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This may be the author’s version of a work that was submitted/accepted
for publication in the following source:
Frossard, Laurent A.
(2014)
Are bone-anchored prostheses about to revolutionise the world of pros-
thetics? In
Australian Orthotic Prosthetic Association (AOPA) Congress, 2014-10-09
- 2014-10-10.
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Are bone-anchored prostheses about to revolutionise the world of prosthetics? 
2014 AOPA Congress   Page 1 of 5 
ARE BONE-ANCHORED PROSTHESES ABOUT TO REVOLUTIONISE 
THE WORLD OF PROSTHETICS? 
 
Frossard Laurent 
(1,2, 3)
 
 
 (1)
 Queensland University of Technology, Brisbane, Australia 
(2)
 University of the Sunshine Coast,  Maroochydore, Australia 
(3)
 Marie-Enfant Rehabilitation Center, Canada 
 
 
Frossard L. Are bone-anchored prostheses about to revolutionise the world of prosthetics? 
Australian Orthotic Prosthetic Association (AOPA) Congress. 2014. Melbourne, Australia. 
p 2 
 
 
Biography 
Dr Laurent Frossard is currently an adjunct 
Professor of Biomechanics at the QUT and 
USC as well as the Chief Scientist Officer at 
YourResearchProject. As project leader and 
active researcher, his expertise in 
Biomechanics relates to the development of 
biomechanical tools and improvement of 
basic knowledge of the locomotion and 
rehabilitation of individuals with lower limb 
loss fitted with osseointegrated implant and 
socket. He is one of the very few 
independent experts in the clinical benefits 
of bone-anchorage prostheses. His academic 
track record includes over 100 publications, 
multiple grants, several supervisions of 
postgraduate students and international 
collaborations. 
 
Abstract  
Individuals with limb amputation fitted with 
conventional socket-suspended prostheses 
often experience socket related discomfort 
leading to a significant decrease in quality of 
life. Most of these concerns can be 
overcome by surgical techniques enabling 
bone-anchored prostheses. In this case, the 
prosthesis is attached directly to the residual 
skeleton through a percutaneous implant.
[1, 2]
  
The primary aim of this study is to present 
the current advances in these surgical 
techniques worldwide with a strong focus on 
the developments in Australia. The 
secondary aim is to provide an overview of 
the possible critical changes that may 
occurred in the world of prosthetic following 
these developments in bone-anchored 
prostheses. 
The current advances will be extracted from 
a systematic literature review including 
approximately 40 articles. The outcomes 
measured will include the estimation of the 
population worldwide as well as the 
complications (e.g., infection, loosening, 
fractures, breakage) and the benefits (e.g., 
functional outcomes, health-related quality 
of life).
[3-20]
 
The population of individuals fitted with a 
bone-anchored prosthesis is approximately 
500 worldwide. Publications focusing on 
infection are sparse. However, superficial 
infections are common (80%) while the rate 
of deep infection is estimated between 6 to 
20%. Loosening and preprosthetic fractures 
are fairly uncommon. Breakage of 
percutaneous parts occurs regularly mainly 
due to fall. All studies reported a significant 
improvement in functional level and overall 
quality of life. 
Several commercial implants are in 
developments in Europe and US.
[21-28]
 The 
number of procedures is consistently 
growing worldwide. This technique might be 
primary way to fit a prosthesis to young and 
Are bone-anchored prostheses about to revolutionise the world of prosthetics? 
2014 AOPA Congress   Page 2 of 5 
active amputees by 2025. Interestingly, 
Australia is currently on the leading country 
worldwide in terms of range of procedures 
and level of amputation, choice of implants, 
rapid population growth, developments of 
governmental reimbursement schemes, etc. 
These developments in bone-anchored 
prostheses could be potentially a game 
changer in the field of prosthetics. The 
fitting requirement (e.g., fall prevention) is 
challenging the use of K-level 
classification.
[9, 10, 13, 14, 17, 20, 29-40]
 It is 
unclear, if the bottom line of prosthetists 
would be affected due to the lack of socket 
manufacturing. However, clearly prosthetists 
could play in key role in referral and follow 
up on patients, particularly in safe fitting of 
the prosthesis
[34]
, replacement of 
percutaneous parts and prevention of 
superficial and deep infection. 
 
References 
1. Branemark, R., P.I. Branemark, B. 
Rydevik, and R.R. Myers, 
Osseointegration in skeletal 
reconstruction and rehabilitation: a 
review. J Rehabil Res Dev, 2001. 
38(2): p. 175-81. 
2. Aschoff, H.H., R.E. Kennon, J.M. 
Keggi, and L.E. Rubin, 
Transcutaneous, distal femoral, 
intramedullary attachment for above-
the-knee prostheses: an endo-exo 
device. J Bone Joint Surg Am, 2010. 
92 Suppl 2(Supplement 2): p. 180-6. 
3. Hagberg, K., E. Hansson, and R. 
Brånemark, Outcome of 
percutaneous osseointegrated 
prostheses for patients with unilateral 
transfemoral amputation at two-year 
follow-up. Archives of Physical 
Medicine and Rehabilitation, 
2014(0). 
4. Tsikandylakis, G., O. Berlin, and R. 
Branemark, Implant Survival, 
Adverse Events, and Bone 
Remodeling of Osseointegrated 
Percutaneous Implants for 
Transhumeral Amputees. Clin 
Orthop Relat Res, 2014: p. 1-10. 
5. Branemark, R., O. Berlin, K. 
Hagberg, P. Bergh, B. Gunterberg, 
and B. Rydevik, A novel 
osseointegrated percutaneous 
prosthetic system for the treatment of 
patients with transfemoral 
amputation: A prospective study of 
51 patients. Bone Joint J, 2014. 
96(1): p. 106-113. 
6. Van de Meent, H., M.T. Hopman, 
and J.P. Frolke, Walking ability and 
quality of life in subjects with 
transfemoral amputation: a 
comparison of osseointegration with 
socket prostheses. Arch Phys Med 
Rehabil, 2013. 94(11): p. 2174-2178. 
7. Berlin, Ö., P. Bergh, M. Dalen, S. 
Eriksson, K. Hagberg, S. Inerot, B. 
Gunterberg, and R. Brånemark, 
Osseointegration in transfemoral 
amputees: the gothenburg 
experience. Journal of Bone & Joint 
Surgery, British Volume, 2012. 94-
B(SUPP XIV): p. 55. 
8. Jacobs, R., R. Brånemark, K. 
Olmarker, B. Rydevik, D. Van 
Steenberghe, and P. Branemark, 
Evaluation of the psychophysical 
detection threshold level for 
vibrotactile and pressure stimulation 
of prosthetic limbs using bone 
anchorage or soft tissue support. 
Prosthetics and Orthotics 
International, 2000. 24(2): p. 133-
142. 
9. Frossard, L., N. Stevenson, J. 
Smeathers, D. Lee Gow, S. Gray, J. 
Sullivan, C. Daniel, E. Häggström, 
K. Hagberg, and R. Brånemark, 
Daily activities of a transfemoral 
amputee fitted with osseointegrated 
fixation: continuous recording of the 
loading for an evidence-based 
practice. Kinesitherapie Revue, 2006. 
6(56-57): p. 53-62. 
Are bone-anchored prostheses about to revolutionise the world of prosthetics? 
2014 AOPA Congress   Page 3 of 5 
10. Frossard, L., K. Hagberg, E. 
Häggström, D.L. Gow, R. 
Brånemark, and M. Pearcy, 
Functional Outcome of Transfemoral 
Amputees Fitted With an 
Osseointegrated Fixation: Temporal 
Gait Characteristics. JPO Journal of 
Prosthetics and Orthotics, 2010. 
22(1): p. 11-20. 
11. Hagberg, K., R. Branemark, B. 
Gunterberg, and B. Rydevik, 
Osseointegrated trans-femoral 
amputation prostheses: Prospective 
results of general and condition-
specific quality of life in 18 patients 
