Osseointegration surgery is a two-stage procedure designed to provide amputees with a direct skeletal connection for their prosthesis. This post by Mr. Matija Krkovic outlines the surgical steps, from preoperative preparation to implant insertion and final integration.
First correction completed with improved alignment visible on X-rays. Progressing as planned.
During revision surgery, a 6.5mm cancellous cannulated screw was carefully positioned to guide docking, though the optimal tibial docking site remains uncertain—whether on the calcaneum alone or both the calcaneum and navicular. A new foot plate was attached, but the docking site was not modified per standard procedure.
Following resection of the distal tibia and talus due to chronic osteomyelitis, bone transport using a fine wire frame was performed. However, misalignment at the docking site became evident only after frame removal. A review of similar cases suggests that the commonly used “dynamisation” period may not be a reliable test for confirming bony healing.
Achieving accurate alignment in tibio-calcaneal fusion using a fine wire frame is a significant challenge. While past successes have relied on luck, recent failures prompted a reassessment of targeting methods. With limited imaging options, a 6.5mm cannulated cancellous screw is now being explored as a surgical target marker to improve precision.
Eight weeks post-cement spacer removal, the patient received an RIA bone graft from the right femur. Despite bacterial growth in micro samples, a six-week antibiotic course was completed. X-rays show promising progress, and the patient is mobilising unaided for short distances, using a stick for longer walks. No clinical signs of infection.
Four weeks post-frame removal, the fractures have united, but walking remains slow with a limp. A potential collapse in the lateral tibial condyle has been observed, with signs of “neofibula” formation. Further assessment with a CT scan is planned, along with cement removal and bone grafting.
After 27 months, the fracture has clinically united. The patient successfully removed connectors between the second and third ring and can walk without additional pain. The next step is frame removal, followed by discussions on removing cement remnants and applying bone graft.
Patient’s activity level continues to improve, still using crutches for mobility. Pin sites remain stable. The frame has been dynamised to allow vertical movement, with a review scheduled in four weeks to assess alignment.
Patient’s activity level has improved significantly, with no major pin site issues apart from one broken pin, which was removed in the clinic. CT scan confirms further progress toward union. Follow-up in six weeks to assess frame dynamisation.
