title: [The first osseointegrated percutaneous prosthesis anchor for above-knee amputees].
abstract: A percutaneous osseointegrated anchoring device for above-knee implantation designed to enable permanent attachment of an artificial limb is described. In addition to a technical description, the two-stage operative procedure, together with the rehabilitation process in an 18-year-old man, is also detailed. Following amputation and complete healing of the soft tissues, a surface-structured metal pin capable of supporting large loads, is driven into the medullary canal of the thigh bone. A metal sleeve having an identical surface structure serves to close off the medullary canal and provide an interface with the soft tissues. Screwed to the end of the pin is a conical metal adapter to which is attached a silicone cylinder whose right-angled distal end is located subcutaneously and ends in a titanium mesh. The first part of the implantation procedure is concluded by closing the silicone cylinder with a plastic plug for 6 weeks to permit osseous integration and the ingrowth of tissue into the mesh. In a second step, the plastic plug is removed via a skin incision, and the permanent load-bearing metal adapter fitted. In the above-mentioned patient wound healing at the metal/tissue interface was complication-free, since the implanted silicone cylinder prevented the "wedge effect" caused by the build-up of "luxuriant" tissue. After a further healing phase of 6 weeks, rehabilitation with an exoprosthesis took only 2 weeks, after which time, the patient was able to walk without a walking aid, and returned to work.
authors.affiliation: Klinik für Chirurgie, Universitätsklinikum Lübeck.
authors.forename: K H
authors.initials: KH
authors.lastname: Staubach
authors.forename: H
authors.initials: H
authors.lastname: Grundei
mesh_terms: D000293:Adolescent; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D001858:Bone Nails; D005269:Femur / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D016348:Osseointegration / Q000502:physiology*; D011474:Prosthesis Design; D016474:Weight-Bearing / Q000502:physiology