title: [Endo-exo prostheses : Osseointegrated percutaneously channeled implants for rehabilitation after limb amputation].
abstract: BACKGROUND
  In 1999 the first endo-exo femoral prosthesis (EEFP) was implanted in Germany in a patient who had suffered a traumatic above-knee amputation. This procedure involves a skeletally anchored exoprosthetic device that is inserted into the residual femur. The distal part of the implant protrudes transcutaneously and allows attachment to a prosthetic limb which provides direct force transmission to the external prosthetic components. The technique originated from dental implantology and helps to avoid possible problems resulting from treatment of amputated limbs using socket prostheses. In the meantime, durability times of over 10 years have now helped to invalidate the initially well-founded reservations held against the procedure.
  
  
  OBJECTIVE
  What advantages can be achieved by osseointegrated and percutaneously channeled prostheses and which problems had to be overcome for treatment.
  
  
  METHODS
  Critical evaluation of data from patients operated on in Lübeck, Germany from January 2003 to December 2014.
  
  
  RESULTS
  With osseointegrated and percutaneously channeled prostheses permanent durability times can be achieved. Infection-associated soft tissue problems at the site of skin protrusion (stoma) can be successfully prevented. The creation of this so-called stoma means acceptance of a possible bacterial portal of entry into the body. Patient satisfaction has so far been high, postoperative rehabilitation is simplified and the technique could possibly lower the costs of medical treatment.
  
  
  CONCLUSIONS
  Endo-exo prostheses have proved to be successful for more than 15 years. A critical appraisal of the indications as well as a close cooperation between the surgeon, orthopedic technician and the associated rehabilitation facilities with the patient are the basis for the long-term success of this relatively new treatment approach.
authors.affiliation: Klinik für Plastische, Hand- und Rekonstruktive Chirurgie, Sana Kliniken Lübeck, Kronsforder Allee 71-73, 23560, Lübeck, Deutschland. horst.aschoff@sana.de.
authors.forename: H-H
authors.initials: HH
authors.lastname: Aschoff
authors.affiliation: Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin Luther Krankenhaus Berlin, Berlin, Deutschland.
authors.forename: D-L
authors.initials: DL
authors.lastname: Juhnke
mesh_terms: D000671:Amputation, Surgical / Q000534:rehabilitation*; D001186:Artificial Limbs; D019544:Equipment Failure Analysis; D019317:Evidence-Based Medicine; D000067190:Exoskeleton Device; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D011474:Prosthesis Design; D012371:Robotics / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Amputation; Bone anchor; Intramedullary implant; Osseointegration; Osseoperception