Consensus statement on the prevention, diagnosis, and management of infection following transcutaneous osseointegration for patients with limb loss: current state-of-the-art and proposed future studies

Abstract

The diagnosis, risk factors, treatment algorithms, and long-term sequelae of superficial and deep, implant-related infections in transdermal, bone-anchored osseointegration are not well-defined. In contrast to the robust experience diagnosing and managing periprosthetic joint infections in total joint arthroplasty, osseointegration surgery has only recently been adopted at a small number of osseointegration centers in the United States, contributing to the lack of long-term outcomes. Through the pooled experience from these osseointegration centers, we present a consensus statement on the perioperative management, incidence, treatment, and diagnostic workup for infectious complications following transdermal, bone-anchored osseointegration.

Keywords: amputation; bone-anchored limb; infection; ossoeintegration; transdermal.

Figure 1.

This patient used tea tree oil for several weeks without informing the surgeon, in an effort to prevent infection. He complained of worsening pain and presented with skin that was cracking, red, and tender. Upon recommendation, he returned to routine hygiene of baby shampoo, and his portal skin returned to a more natural skin appearance within 2 weeks. The patient has remained fully active in a labor career and has not had any infectious concerns in over a year since.

Figure 2.

Clinical photograph and MRI left tibia of a patient with sinus tract that was identified as a periosteal abscess, not an implant-threatening infection. This was managed with debridement with implant retention and a course of parenteral antibiotics. The patient remains highly ambulatory and has not had another infectious episode in over 3 years since.