Rehabilitation after osseointegration

AOFE clinics cooperates with a rehabilitation center.

Start of the osseointegration prosthesis rehabilitation

Rehabilitation starts 1 week after the second operative treatment or 3 weeks after surgery when the surgical treatment is performed in one go. The multidisaplinary team will discuss and design your rehabilitation program which best suites your needs. 

Muscle strain

Muscle pain is an important limiting factor for progress in rehabilitation. Particularly in people with an above knee osseointegration prosthesis, the buttocks and stump muscles have been seriously weakened after many years of socket use. When walking with an osseointegration prosthesis, the stump muscles must be fit and strong to stabilise the osseointegrated leg prosthesis. This muscle building during rehabilitation can be accompanied by a lot of muscle pain. The rehabilitation team will guide you through this and if necessary prescribe painkillers or adjust the rehabilitation rate. Muscle pain in the stump occurs especially when the crutches are phased out. Sometimes it is necessary to take a rehabilitation break when the pain is a limiting factor for walking training without walking aids.

Prosthesis-alignment

The prosthesis adjustment is an important aspect of rehabilitation and depends on the rehabilitation phase. The prosthetist is therefore a permanent member of the AOFE Clinics rehabilitation team.

Stoma-care instructions

The occupational therapist or c0-ordinator  of the AOFE Clinics osseointegration team will take you through the instructions of the stoma cleaning. The rehabilitation doctor is present weekly at the rehabilitation session and can prescribe stoma care products if necessary in case of stoma problems.

Duration of rehabilitation

Non-Dutch patiënts undergo four weeks of rehabilitation in case of a below knee osseointegrated prosthesis and six weeks in case of an above knee osseointegrated prosthesis. Extra rehabilitation will be prescribed if necessary in the relevant home country. In Dutch patients, rehabilitation lasts about six weeks with a below knee osseointegrated prosthesis and 12 weeks with an above knee osseointegrated prosthesis. The rehabilitation doctor will discuss the progress with you and the team and tailor the rehabilitation content and duration to suit you.

 
Above knee osseointegration prosthesis rehabilitation protocol (standard)
Week 1: Progressive body weight bearing on the prosthesis
- Attach and align prosthesis including connector instructions 
- Using the prosthesis to load up with a weight scale up to 100% of the body weight
- Exercises for hip mobility, strength, training, for torso and stump muscles 
- Instructions for stoma care and instructions for pain management 
Week 2 and 3:Walking between parallel bars 
- Stand and balance training
- Gait patterns  training: sideways, backwards, stopping and turning
Week 4 to 6: Gait training with or without crutches
- Basic gait training with crutches 
- Gait training on uneven surface
- Final prosthesis adjustment and alignment
Week 7 to 11: Advanced gait training (optional)
- Gait training on slopes, obstacles, double tasks
- Climbing stairs, bicycling
 
Above knee osseointegration prosthesis rehabilitation protocol (slow)
Indication for slow protocol: surgical bone reconstruction in combination with  OI implant
Week 1- 6: Progressive body weight bearing on the prosthesis up to 50% of the body weight
- Attach and align prosthesis including training to attach connector 
- Using the prosthesis to load up to 50% of the body weight with the help of the scales
- Standing and balance training
- Gait training between parallel bars or with crutches up to 50% of the body weight
- Exercises for hip mobility, strength training for trunk and stump muscles
- Instructions for stoma care and instructions for pain management
Week 7-12: Progressive body weight bearing on the  prosthesis up to 100% of body weight
- Gait training with or without crutches up to 100% of the body weight
- Gait patterns training: sideways, backwards, stopping, turning, uneven surfaces
- Climbing stairs and bicycling
- Final prosthesis alignment and adjustment
 
Below knee osseointegrationprotesis rehabilitation protocol
Week 1: Progressive body weight bearing on the prosthesis 
- Attach and align prosthesis including training to attach connector
- Progressive weight bearing on the prosthesis up to 100% of the body weight
- Exercises for hip mobility, strength training for torso and stump muscles
- Instructions for stoma care and instructions for pain management.
Week 2: Gait training between parallel bars
- Standing and balance training
- Gait patterns training: sideways, backwards, stopping and turning
Week 3: Gait training with crutches
- Basic gait training with crutches
- Climbing stairs
- Gait training on uneven surfaces.
Week 4: Gait training without crutches
- Gait patterns training without walking aids
- Gait training on slopes, obstacles, double tasks
- Final prosthesis alignment and adjustment