• Pablo S Corona, Enrique A Vargas Meouchi, Jesús Manuel García Hernández, Rosa Fraile Soriano, Almudena Crespo-Fresno, Daniela Issa-Benítez, Munjed Al Mudaris, and Francisco Soldado.
• Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebrón University Hospital, Barcelona, Spain; Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; Musculoskeletal Tissue Engineering Group, Vall d'Hebrón Research Institute (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Spain.
• Injury. 2024 Apr 1; 55 (4): 111424111424.

IntroductionPatients with above-knee amputations (AKA) are normally treated with the traditional socket-mounted prosthesis (SMP), which is associated with a high incidence of problems. Osseointegration has been proposed as a promising option for avoiding many common SMP drawbacks. Several concerns have arisen regarding amputee osseointegration, however, mainly with respect to infection. We report on the safety of a single-stage osseointegration protocol using an antibiotic-loaded hydrogel to coat the intramedullary implant.Materials And MethodsWe retrospectively reviewed all AKA cases treated at our center between January 2019 and April 2022, in which a transcutaneous osseointegrated implant was used in a single-stage strategy, together with a rapid-resorbable hydrogel loaded with vancomycin and gentamicin. The specific protocol used, infection rate, implant osseointegration rate and implant survivorship were determined after a minimum follow-up of 12 months.ResultsEleven osseointegration cases were included in the study, with an average of 16 years post-amputation (range: 3-35 years). After a median follow-up of 24 months (range 12-49 months) no patient had suffered any implant-related infection. Osseointegration of the implant had been achieved in all cases. The mid-term survivorship of the implant in our series was 100 % at the end of follow-up. Radiographs of all cases showed no loosening of the implant. Further, 91 % of the series patients were able to walk without restrictions after the rehabilitation process.ConclusionsThe single-stage osseointegration protocol for AKA, using a rapid-resorbable hydrogel loaded with vancomycin and gentamicin, yields low rates of implant-related deep infection. This protocol consistently delivers high rates of radiological osseointegration, with no hydrogel-associated complications.Copyright © 2024 Elsevier Ltd. All rights reserved.

18 keywords...

hide…