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Osseointegrated titanium implants for limb prostheses attachments: infectious complications.

Journal article
Authors Jonatan Tillander
Kerstin Hagberg
Lars Hagberg
Rickard Brånemark
Published in Clinical orthopaedics and related research
Volume 468
Issue 10
Pages 2781-2788
ISSN 1528-1132
Publication year 2010
Published at Institute of Biomedicine, Department of Infectious Medicine
Institute of Clinical Sciences, Department of Orthopaedics
Pages 2781-2788
Language en
Keywords Adult, Aged, Amputation, Anti-Bacterial Agents, therapeutic use, Artificial Limbs, microbiology, Device Removal, Female, Humans, Male, Middle Aged, Osseointegration, Prospective Studies, Prosthesis Design, Prosthesis-Related Infections, microbiology, radiography, therapy, Reoperation, Skin, microbiology, Surgical Wound Infection, microbiology, radiography, therapy, Sweden, Time Factors, Titanium, Treatment Outcome
Subject categories Biomaterials, Surgical research


BACKGROUND: The concept of osseointegration involves direct contact between titanium implant and bone. This transcutaneous prosthetic system for amputees is intended to assure stable long-term fixation. Most metal transcutaneous implants have failed, primarily owing to infection. QUESTIONS/PURPOSES: We determined the frequency and describe the presentation of infectious complications with this novel method. We also evaluated the bacterial flora at the skin-penetration area and its relation to the development of local and implant-related infection. PATIENTS AND METHODS: We prospectively followed 39 patients with arm and leg amputations fitted with transcutaneous osseointegrated titanium implants a mean of 56 months earlier (range, 132-133 months). There were 33 femoral, one tibial, four ulnar, four radial, and three humeral implants. Patients were selected during a 6-month period in 2005 and identically reevaluated after 3 years. Implant infection was defined as definite, probable, or possible based on clinical, radiologic, and microbiologic evidence. RESULTS: The frequency of implant infection was 5% at inclusion and 18% at followup. One patient with infection recovered owing to antibiotic treatment and another patient had the implant removed. Most implant infections had low infectious activity, and in five of the seven patients with infections, prosthetic use was not affected. The most common bacteria in superficial and deep cultures were Staphylococcus aureus and coagulase-negative staphylococci. CONCLUSIONS: Despite frequent colonization around the skin-implant interface by potentially virulent bacteria such as Staphylococcus aureus and bacteria associated with biomedical device infections such as coagulase-negative staphylococci, this titanium implant system for bone-anchored prostheses caused few infections leading to disability or implant removal. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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