[Endo-exo prostheses : Osseointegrated percutaneously channeled implants for rehabilitation after limb amputation]. / Endo-Exo-Prothesen : Osseointegrierte, perkutan ausgeleitete Implantate zur Rehabilitation nach Gliedmaßenamputation.

BACKGROUND: In 1999 the first endo-exo femoral prosthesis (EEFP) was implanted in Germany in a patient who had suffered a traumatic above-knee amputation. This procedure involves a skeletally anchored exoprosthetic device that is inserted into the residual femur. The distal part of the implant protrudes transcutaneously and allows attachment to a prosthetic limb which provides direct force transmission to the external prosthetic components. The technique originated from dental implantology and helps to avoid possible problems resulting from treatment of amputated limbs using socket prostheses. In the meantime, durability times of over 10 years have now helped to invalidate the initially well-founded reservations held against the procedure. OBJECTIVE: What advantages can be achieved by osseointegrated and percutaneously channeled prostheses and which problems had to be overcome for treatment. MATERIAL AND METHODS: Critical evaluation of data from patients operated on in Lübeck, Germany from January 2003 to December 2014. RESULTS: With osseointegrated and percutaneously channeled prostheses permanent durability times can be achieved. Infection-associated soft tissue problems at the site of skin protrusion (stoma) can be successfully prevented. The creation of this so-called stoma means acceptance of a possible bacterial portal of entry into the body. Patient satisfaction has so far been high, postoperative rehabilitation is simplified and the technique could possibly lower the costs of medical treatment. CONCLUSION: Endo-exo prostheses have proved to be successful for more than 15 years. A critical appraisal of the indications as well as a close cooperation between the surgeon, orthopedic technician and the associated rehabilitation facilities with the patient are the basis for the long-term success of this relatively new treatment approach.

[Endo-exo prostheses following limb-amputation]. / Endo-Exo-Prothesen nach Gliedmaßenamputation.

BACKGROUND AND OBJECTIVE: Rehabilitation of patients having undergone limb amputation is difficult due to problems related to poor socket fit, which often deteriorates comfort, gait and the ability to take part in everyday life and work. The endo-exo prosthesis has been an alternative provision for people having undergone lower limb amputation for reasons other than diabetes or peripheral vascular disease for more than 10 years. The system consists of an intramedullar, osseointegrated and skin perforating prosthesis, which is implanted in the remaining bone and has an abutment to allow the attachment of the external prosthetic part including the knee joint in the case of a trans-femoral amputation. The idea originates in findings of modern tooth-implantology and involves a two-step operation. This study focuses on one centre's experience with the endo-exo prostheses in Lübeck, Germany, to describe and discuss the reliability of this alternative treatment method after lower limb amputation. MATERIALS AND METHODS: This article presents the results of lower limb amputees operated on in Lübeck, Germany between 1999-2013. It focuses on theoretical aspects of osseointegration and different clinically-based findings using the endo-exo technique over the last decade. RESULTS: 74 lower-limb amputees were treated with an endo-exo prosthesis until December 2013. There were only 4 verified intramedullar infections, yet there were many unplanned surgical revisions secondary to soft-tissue infections in the beginning. They were successfully encountered via clinically-based changes that were made concerning implant design, wound treatment and operative technique. CONCLUSIONS: Since 1990 a few groups have developed an innovative method that provides an alternative to traditional socket-type prostheses. This involves a skeletally anchored device that is inserted into the remaining stump and provides osseointegration into the bone. The distal part of the implant protrudes transcutaneously and allows attachment to a prosthetic limb. This creates a hard point where the forces are transmitted through the skeleton with a more physiological pathway because the bone becomes the force carrier again, closer in biomechanics to an able-bodied person. With long-term numbers that show successful osseointegration for more than 10 years it is evident that obligate bacterial colonization does not necessarily lead to an intramedullar infection. Especially short stumps that are difficult to treat with a socket can be successfully fitted with an endo-exo prosthesis. Amputees who would otherwise be bound to a wheelchair due to their challenging situation should specifically be regarded as potential profiteers of this novel treatment option.

[Evaluation of 10 years experience with endo-exo femur prostheses - background, data and results]. / 10 Jahre Endo-Exo-Femurprothetik zur Rehabilitation nach Oberschenkelamputation - Daten, Fakten und Ergebnisse.

Between 1999 and 2011 the Endo-Exo femur prosthesis has been applied to 54 patients. This comparatively new method for patient rehabilitation after upper leg amputation includes a two-step surgical procedure. The first step is an operation where the endomodule of the stem prosthesis is implanted in the bone via a press-fit technique. Then the soft tissue coat is closed to give the bone enough time for a secure osseointegration of the prosthesis. About six weeks later a stoma is cut out and the adapter for the exo-part is connected. The prosthesis is therefore intramedullary anchored and percutaneously penetrating the skin. A critical examination of this procedure has to put its main attention to the latent danger of an ascending, intramedullary infection. This may arise from the skin-penetrating stoma region at the distal stump. All data derived from patients operated in Lübeck, Germany have been evaluated focusing on reasons for objectionable operative procedures and their resulting terms of treatment. The evaluation shows that the initially high rate of stoma-associated infections of the soft tissue coat could be dramatically reduced through a change of design of the skin-penetrating parts. In between January 2009 and December 2011 (altogether 24 implants/23 patients) no operative revisions had to be undertaken because of infections of the stoma. Next to this there are more characteristics conditionally caused by the implant - like fractures of the affected extremity and other complications - presented in terms of cause-related case histories.