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Review
. 2025 Mar 7;8(1 Suppl):e370.
doi: 10.1097/OI9.0000000000000370. eCollection 2025 Mar.

A conceptual framework for soft tissue management of transdermal bone-anchored implants in extremity prostheses

Matthew Wordsworth  1   2 , Colin J Harrington  3 , Luke Juckett  2 , Jason M Souza  2 ; Global Collaborative Congress on Osseointegration (GCCO)
Collaborators, Affiliations
Review

A conceptual framework for soft tissue management of transdermal bone-anchored implants in extremity prostheses

Matthew Wordsworth et al. OTA Int. .

Abstract

Soft tissue complications are among the most common reasons for revision surgery following transdermal, bone-anchored osseointegration. While many orthopaedic surgeons are familiar and experienced with the use of intramedullary implants, the soft tissue management surrounding a percutaneous and permanent implant in continuity with the outside environment remains a challenging problem. With this in mind, we present our rationale and a framework for soft tissue considerations in preparation for bone-anchored osseointegration based on early experiences with most commercially available osseointegration systems.

Keywords: bone-anchored osseointegration; soft tissue; transdermal bone-anchored implants.

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Conflict of interest statement

Disclosures of conflicts of interest: Leah Gitajn received consulting fees from Stryker and Paragon28. She also has a leadership or fiduciary role in the OTA program committee and AO research committee. Danielle Melton has DoD contract OP220013 and CDMRP Grant OR210169. She also has consulting fees for Paradigm Medical Director and has received payment for lectures at the State of the Science Conference on Osseointegration. Danielle Melton has received payment for expert testimony while acting as a consultant and expert witness in multiple cases. She has received support from Amputee Coalition BOD to travel and attend meetings. She has participated in the Data Safety Monitoring Advisory Board for External Advisory Panel for Limb Loss Prevention Registry. Danielle Melton has a leadership or fiduciary role in METRC Executive Council, Amputee Coalition Board of Directors, and in Catapult Board of Directors. Kyle Potter has a CDMRP PRORP grant/contract with DoD-USUHS Restoral. He also has consulting fees with Integrum and Signature. Dr. Hsu reports consultancy for Globus Medical and personal fees from Smith & Nephew speakers' bureau. Robert Rozbruch reports consulting fees from Nuvasive and J&J. He also reports having stock with Osteosys. Jason Stoneback reports royalties from AQ Solutions as well as consulting fees from AQ Solutions and Smith and Nephew. He reports payment for lectures from Smith and Nephew and AQ Solutions. Jason Stoneback states he has received payment for expert testimony in multiple cases. He notes he has received support to travel and attend meetings from Smith and Nephew and AQ Solutions. He reports planning a patent for a Rotational Intramedullary Nail. Jason Stoneback states he is the secretary for ISPO Special Interest Group for Bone-Anchored Limbs and is a board member for Justin Sports Medicine Team Annual Conference. He also reports stock with Validus Cellular Therapeutics. Jason Souza is a paid consultant for Balmoral Medical, LLC, Checkpoint, Inc, and Integrum, Inc. The remaining authors declare they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
OPRA implant system demonstrating the soft tissue surrounding the abutment thinned to the level of the dermis. This technique aims to minimize soft tissue motion by promoting adherence of the skin to the bone surrounding the abutment.
Figure 2.
Figure 2.
A long porous-coated stem system without soft tissue thinning.
Figure 3.
Figure 3.
Spectrum of relative motion and tissue vascularity with various transdermal bone-anchored implant systems.
See this image and copyright information in PMC

References

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