Lower extremity osseointegration for amputees with diabetes mellitus and vascular disease

Objective The aim of this study was to describe outcomes of osseointegration in amputees with diabetes mellitus (DM) and/or peripheral vascular disease (PVD).

Design This was a case series.

Setting The study was conducted at an urban tertiary referral academic medical center.

Patients/Participants Five patients (1 with DM, 3 with PVD, 1 with both; 4 transtibial, 1 transfemoral) with a follow-up duration of 4.1 ± 0.3 (3.6-4.3) years were included.

Intervention Revision amputation with press-fit osseointegration implant insertion was performed.

Main Outcome Measurements Primary outcomes included adverse events requiring nonsurgical or surgical intervention. Secondary outcomes included patient-reported outcome measures (PROMs) and mobility performance.

Results No patients experienced implant loosening, periprosthetic fracture, procedure-related systemic complications, or death. Three patients received additional surgery: one had osteomyelitis, prompting debridement after 9 months; 2 underwent refashioning to reduce redundant skin around the portal site at 4 years. All PROMs improved significantly. All patients improved by at least one K-level.

Conclusion Osseointegration appears safe to consider for appropriately selected patients with DM and/or PVD. Only one patient had an infection, requiring surgical debridement. The 2 refashioning cases were not infected and may have been avoidable with more aggressive tissue reduction at index surgery. No deaths or systemic complications occurred. Conscientious use and study of osseointegration may help optimize rehabilitation for amputees with DM and/or PVD.