CLEVELAND — Cleveland Clinic surgeons are attaching prosthetic limbs directly to patients’ bones, a technique that breaks with a long-standing orthopedic rule and is aimed at people with limb loss who cannot succeed with a conventional socket prosthesis, according to Becker’s Spine Review, which summarized a Nov. 3 article from the health system.
The technique, called osseointegration, anchors a metal implant inside the residual bone and extends it through the skin, where an external prosthesis connects to it. Lukas Nystrom, MD, a Cleveland Clinic orthopedic surgeon, said the direct connection transfers force from the skeleton far more efficiently than a socket, according to Becker’s Spine Review. Sockets lose energy through soft tissue and can cause friction, skin breakdown and fit problems, he said.
The approach upends a core orthopedic principle — sealing implants away from the outside environment. Instead, surgeons build a stable skin-implant interface designed to prevent deep infection, a principle dental implants already use, Dr. Nystrom said in the account published by Becker’s Spine Review.
Cleveland Clinic targets patients who have failed a socket prosthesis or are unlikely to succeed with one, including those with very short residual limbs, according to Becker’s Spine Review. An active infection rules a patient out, and the team generally avoids the procedure in smokers. Surgeons assess limb shape and soft tissue rather than relying on body mass index alone.
The surgery is performed in two stages roughly two to three months apart, followed by a gradual weight-bearing protocol over the first three months, Becker’s Spine Review reported. Psychologists, social workers, physical therapists and prosthetists support patients through the process. Infection at the skin-implant interface remains the central risk, though superficial infections generally respond to oral antibiotics.
Steven Schulz, MD, a Cleveland Clinic plastic surgeon, said pairing osseointegration with nerve procedures such as targeted muscle reinnervation could produce prostheses with sensory feedback, according to Becker’s Spine Review. “This is the first step toward the future of prosthetics,” Dr. Schulz told the health system in remarks reported by Becker’s Spine Review.
Sweden first introduced the technique for lower-extremity amputations in the 1990s, and it has since expanded worldwide as implant design and surgical technique advanced, according to Becker’s Spine Review.
For Ohio patients living with limb loss, the program offers another option when a traditional socket has failed. What happens next for interested patients is an evaluation by the Cleveland Clinic team, which decides candidacy based on the limb, the soft tissue and the absence of active infection.
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