Professor Munjed Al Muderis Leads Investigation into Osseointegration Development

Professor Munjed Al Muderis has lead an investigation titled “Transcutaneous Osseointegration for Amputees: What Is It, How Did It Evolve, and What May Develop?”, with a team of researchers including Jason Shih Hoellwarth, Kevin Tetsworth and Muhammad Adeel Akhtar.

The paper explores the transformative potential of transcutaneous osseointegration for amputees (TOFA). This surgical technique involves the insertion of a permanent metal prosthetic anchor directly into an amputee’s residual limb, providing a stable connection to an external prosthesis. The paper, accepted for publication in January this year, sheds light on the evolution of TOFA, its recent advancements, and the future developments that may further enhance prosthetic utility.

Recent findings highlighted in the paper demonstrate that TOFA significantly improves the quality of life and mobility of amputees dissatisfied with traditional prostheses. Patients who have undergone TOFA experience substantial functional improvements and express radical changes in their daily lives. The technique has proven to be safe for amputees with various medical conditions, and adjunctive technologies such as sensory and motor functions can be seamlessly integrated. Although infection remains a common adverse experience (occurring in approximately 5-20% of cases), recent soft tissue techniques are expected to further enhance the safety and efficacy of TOFA. The emerging field of neural technology holds great promise for the future, offering potential advancements that could revolutionize prosthetic functionality.

Commenting on the paper Professor Munjed Al Muderis said: “TOFA represents a paradigm shift in amputee rehabilitation by eliminating the traditional prosthetic (TP) socket and providing a stable, permanent, and skeletally anchored prosthetic attachment. This breakthrough offers hope for improved rehabilitation techniques and devices for individuals who have experienced limb loss. By transmitting forces more efficiently through the bones of the limb, TOFA allows for enhanced mobility, increased comfort, and better overall prosthesis use. Furthermore, the integration of TOFA with novel technologies opens up possibilities for future developments that could further improve the lives of amputees.”

The study also traces the historical evolution of transcutaneous implants and highlights the scientific advancements that have contributed to the development and success of TOFA. From ancient attempts at limb replacement to modern experiments with various implant materials, surgeons and researchers have progressively refined the technique to achieve optimal outcomes. Titanium alloy, specifically Ti6Al4V, has emerged as the material of choice for TOFA implants due to its bioinert properties, strong integration with bone, and resistance to corrosion.

TOFA offers significant benefits to amputees, as evidenced by numerous systematic reviews. Patients who undergo TOFA report a radical improvement in quality of life, increased mobility, and a higher level of satisfaction compared to traditional prostheses. The elimination of common problems associated with TP, such as sweating and discomfort, further contributes to positive outcomes. Functional improvements, including the ability to wear the prosthesis every day and enhanced performance in tasks such as walking and hip motion, have been observed in TOFA recipients.

While there are potential risks associated with TOFA, studies indicate a low incidence of complications.

The research paper can be accessed here: