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ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 32-39

Transcutaneous osseointegration for oncologic amputees with and without radiation therapy: An observational cohort study


1 Limb Salvage and Amputation Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
2 Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
3 NHS Fife, Hayfield Rd, Kirkcaldy, United Kingdom
4 Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia

Correspondence Address:
Jason Shih Hoellwarth
535 East 70th Street, New York 10021, NY
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jllr.jllr_15_22

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Context: Transcutaneous osseointegration for amputees (TOFA) consistently confers significant improvement in mobility and quality of life (QOL) for amputees using a traditional socket prosthesis. Limb radiation therapy (XRT) Has traditionally been considered hard contraindication against TOFA but has never actually been examined. Aims: This study evaluated the changes in mobility and QOL, and also the complications, for oncologic amputees provided TOFA: 9 with XRT, and 23 with no radiation therapy (NRT). Settings and Design: A retrospective registry review of all oncologic amputees was performed. Subjects and Methods: The patients' mobility (daily prosthesis wear hours, K-level, Timed Up and Go, and 6-min walk test [6MWT]) and QOL survey data (Questionnaire for Persons with a Transfemoral Amputation) were compared before TOFA and at the latest follow-up. Statistical Analysis Used: Fisher's exact test for frequencies, and Student's t-test for means (significance, P < 0.05). Results: Regarding mobility, the cohorts were similar to one another before and after TOFA, and both cohorts improved following osseointegration (statistically significant: XRT wear hours [P = 0.029], NRT K-level [P < 0.001], and NRT 6MWT [P = 0.046]). Both cohorts' QOL was also similar before and after TOFA, and both cohorts again improved following osseointegration (significant differences: XRT problem score [P = 0.021], NRT problem score [P < 0.001], and NRT global score [P < 0.001]). Three XRT patients (33%) and one NRT patient (4%) required removal (P = 0.048). Conclusions: While radiation therapy may be associated with increased risk of postoperative implant loosening, it seems unjustifiable to flatly contraindicate osseointegration for oncologic amputees solely because of prior limb irradiation.


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