Referral and prescreening
You can request a referral from your general practitioner or medical specialist for osseointegration prosthesis treatment in the AOFE Clinics in Utrecht. You can also register on this website by means of the contact form with questions about your amputation and your medical history. You may find the form on the "contact" page of this website. The contact form is evaluated by the osseointegration team and on the basis of this pre-screening it is determined whether you may be eligible for the osseointegration treatment. You will receive a message about this decision and depending on your situation you will receive an invitation for an intake interview at the AOFE Clinics in Utrecht.
The first consultation in the AOFE Clinics takes place in a multidisciplinary setting. During this meeting, you will receive all information about the osseointegration treatment from the surgeon and rehabilitation physician and you can get acquainted with peer experts (former osseointegration patients). The peer experts tell about their experiences with the osseointegration prosthesis and show how the prosthesis works. X-rays are also taken and, if necessary, a CT scan. Based on this intake, we will discuss with you whether you can qualify for the operation and you will receive an appointment for the anaesthesiologist and an appointment for the first surgery.
The anaesthesiologist will assess your medical history. You can discuss your preference with the anaesthesiologist for general anesthesia or an epidural. You will also receive information in preparation for the surgery.
The first surgery
On the day of surgery, you report at the appointed time at the surgery department of the AOFE Clinics at the Hospitaal in Utrecht. You are requested to bring your prosthesis. The prosthesis is retrieved by the prosthetist and converted with an osseointegration connector into an osseointegration prosthesis. Please note that you can not use your prosthesis after the first surgery. Therefore take a wheelchair or crutches with you. The prosthesis is delivered at the first rehab session. During the surgery you are continuously under the supervision of the surgical team. The surgery team consists of the osseointegration surgeon, anesthesiologist, operating assistants and anesthesia assistants. During the first surgery, a titanium implant is inserted into the bone of your residual limb and the stump is closed again. In some cases, the bone of the residual limb has to be shortened and sometimes excess skin and soft tisue are removed. After the surgery you will stay briefly on the recovery room until you are fully conscious.
The osseointegration prosthesis system
The AOFE Clinics uses the Dutch OTN Implants osseointegration system. This system consists of 3 parts: 1. an uncemented press fit titanium implant, 2. a titanium adapter that is inserted through the skin into the implant and 3. a connector that connects the adapter to the external prosthesis. The titanium implant that is inserted into the bone of the residual limb has a rough surface for maximum osseointegration capacity. The diameter of the implant is chosen by the surgeon on the basis of the diameter of the marrow cavity of the bone. The diameter of the implant is slightly larger than the medullary cavity so that the implant is anchored in the bone (press fit). In people with a short above knee amputation or in people with a below knee amputation, the implants are custom made on the basis of a CT scan of the bone.
Hospital stay after the first surgery
As soon as you are completely awake, you return to the short stay department where you stay for 2 to 3 days. In this department, doctors, nurses, carers and administrative staff work. They ensure an optimal stay. Your osseointegration surgeon maintains close contact with the treatment team of the short stay department and will also visit you immediately after the surgery. Before your discharge, an X-ray is made and you will receive an appointment for the second surgery. The stitches can be removed by the doctor after two weeks.
The second surgery
Approximately 6 weeks after the first surgery you will be called for the second surgery. The second surgery is a minor procedure. The surgeon makes a small hole in the skin (stoma) and attaches the adapter through the skin into the implant. After the surgery you may go home the same day after you have received instructions from the nurse for the cleaning of the stoma. You will also receive an appointment for rehabilitation in the Military Rehabilitation Center in Doorn.
Two surgeries at the same time
In some cases it is possible to perform both surgeries simultaneously. This will be discussed with the surgeon in consultation with you at the intake meeting.
Start of rehabilitation
Rehabilitation takes place in an outpatient department at the Rehabilitation Center in the Netherlands (see "Rehabilitation" on this website). The osseointegration rehabilitation starts 1 to 2 weeks of the second surgery. If both surgeries are performed simultaneously, the rehabilitation starts 3 weeks after the surgery. During the rehabilitation period, foreign patients and their familiy can use the family apartments in a hotel in the area. AOFE clinics can arrange that.