at 2-year follow-up. Prosthetics and 
Orthotics International, 2008. 32(1): 
p. 29 - 41. 
12. Hagberg, K. and R. Branemark, One 
hundred patients treated with 
osseointegrated transfemoral 
amputation prostheses-rehabilitation 
perspective. J Rehabil Res Dev, 
2009. 46(3): p. 331-44. 
13. Lee, W., L. Frossard, K. Hagberg, E. 
Haggstrom, and R. Brånemark, 
Kinetics analysis of transfemoral 
amputees fitted with osseointegrated 
fixation performing common 
activities of daily living. Clinical 
Biomechanics, 2007. 22(6): p. 665-
673. 
14. Frossard, L., N. Stevenson, J. 
Smeathers, E. Haggstrom, K. 
Hagberg, J. Sullivan, D. Ewins, D.L. 
Gow, S. Gray, and R. Branemark, 
Monitoring of the load regime 
applied on the osseointegrated 
fixation of a trans-femoral amputee: 
a tool for evidence-based practice. 
Prosthet Orthot Int, 2008. 32(1): p. 
68-78. 
15. Hagberg, K., E. Haggstrom, M. 
Uden, and R. Branemark, Socket 
versus bone-anchored trans-femoral 
prostheses: hip range of motion and 
sitting comfort. Prosthet Orthot Int, 
2005. 29(2): p. 153-163. 
16. Rubin, L., L. Kennon, J. Keggi, and 
H. Aschoff, Surgical management  of 
trans-femoral amputation with a  
transcutaneous, press-fit distal 
femoral intra-medullary device: 
analysis with minimum 2 year 
follow-up. Journal of Bone & Joint 
Surgery, British Volume, 2012. 94-
B(SUPP XXI): p. 95. 
17. Frossard, L., R. Tranberg, E. 
Haggstrom, M. Pearcy, and R. 
Branemark, Fall of a transfemoral 
amputee fitted with osseointegrated 
fixation: loading impact on residuum. 
Gait & Posture, 2009. 
30(Supplement 2): p. S151-S152. 
18. Nebergall, A., C. Bragdon, A. 
Antonellis, J. Karrholm, R. 
Branemark, and H. Malchau, Stable 
fixation of an osseointegated implant 
system for above-the-knee amputees: 
titel RSA and radiographic 
evaluation of migration and bone 
remodeling in 55 cases. Acta Orthop, 
2012. 83(2): p. 121-8. 
19. Tillander, J., K. Hagberg, L. 
Hagberg, and R. Branemark, 
Osseointegrated titanium implants 
for limb prostheses attachments: 
infectious complications. Clin 
Orthop Relat Res, 2010. 468(10): p. 
2781-8. 
20. Frossard, L.A., R. Tranberg, E. 
Haggstrom, M. Pearcy, and R. 
Branemark, Load on osseointegrated 
fixation of a transfemoral amputee 
during a fall: loading, descent, 
impact and recovery analysis. 
Prosthet Orthot Int, 2010. 34(1): p. 
85-97. 
21. Shevtsov, M.A., O.V. Galibin, N.M. 
Yudintceva, M.I. Blinova, G.P. 
Pinaev, A.A. Ivanova, O.N. 
Savchenko, D.N. Suslov, I.L. 
Potokin, E. Pitkin, G. Raykhtsaum, 
and M.R. Pitkin, Two-stage 
implantation of the skin and bone 
integrated pylon (SBIP) seeded with 
Are bone-anchored prostheses about to revolutionise the world of prosthetics? 
2014 AOPA Congress   Page 4 of 5 
autologous fibroblasts induced into 
osteoblast differentiation for direct 
skeletal attachment of limb 
prostheses. Journal of Biomedical 
Materials Research Part A, 2013: p. 
