Surgical Tribune America

Surgeons perform first osseointegration surgery on amputee in US

By Surgical Tribune
May 09, 2016

SAN FRANCISCO, USA: Developed as an alternative to traditional socket-based prostheses, Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) have been applied for over 20 years to improve the treatment and quality of life of amputee patients. Until recently, the technology has mainly been used outside the U.S. Now, surgeons at the International Center for Osseointegration Research, Education and Surgery (iCORES) at the University of California, San Francisco (UCSF) have successfully performed the first such osseointegration surgery in the country.

George Kocelj, the first American patient treated with OPRA, lost most of his right leg owing to a rare nerve tumor caused by neurofibromatosis. The 54-year-old had tried several external prostheses before, but without success. As the sockets of these prostheses were unworkable for him, he largely had to rely on a wheelchair.

Overseeing Kocelj’s tumor treatment was Richard J. O’Donnell, Professor of Clinical Orthopedic Surgery and chief of the Orthopedic Surgical Oncology Clinic at UCSF Medical Center. He suggested the OPRA approach, which entails anchoring an external prosthesis directly to the patient’s remaining bone through a permanently implanted titanium screw. Thus, the prosthesis always attaches correctly and remains firmly in place, preventing patients from suffering pressure sores, pain, heat, chafing and general discomfort often found with traditional solutions.

The OPRA program at UCSF was developed by Dr. Rickard Brånemark, a visiting associate professor at the Department of Orthopaedic Surgery. Recruited to UCSF from Sweden for a two-year appointment, Brånemark has extensive expertise in osseointegration, having led studies on percutaneous titanium implants for amputee patients for more than 25 years. Moreover, he has established various centers for amputee care throughout Europe, Asia, Australia and South America. Although the technology is available in several other countries, this is the first patient to be treated in the U.S. since the device was approved by the Food and Drug Administration last July.

Osseointegration was pioneered by Brånemark’s late father, Prof. Per-Ingvar Brånemark, who first discovered that bone can integrate with titanium components in the 1950s. To date, the technology has mainly been used to anchor dental implants, helping millions of patients worldwide.

Two procedures are necessary in order to place an OPRA. In the first surgery, a cylindrical fixture is implanted into the central canal of the remaining bone. About six months later, after bone has grown to secure the implant firmly, the second operation places an abutment that extends through the skin, connecting to the external prosthesis. The patient then works with a physical therapist to gradually place weight on the implant using a training prosthesis. Rehabilitation takes around six months and includes fitting a customized final prosthesis.

“I’m nervous, excited and overwhelmed,” Kocelj said before the surgery. “Just being able to walk and go is so exciting. It means a better quality of life.” On April 26, O’Donnell, Brånemark and Dr. Rosanna L. Wustrack, Assistant Professor of Clinical Orthopedics, performed the first OPRA procedure on Kocelj. The second surgery is planned for fall.

“UCSF has been at the forefront of developing osseointegration technology to save the limbs of cancer patients for four decades,” O’Donnell said. “However, when amputation is necessary, iCORES is now able to provide osseointegration techniques to these patients as well.”

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