Transcutaneous, osseointegrated prosthetic systems (TOPS) for rehabilitation following limb loss have proven their efficiency for patients with unconquerable difficulties wearing conventional socket prostheses over almost 30 years. During this time it became evident, that the surgical part only represents one module of the osseointegration procedure. The consecutive prosthetists work and add on physical rehabilitation cannot be seen as less important to the whole procedure. In the course of this adaption, adjustment and alignment of the exoprosthetic parts are representing new challenges to the skills of the prosthetist.
First the completely new prosthetic devices at the linkage between the skin perforating devices and the exoprosthesis must be understood. This prosthetic complex consists of a security component and different elements to ensure an anatomical correct adaption of the exoprosthesis to the osseointegrated implant. This accuracy is most important due to the direct transmission of load from prosthesis to bone. Further the joints proximal to the implant are supposed to react much more sensitive when they have to deal with an incorrect alignment of the exoprosthesis compared to a conventional socket prosthesis. We share our knowledge and clinical experience how prosthesis components should be biomechanically correct aligned.
Similar considerations are pertaining for the physical rehabilitation following transcuateneous osseointegration. In consultation with surgeon and prosthetist the physiotherapist has to induce weight bearing and training. The observation and correction of gait and joint function are his responsibility and only a critical feed back to the patient enables him to achieve the best result possible.
Statement of the objective / learning objectives
With regard to their bone-guided function TOPS are demanding a different prosthetists understanding concerning adjustment and alignment of the exoprostheses. An included advanced pre- and postoperatively physiotherapy.leads to a measurable benefit for the patient.