Abstract

OLIVEIRA, Vânia; CANTISTA, Pedro; BRANMARK, Rickard  and  CARDOSO, Pedro. Osteointegração nos amputados: um passo em frente!. Rev. Port. Ortop. Traum. [online]. 2015, vol.23, n.2, pp.168-176. ISSN 1646-2122.

Aim: In Portugal, until now, amputees above and below knee require frequently exchanges of the prostheses used for rehabilitation due to enlargement, instability, discomfort, skin problems and stump pain that cause functional impairment and loss of quality of life. In 1990, Sweden adopted the technique of osseointegration in lower and upper limb with the innovative development of prosthesis with bone fixation, eliminating contact with skin and allowing gain of function and freedom of these patients, and an important socio-economic impact. The development of the OPRA protocol allowed setting indications and selection of patients and scheduling an individual rehabilitation process. The technique involves two surgical times in the long bones. The authors report the first clinical case of osseointegration held in Portugal. Case Report: A male amputee used to require frequent replacement of the rehabilitation socket prosthesis and was selected to osseointegration. On S1 osseointegration was introduced an intramedullary implant. After 6 months, on S2 was placed the titanium abutment that protrudes to the skin, accompanied by stabilization procedure of soft tissue. The rehabilitation program was gradual and individualized. The visual analogue pain scale was used to control the progression of functional recovery. The patient is satisfied and able to perform effectively activities unattainable until here. Discussion: The osseointegration involves a multidisciplinary team and aims to promote quality of life and recover effectively amputated patients for the active society. In this first patient, there was gain of function and freedom with clear psycho-socioeconomic impact. Factors such as the structure, dynamics and biochemistry of bone tissue and the stabilization of soft tissues are fundamental. Possible complications include infection, skin necrosis, loosening, and fracture. The biomechanical advantages are increased safety, support of soft tissues, prosthetic stability and, in the case of amputations above knee, higher knee flexion. Conclusion: The osseointegration represents a step forward in the rehabilitation of amputees and the authors believe that it will contribute in the future to provide the prosthetic artificial sensorimotor function, with the development of neuroscience, robotics and electrical and biomedical engineering. The osseointegration allowed designing a different, more active life for this patient by combining the biomechanical, physiological, psychological, social and economic impacts.

Keywords : Osseointegration; OPRA protocol; amputee; function; prosthesis.

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