Approximately 2,000 Skeletal transcutaneous osseointegration (STOI) procedures have been performed worldwide as of 2020, more than half of which have been performed by the Osseointegration Group of Australia using a press-fit technique with either ILP or OPL implant designs. Despite the consistently demonstrated clinical benefits, concerns regarding potential complications following STOI have slowed its widespread adoption. As more patients are followed for a longer period of time, longitudinal studies have confirmed complication rates are very acceptable, similar to those of total ankle and total elbow replacements. One of the major risk category is implant removal. The primary goal of this study was to investigate the complications and technical issues associated with transtibial osseointegration implant removal due to any cause. The focus here will be on the press-fit ILP and OPL implants, including the indications for removal and patient outcomes following removal. A review of our osseointegration registry between November 2010 and March 2022 was performed. Inclusion criteria were patients who have undergone removal of a transtibial osseointegration implant due to any cause. Selected patients either had a follow-up of at least two years or had their index osseointegration surgery at least two years prior to when the study was performed. Patients who have had osseointegration at other anatomic levels, and patients who underwent simultaneous total knee replacement with transtibial osseointegration were excluded from the registry search.Introduction
Materials & Methods
The results of hip injections for 63 patients with hip pain are presented. Injection of 80mg of methylprednisolone and bupivacaine by an anterior approach was performed with x-ray screening. Patients were noted as having either a normal x-ray (10), mild osteoarthritis (21), moderate osteoarthritis (13) and severe osteoarthritis (19), those in the severe group were generally unfit for hip surgery. Outcome was judged by an Oxford hip score, which was calculated pre-injection, at one month, and at three months. At three months all with a normal x-ray were improved, 19 with mild changes were improved 2 deteriorated, 9 with moderate changes improved, 2 stayed the same, 2 deteriorated and 13 with severe changes were improved, 4 deteriorated and 2 were unchanged. Improvements were with pain scores not function. Of those improved all thought the procedure worthwhile. Two patients described numbness and weakness at the anterior thigh area, which recovered quickly. We feel that this is a useful technique to give symptomatic relief in-patients not suitable for hip replacement.
