available
File version
Author(s)
Frossard, Laurent
Griffith University Author(s)
Primary Supervisor
Other Supervisors
Editor(s)
Date
2021
Size
File type(s)
Location

Virtual

License
Abstract

Background Bionic solutions like bone-anchored prosthesis (BAP) connected to osseointegrated implant could profoundly change life.1-11 However, the decision to choose the treatment could be overwhelming because of the complexity of information to consider.12, 13 Prosthetists can empower patients with critical considerations, so that educated decision about treatments options with bionic solutions could be made.13, 14 There is need for a study outlining essential information about the efficacy and safety of BAP that prosthetists should share with their patients. 1, 15-19

Aim This literature review presented benefits and harms of BAP, put in perspective these outcomes and suggested a balance view of what is at stake when considering BAP.2-7, 16-24

Method Literature searches focused role of prosthetist in the delivery of prosthetic care for patients fitted with BAP as well as the benefits and harms of the treatment. The methods including studies inclusion criteria, search strategies and data extraction followed essentially the protocol proposed by Vertriest et al (2017) and Pather et al (2018).25, 26

Results Osseointegrated implants eliminate problems encountered with a socket (e.g., skin problems) and improves prosthetic use, embodiment, range of motion, sitting comfort, donning and doffing, osseoperception and walking ability that, altogether, increased quality of life by 17% compared to typical socket prostheses.15, 18, 27-36 However, these outcomes might be overestimated because of “three boosters”: placebo effect, preconceived favorable view and fitting of advanced components.37 Direct skeletal attachments have little effect on phantom pain. The bone/implant coupling is prone to risks of loosening (6%), periprosthetic fractures (9%), mechanical failure of implant parts (31%) as well as deep (41%) and superficial (100%) infections that could lead to the removal of the implant in up to 20% of cases.15, 18 These adverse events could cause residuum pain, disturb the lifestyle and cost money.37 Discussion and conclusion Based on these outcomes, prosthetists might explain to patients that considering osseointegration comes down to resolving what I call the “20/20 dilemma”. The quality of life is likely to improve by 17% to 20%. This biggest risk of failure is about 20%. Patients will have, then, to determine if a bionic solution is too good to pass or too bad to grab. Role of prosthetists in the delivery of bionic solutions has been overlooked although they prevent load-related adverse events.

Journal Title
Conference Title

2021 International Society of Prosthetics and Orthotics (ISPO) World Congress

Book Title
Edition
Volume
Issue
Thesis Type
Degree Program
School
DOI
Patent number
Funder(s)
Grant identifier(s)
Rights Statement
Rights Statement
Item Access Status
Note
Access the data
Related item(s)
Subject

Biomedical engineering

Persistent link to this record
Citation

Frossard, L, Choosing osseointegration: Should prosthetists refer to the “20/20 dilemma”?, 2021