title: Osseointegrated total hip replacement connected to a lower limb prosthesis: a proof-of-concept study with three cases.
abstract: BACKGROUND
  Osseointegrated implants are a suitable alternative for prosthetic attachment in individuals with a transfemoral amputation, who are unable to wear a socket. However, the small bone-implant contact area, reduced muscular leverage, and osteoporosis contraindicate osseointegrated implant use in transfemoral amputees with osteoporosis and a short residuum. We report on the feasibility of combining total hip replacement (THR) with an osseointegrated implant for prosthetic attachment.
  
  
  METHODS
  We retrospectively reviewed the cases of three transfemoral amputees who underwent osseointegration with THR between 2013 and 2014. In a two-stage procedure, a custom-made femoral prosthesis was connected to a THR with a modular revision stem and a stoma was created. Clinical outcomes were assessed at baseline and 1.5-2.5-year follow-up using standard measures of health-related quality of life, ambulation, and activity levels including the Short Form-36 (SF-36), Questionnaire for Transfemoral Amputees (Q-TFA), Timed Up and Go test, and 6-min walk test.
  
  
  RESULTS
  Patient age ranged from 35 to 65 years. There were no major adverse events, but there was one case of superficial infection. All patients showed improved Q-TFA and SF-36 scores. Two patients who were wheelchair-bound at baseline became community ambulators, and the third patient exhibited improved ambulation.
  
  
  CONCLUSIONS
  This study demonstrated the feasibility of combining a THR with an osseointegrated implant in transfemoral amputees.
authors.affiliation: School of Medicine, University of Notre Dame Australia, Sydney, Australia. adk_sun@hotmail.com.|Norwest Private Hospital, Sydney, Australia. adk_sun@hotmail.com.|Rural Clinical School, University of Notre Dame Australia, Sydney, Australia. adk_sun@hotmail.com.
authors.forename: Aditya
authors.initials: A
authors.lastname: Khemka
authors.affiliation: The Australian School of Advanced Medicine, Macquarie University, Sydney, Australia. dr_chalak@yahoo.com.
authors.forename: Chalak I
authors.initials: CI
authors.lastname: FarajAllah
authors.affiliation: School of Medicine, University of Notre Dame Australia, Sydney, Australia. sally.lord@nd.edu.au.|Rural Clinical School, University of Notre Dame Australia, Sydney, Australia. sally.lord@nd.edu.au.|National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, Australia. sally.lord@nd.edu.au.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Lord
authors.affiliation: Norwest Private Hospital, Sydney, Australia. belindabosley@gmail.com.
authors.forename: Belinda
authors.initials: B
authors.lastname: Bosley
authors.affiliation: School of Medicine, University of Notre Dame Australia, Sydney, Australia. munjed@me.com.|Norwest Private Hospital, Sydney, Australia. munjed@me.com.|The Australian School of Advanced Medicine, Macquarie University, Sydney, Australia. munjed@me.com.
authors.forename: Munjed
authors.initials: M
authors.lastname: Al Muderis
mesh_terms: D000328:Adult; D000368:Aged; D000674:Amputees; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation; D001186:Artificial Limbs; D000069343:Bone-Implant Interface / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D011182:Postoperative Care / Q000379:methods; D011474:Prosthesis Design; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome