Osseointegration surgery

Improved prosthesis & techniques

For patients with a leg amputation who experience problems with mobility wearing a socket prosthetic connection, there is now a new method (osseointegrated) for anchoring the prosthesis to the body. The surgeon can insert an orthopedic implant through the skin directly into the bone of the stump. The artificial leg can be connected to this implant by means of a click system. This new technique is called osseointegration, and the prosthesis is also called click prosthesis. Doctors use the term osseointegration surgery prosthesis or bone anchoring prosthesis. The opening of the skin through which the implant protrudes is called a stoma.

Osseointegratie bij AOFE - scientific research for the best Osseointegration surgery at AOFE Clinics

The osseointegration treatment

You can ask your general practitioner or medical specialist for a referral for osseointegration prosthesis treatment in the AOFE Clinics in Roozendaal (Arnhem). You are also asked to register by means of the general registration form on this website.

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 Rozendaal (Arnhem). For practical reasons, this first contact is preferably done via video calling.

The intake process 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 experienced expert. The experience expert 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 on this intake, we will discuss with you whether you are eligible for the operation and follow-up appointments will be made to realize your treatment.

As soon as it has been decided that you can start the procedure 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. You can discuss your preference for general anesthesia or an epidural with the anesthetist. Information in preparation for the operation will be sent to you.

You should make an appointment with your prosthetist prior to surgery. The prosthetist makes the request for the connector. Once the connector has been received, the prosthesis maker will make an appointment with you to convert the prostheses into an osseointegration prosthesis. In this way you can start the rehabilitation in time.

We do recommend ordering the connector from the same manufacturer as the implant. 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 instrument maker/prosthesis maker, AOFE Clinics works together with MRC-Aardenburg. They can help you further.

On the day of the operation, report to the reception of the AOFE Clinics in Roozendaal (Arnhem) 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 extends out through the stoma. In some cases, the stump bone needs to be shortened slightly, and sometimes excess skin, subcutaneous fat, and muscle is removed. After the operation you will stay briefly in the recovery room until you are fully conscious.

The AOFE Clinics uses the Dutch OTN Implants osseointegration system. 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 sometimes custom-made based on a CT scan of the bone.

Patient care means a lot for us. Once you are fully awake you will return to the ward to continue to recover from the surgery. You can stay at our location at Roozendaal (Arnhem) 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 maintain 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.

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

How does the osseointegration surgery go?

The animation below shows the surgical procedure after an upper leg amputation.

The benefits and disadvantages of osseointegration

  • Better control over the prosthesis and more stability (safety)
  • Wearing time of the prosthesis increases significantly
  • Walking takes less energy
  • “Prosthesis feeling” (better contact with the ground)
  • Prosthesis always fits
  • Better seating comfort
  • Prosthesis does not come off while sitting/walking/cycling
  • Prosthesis is easy to done and doff
  • No perspiration problems in summer
  • Standing in the shower is not a problem
  • More quality of life
  • Stoma should be cleaned twice a day
  • No contact sports, running, skiing
  • Risk of stoma irritations and infections

Now I can walk without pain…. and I'm enjoying life!

Lees Jeff’s verhaal

Osseointegration has returned my freedom

Lees Veronique’s verhaal
Dicky de Best ervaringsdeskundige

Do you have any questions or do
you want to sign up?

You can register directly for an intake interview. Do you still have questions? Then look through the frequently asked questions or ask your question to one of our specialists.