From Bench to Bedside: A Perfect Fit? Osseointegration Can Improve Function for Patients with Amputations

T he first patent for a suction socket for patients with lower limb amputations in the United States was filed during the Civil War [5]. Subsequently, numerous advances in prostheses and surgical techniques have dramatically improved the functional potential of many patients with limb loss. Unfortunately, while the materials used have evolved, many basic fitting techniques and socket-design principles have not changed for decades. Therefore, the primary patient-prosthesis interface—the socket—has not kept pace with the new surgical techniques or the microprocessors, sensors, and motors that have enabled these recent advances. As such, amputation socketrelated problems ranging from ulceration, folliculitis, malodor, sweating, and loss of suspension, discomfort and pain—all of which can dramatically decrease patient function and satisfaction—persist largely unmitigated. Enter osseointegration, the direct skeletal attachment of a prosthesis to a residual limb. The concept of osseointegration began in the mouths of patients and mind of Per Invar Branemark using dental implants during the middle of the last century. Starting with successful translational studies in rabbits, Dr. Branemark successfully demonstrated that bone could rigidly adhere and ‘‘heal’’ to implanted titanium fixtures. He rapidly moved to human use for reconstructive oral surgery, and the results of his early efforts were impressive—despite working in A Note from the Editor-In-Chief: I am pleased to present the next installment of ‘‘From Bench to Bedside,’’ a quarterly column written by Benjamin K. Potter MD. Dr. Potter is a clinician-scientist in the Department of Orthopaedics at Walter Reed National Military Medical Center and in the Department of Surgery at the Uniformed Services University of Health Sciences. His column investigates important developments that are making—or are about to make—the transition from the laboratory to clinical practice, as well as technologies and approaches that have recently made that jump. The institution of one or more of the authors (BKP) has received, during the study period, funding from Congressionally Directed Medical Research Programs. All ICMJE Conflict of Interest Forms for authors andClinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. The author is an employee of the US Government and this work was prepared as part of his official duties. As such, there is no copyright to transfer. The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Army, Department of the Navy, Department of Defense, nor the U.S. Government. I certify that all individuals who qualify as authors have been listed; each has participated in the conception and design of this work, the analysis of data, the writing of the document, and the approval of the submission of this version; that the document represents valid work; that if I used information derived from another source, I obtained all necessary approvals to use it and made appropriate acknowledgements in the document; and that each takes public responsibility for it. Nothing in the presentation implies any Federal/DOA/ DON/DOD endorsement. The author received no financial support for this editorial.