Essence of rehabilitation in osseointegration program
Once the surgical procedure has been completed, rehabilitation is a fundamental part of the program. It is necessary for the biological phenomenon of osseointegration between the implanted material and the bone. Communication and coordination between the surgical team and the rehabilitation team is important to share relevant information about the surgical procedure and the rehabilitation team’s objectives.
The main objective is to remove the sockets of patients who do not tolerate it. To achieve this, patients must progressively adapt to load their body weight on the remanent femoral bone and not on the ischial bone, as with the socket prosthetic.
The benefit in terms of improved functional capacity and gait is a secondary objective, although it is noteworthy that it is achieved in an evident manner in the majority of patients who have been osseointegrated.
The team of professionals involved in the rehabilitation process is characterized by its interdisciplinary nature and ability to work together. This team is led and coordinated by a rehabilitation physician who is an expert in orthoprosthetic medicine for amputees. He or she will guide the patient’s progression within the rehabilitation program and will supervise the transition between its different phases.
Another key professional in the team is the physiotherapist, who performs the specific physiotherapy treatment indicated in each phase. The orthopaedic technician is in charge of carrying out the work of adaptation, assembly and alignment of the different prosthetic components in the osseointegrated prosthesis.
When does the rehabilitation program start after osseointegration surgery?
Ideally, the rehabilitation program begins in the immediate postoperative period, 48-72 hours after surgery, with the objective of optimizing post-surgical positioning and instructing the patient on the proper positions to avoid unwanted joint retractions.
What are the phases of the process?
The rehabilitation program we use is based on the protocol used by the Australian osseointegration group (OGAAP-Osseointegration Group Australia Accelerated Protocol).
There are two main phases.
The first phase, called the initial or loading phase. This phase is a combination of; firstly, the optimization of the patient’s overall musculoskeletal condition through exercises to maintain overall joint balance, strengthening and stretching. Secondly, the application of increasing loads on the patient’s bone stump, who will progress in the capacity to transmit his body weight through his osseointegrated femur. This first phase’s duration and progression are calculated individually for each patient, based on various clinical criteria. In most patients the duration ranges approximately between 6 and 9 weeks.
The second phase of the program begins with the prosthetic adjustment, in which the external connector of the osseointegration is assembled with the prosthesis previously used by the patient, obviously without its prosthetic socket. After the necessary individualized prosthetic realignment, the gait retraining with technical aids begins. From this phase on, the patient will be able to use his osseointegrated prosthesis with a progression that will be marked weekly by the rehabilitation physician. The duration of this second phase is approximately 12 weeks, after which the patient will be able to dispense with the use of technical aids for walking.
Is this rehabilitation program painful?
The rehabilitation program is based on painless therapeutic exercise, and the progressive loads on the amputation stump are very well tolerated. The absence of pain at the implant-bone interface is a constant throughout the program, and in turn is an indicator of the satisfactory evolution of the biological process of osseointegration.
What is the ultimate goal of the rehabilitation process after osseointegration?
The purpose of the program is not only to ensure that the patient is able to walk with his osseointegrated prosthesis, but also that the qualitative improvement in his ability to move is reflected in his social participation and quality of life. Once the program has been completed, the patient will be discharged from the program and will continue to undergo regular medical check-ups.
The rehabilitation process is led by Dra. Almudena Crespo and is performed in the facilities of the Clínica Corachán. It is located at c/ Rafael Batlle nº 20, 500 meters from the Clinic and has a structural physiotherapy unit aimed at personalized treatments, a gym with all kinds of mechanotherapy and advanced electromedical equipment.