A Transcutaneous Intramedullary Attachment For AKA Prostheses

Abstract

Achieving good functional results for ambulatory amputees with above-knee amputation (AKA) can be challenging. Patients) often experience poor socket fit exacerbated by minor weight changes, sweating, and skin problems. There have been several attempts at transcutaneous intramedullary fixation with good results. Several investigators have had success since the late 1990’s with a number of patients undergoing percutaneous, osteointegrated prosthesis implantation. Contemporary strategies include a transcutaneous, press-fit distal femoral intramedullary device whose distal external aspect serves as a hard point for AKA prosthesis attachment (Figure 1). Typically the implant is placed in retrograde fashion as a first stage, followed approximately 6 to 8 weeks later by stomatization in which the distal aspect of the implant is exposed and an extension added for fixation of the AKA prosthesis. Indications for surgery typically are persistent AKA prosthesis socket difficulties with a history of AKA following trauma or tumor.