title: Osseointegrated titanium implants for limb prostheses attachments: infectious complications.
abstract: BACKGROUND
  The concept of osseointegration involves direct contact between titanium implant and bone. This transcutaneous prosthetic system for amputees is intended to assure stable long-term fixation. Most metal transcutaneous implants have failed, primarily owing to infection.
  
  
  OBJECTIVE
  We determined the frequency and describe the presentation of infectious complications with this novel method. We also evaluated the bacterial flora at the skin-penetration area and its relation to the development of local and implant-related infection.
  
  
  METHODS
  We prospectively followed 39 patients with arm and leg amputations fitted with transcutaneous osseointegrated titanium implants a mean of 56 months earlier (range, 132-133 months). There were 33 femoral, one tibial, four ulnar, four radial, and three humeral implants. Patients were selected during a 6-month period in 2005 and identically reevaluated after 3 years. Implant infection was defined as definite, probable, or possible based on clinical, radiologic, and microbiologic evidence.
  
  
  RESULTS
  The frequency of implant infection was 5% at inclusion and 18% at followup. One patient with infection recovered owing to antibiotic treatment and another patient had the implant removed. Most implant infections had low infectious activity, and in five of the seven patients with infections, prosthetic use was not affected. The most common bacteria in superficial and deep cultures were Staphylococcus aureus and coagulase-negative staphylococci.
  
  
  CONCLUSIONS
  Despite frequent colonization around the skin-implant interface by potentially virulent bacteria such as Staphylococcus aureus and bacteria associated with biomedical device infections such as coagulase-negative staphylococci, this titanium implant system for bone-anchored prostheses caused few infections leading to disability or implant removal.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Infectious Diseases, University of Gothenburg, SE-416 85, Göteborg, Sweden. jonatan.tillander@vgregion.se
authors.forename: Jonatan
authors.initials: J
authors.lastname: Tillander
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hagberg
authors.forename: Lars
authors.initials: L
authors.lastname: Hagberg
authors.forename: Rickard
authors.initials: R
authors.lastname: Brånemark
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001186:Artificial Limbs / Q000382:microbiology*; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D011446:Prospective Studies; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D011859:Radiography; D012086:Reoperation; D012867:Skin / Q000382:microbiology; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D013548:Sweden; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D014025:Titanium
references.citation: Arch Phys Med Rehabil. 2005 Apr;86(4):659-63
references.pmid: 15827914
references.citation: J Am Acad Dermatol. 2000 Mar;42(3):501-7
references.pmid: 10688725
references.citation: Prosthet Orthot Int. 2001 Dec;25(3):186-94
references.pmid: 11860092
references.citation: J Rehabil Res Dev. 2001 Mar-Apr;38(2):175-81
references.pmid: 11392650
references.citation: Ann Otol Rhinol Laryngol Suppl. 2005 Dec;195:2-12
references.pmid: 16619473
references.citation: Disabil Rehabil. 2003 May 6;25(9):480-6
references.pmid: 12745943
references.citation: Prosthet Orthot Int. 2008 Mar;32(1):29-41
references.pmid: 18330803
references.citation: Scand J Plast Reconstr Surg Hand Surg. 1997 Sep;31(3):185-95
references.pmid: 9299679
references.citation: Bull Prosthet Res. 1976 Spring;(10-25):69-96
references.pmid: 1009256
references.citation: J Rehabil Res Dev. 1985 Jul;22(3):99-102
references.pmid: 3835269
references.citation: Clin Orthop Relat Res. 1981 Jan-Feb;(154):201-7
references.pmid: 7009009
references.citation: Clin Orthop Relat Res. 1999 Apr;(361):55-62
references.pmid: 10212596
references.citation: J Clin Microbiol. 1998 Oct;36(10):2932-9
references.pmid: 9738046
references.citation: Prosthet Orthot Int. 2005 Aug;29(2):153-63
references.pmid: 16281724
references.citation: J Bone Joint Surg Br. 1996 Jul;78(4):647-51
references.pmid: 8682836
references.citation: Scand J Plast Reconstr Surg Suppl. 1977;16:1-132
references.pmid: 356184
references.citation: J Rehabil Res Dev. 2009;46(3):331-44
references.pmid: 19675986
references.citation: Infection. 2003 Mar;31(2):99-108
references.pmid: 12682815
references.citation: Prosthet Orthot Int. 2003 Aug;27(2):114-20
references.pmid: 14571941
references.citation: Orthopade. 2004 Dec;33(12):1411-26; 1427-8
references.pmid: 15551049
references.citation: Arch Phys Med Rehabil. 2000 Mar;81(3):292-300
references.pmid: 10724073
references.citation: Ann Biomed Eng. 1977 Mar;5(1):34-46
references.pmid: 851262
references.citation: BMJ. 2001 Sep 29;323(7315):732-5
references.pmid: 11576982
references.citation: Int J Oral Maxillofac Implants. 1990 Winter;5(4):347-59
references.pmid: 2094653
references.citation: Clin Implant Dent Relat Res. 2009 Mar;11(1):24-36
references.pmid: 18384407
references.citation: Clin Microbiol Rev. 2002 Apr;15(2):167-93
references.pmid: 11932229
references.citation: J Hand Surg Am. 2004 Jan;29(1):32-8
references.pmid: 14751100
references.citation: J Bone Joint Surg Br. 1994 Sep;76(5):717-20
references.pmid: 8083257
references.citation: Arch Phys Med Rehabil. 2004 May;85(5):723-9
references.pmid: 15129395
references.citation: Drugs. 2005;65(2):179-214
references.pmid: 15631541
references.citation: Br J Surg. 2000 Mar;87(3):328-37
references.pmid: 10718803
references.citation: APMIS. 2006 Jun;114(6):449-52
references.pmid: 16856967