The osseointegration treatment

Referrals

You may ask your general practitioner or medical specialist for a referral for osseointegration treatment in the AOFE Clinics in Utrecht. Once you have contacted us you wil be asked to register by means of the general registration form on this website. See also on this website "who is eligible for an osseointegration (click) prosthesis".

Pre-screening

After your referral you will receive a questionnaire from the AOFE Clinics with questions about your amputation and your medical history. This questionnaire will be assessed by the osseointegration team and based on this pre-screening, it will be determined whether you may be eligible for osseointegration treatment. You will receive a message about this and, depending on your situation, you will receive an invitation for an intake interview at the AOFE Clinics in Utrecht. For practical reasons, this first contact is preferably done via video calling.

Intake

The intake takes place at the multidisciplinary intake clinic. During this meeting you will receive all information about osseointegration treatment from the surgeon and rehabilitation physician and you can meet an expert patient. This person had this treatment before and tells about the experiences with the osseointegration (click) prosthesis and shows how the prosthesis works. Prior to this appointment, X-rays may be taken and, if necessary, a CT scan. Based of this intake, we will discuss with you whether you are eligible for the surgical treatment and follow-up appointments will be made to realize your treatment.

Anesthesia

As soon as it has been decided that you can be treated with us, you will be given an appointment with the anesthetist for pre-operative screening (POS). At AOFE Clinics you can only be treated if your medical history allows it. You can discuss your preference for general anesthesia or an epidural with the anesthesiologist. Information in preparation for the operation will be sent to you.

Artificial Limbl

You should make an appointment with your prosthetist prior to surgery. The prosthetist orders the connector at OTNimplants (www.otnimplants.nl). Once the connector has been received, the prosthetist will make an appointment with you to convert the socket prosthesis into an osseointegration prosthesis. This way you can start the rehabilitation in time.

We do recommend ordering the connector from the same manufacturer as the implant for safety reasons. They have investigated the forces of the various coupling pieces in relation to the implant.

If for some reason it does not work with your own prosthetist, AOFE Clinics collaborates with the prosthetist company at the Military Rehabilitation Center in Doorn (www.defensie.nl search for 'Aardenburg') who will be happy to further help you.

The operation

On the day of the operation, report to the reception of the AOFE Clinics at Annatommie Medisch Centrum in Utrecht (www.annatommiemc.nl) at the agreed time. Because you will not be able to wear a prosthesis for a number of weeks after the operation, we ask you to bring a wheelchair or crutches. During the operation you will be continuously supervised by the surgery team. The operating team consists of the (orthopedic) surgeon, anesthetist, operating assistants and anesthetists. During the surgery, a metal implant is placed in the bone of your stump and the stump is closed again over the adapter that protrudes through the slin which is called 'stoma'. In some cases, the stump bone needs to be shortened slightly, and sometimes excess skin, subcutaneous fat, and redundant muscle is removed. After the operation you will stay briefly in the recovery room until you are fully conscious.

The Osseointegration Prosthesis System

The AOFE Clinics uses the Dutch OTN Implants osseointegration system BADAL X. (www.otnimplants.nl search for 'Badal X') This system consists of an uncemented press-fit titanium implant, a titanium adapter that is inserted through the skin into the implant and a connector that connects the adapter to the external prosthesis. The titanium implant that is placed in the bone of the stump has a rough surface for maximum osseointegration capacity. The exact dimensions of the implant are chosen by the surgeon based on the stump bone anatomy. In people with an extremely short upper or lower leg stump, the implants are custom-made based on a CT scan of the bone.

Length of stay after surgery

Once fully awake you will return to the ward to continue to recover from the surgery. You can stay at our location at Annatommie Utrecht for a maximum of two nights. Doctors, nurses, carers and administrative staff work in this department. They ensure an optimal stay. Your (orthopedic) surgeon will keep in close contact with the treatment team of the nursing ward and will also visit you immediately after the operation. Before you are discharged, a check-up X-ray will be made and you will receive an appointment for rehabilitation. The stitches can be removed after two to three weeks at our outpatient clinic or by your GP.

Start rehabilitation

The first phase of the rehabilitation takes place in the rehabilitation center MRC in Doorn (see "Rehabilitation" on this website). This will start 3-6 weeks after the operation, depending on bone quality and ingrowth. It is possible that it is advised to start later than has been discussed with your prior to the operation.This will be individually coordinated with you.