Peripheral vascular disease, or PVD, has traditionally been considered problematic for osseointegration due to concerns around impaired wound healing and the increased risk of post-operative infection.
PVD is characterised by reduced circulation in the limbs as a result of the narrowing and blockage of blood vessels and, once very advanced, is often treated by amputation. In fact, PVD is the leading cause of lower-limb amputation in developed countries.[1] Because adequate blood flow is necessary for wound healing and to deliver the nutrients and immune cells needed to fight infection, both of these processes can be impaired by PVD.
Osseointegration involves the in-growth of bone into the surface of the implant, with the implant itself crossing the skin barrier to enable connection with the external prosthetic. For those with PVD, bone quality and the ability to integrate can both be compromised, while transcutaneous nature of the implant has traditionally been associated with a greater risk of infection which could ultimately lead to serious complications, including implant failure.
Today, advancements in surgical technique and pre- and post-operative care are gradually overcoming these difficulties, and increasingly ruling out PVD as the absolute contraindication for osseointegration that it once was.
Research carried out by the Osseointegration Group team has been key to driving this change.
Working with both transfemoral and transtibial amputees with PVD, Prof. Munjed Al Muderis and the team have shown how, with careful assessment and monitoring, and the use of innovative surgical and rehabilitation protocols, patients with PVD can achieve improvements across a range of measures.
Our latest study, published at the end of November in the Journal of the American Academy of Orthopaedic Surgeons. Global Research and Reviews, illustrates the example of an 84-year-old patient with PVD at 10-year follow-up post-osseointegration. [2] With improvements in 6-Minute Walking Test and Timed-Up-and-Go scores, as well as dramatic increase in multiple scale quality of life scores from baseline, the study postulates that osseointegration may have been life-extending in this case.
Despite his history of PVD, the patient experienced no deep infection and didn’t require any additional surgical procedures following osseointegration, supporting the identification of significant long-term improvement for certain PVD patients.
If you have been diagnosed with PVD, or have undergone amputation as a result of PVD, and would like to learn more about osseointegration, get in touch.
[1] Akhtar, M., Hoellwarth, J., Al-Jawazneh, S., Lu, W., Roberts, C. and Al Muderis, M. 2021. Transtibial osseointegration for patients with Peripheral Vascular Disease: A case series of 6 patients with minimum 3-year follow-up. JBJS Open Access 6(2):e20.00113.
[2] Wongcharoenwatana, J., Alttahir, M., Arrieta, N.J., and Al Muderis M. 2024. First peripheral vascular disease patient with 10-year follow-up after transtibial osseointegration. Journal of the American Academy of Orthopaedic Surgeons. Global Research and Reviews 8(11):e24.00229.
