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Osseointegrated total hip replacement connected to a lower limb prosthesis: a proof-of-concept study with three cases
Journal of Orthopaedic Surgery and Research (2016)
  • Aditya Khemka, Norwest Private Hospital
  • Chalak I FarajAllah, Macquarie University
  • Sally Lord, The University of Notre Dame Australia
  • Belinda Bosley, Norwest Private Hospital
  • Munjed Al Muderis, Norwest Private Hospital
Background: Osseointegrated implants are a suitable alternative for prosthetic attachment in individuals with a
transfemoral amputation, who are unable to wear a socket. However, the small bone-implant contact area, reduced
muscular leverage, and osteoporosis contraindicate osseointegrated implant use in transfemoral amputees with
osteoporosis and a short residuum. We report on the feasibility of combining total hip replacement (THR) with an
osseointegrated implant for prosthetic attachment.
Methods: We retrospectively reviewed the cases of three transfemoral amputees who underwent osseointegration
with THR between 2013 and 2014. In a two-stage procedure, a custom-made femoral prosthesis was connected to
a THR with a modular revision stem and a stoma was created. Clinical outcomes were assessed at baseline and
1.5–2.5-year follow-up using standard measures of health-related quality of life, ambulation, and activity levels including
the Short Form-36 (SF-36), Questionnaire for Transfemoral Amputees (Q-TFA), Timed Up and Go test, and 6-min walk test.
Results: Patient age ranged from 35 to 65 years. There were no major adverse events, but there was one case of
superficial infection. All patients showed improved Q-TFA and SF-36 scores. Two patients who were wheelchair-bound
at baseline became community ambulators, and the third patient exhibited improved ambulation.
Conclusions: This study demonstrated the feasibility of combining a THR with an osseointegrated implant in
transfemoral amputees.
Publication Date
Citation Information
Khemka, A., FarajAllah, C., Lord, S., Bosley, B., and Al Muderis, M. (2016). Osseointegrated total hip replacement connected to a lower limb prosthesis: a proof-of-concept study with three cases. Journal of Orthopaedic Surgery and Research, 11. DOI: 10.1186/s13018-016-0348-3