n/a-n/a. 
22. Jeyapalina, S., J.P. Beck, K.N. 
Bachus, O. Chalayon, and R.D. 
Bloebaum, Radiographic Evaluation 
of Bone Adaptation Adjacent to 
Percutaneous Osseointegrated 
Prostheses in a Sheep Model. Clin 
Orthop Relat Res, 2014: p. 1-12. 
23. Holt, B.M., K.N. Bachus, J.P. Beck, 
R.D. Bloebaum, and S. Jeyapalina, 
Immediate post-implantation skin 
immobilization decreases skin 
regression around percutaneous 
osseointegrated prosthetic implant 
systems. J Biomed Mater Res A, 
2013. 101(7): p. 2075-82. 
24. Jeyapalina, S., J.P. Beck, R.D. 
Bloebaum, and K.N. Bachus, 
Progression of Bone Ingrowth and 
Attachment Strength for Stability of 
Percutaneous Osseointegrated 
Prostheses. Clin Orthop Relat Res, 
2013: p. 1-9. 
25. Shelton, T.J., J.P. Beck, R.D. 
Bloebaum, and K.N. Bachus, 
Percutaneous osseointegrated 
prostheses for amputees: Limb 
compensation in a 12-month ovine 
model. J Biomech, 2011. 44(15): p. 
2601-6. 
26. Tomaszewski, P.K., N. Verdonschot, 
S.K. Bulstra, and G.J. Verkerke, A 
New Osseointegrated Fixation 
Implant for Amputated Patients. 
Journal of Biomechanics, 2012. 
45(0): p. S322. 
27. Tomaszewski, P.K., B. Lasnier, G. 
Hannink, G.J. Verkerke, and N. 
Verdonschot, Experimental 
assessment of a new direct fixation 
implant for artificial limbs. J Mech 
Behav Biomed Mater, 2013. 21: p. 
77-85. 
28. Tomaszewski, P.K., M. van Diest, 
S.K. Bulstra, N. Verdonschot, and 
G.J. Verkerke, Numerical analysis of 
an osseointegrated prosthesis fixation 
with reduced bone failure risk and 
periprosthetic bone loss. J Biomech, 
2012. 45(11): p. 1875-80. 
29. Vertriest, S., P. Coorevits, K. 
Hagberg, R. Branemark, E. 
Haggstrom, G. Vanderstraeten, and 
L. Frossard, Static Load Bearing 
Exercises of Individuals With 
Transfemoral Amputation Fitted 
With an Osseointegrated Implant: 
Reliability of Kinetic Data. IEEE 
Trans Neural Syst Rehabil Eng, 
2014. In press. 
30. Dumas, R., L. Cheze, and L. 
Frossard, Loading applied on 
prosthetic knee of transfemoral 
amputee: comparison of inverse 
dynamics and direct measurements. 
Gait Posture, 2009. 30(4): p. 560-2. 
31. Lee, W.C., J.M. Doocey, R. 
Branemark, C.J. Adam, J.H. Evans, 
M.J. Pearcy, and L.A. Frossard, FE 
stress analysis of the interface 
between the bone and an 
osseointegrated implant for 
amputees--implications to refine the 
rehabilitation program. Clin Biomech 
(Bristol, Avon), 2008. 23(10): p. 
1243-50. 
32. Frossard, L., J. Beck, M. Dillon, M. 
Chappell, and J.H. Evans, 
Development and preliminary testing 
of a device for the direct 
measurement of forces and moments 
in the prosthetic limb of transfemoral 
amputees during activities of daily 
living. Journal of Prosthetics and 
Orthotics, 2003. 15(4): p. 135-142. 
33. Lee, W.C., L.A. Frossard, K. 
Hagberg, E. Haggstrom, D.L. Gow, 
S. Gray, and R. Branemark, 
Magnitude and variability of loading 
on the osseointegrated implant of 
transfemoral amputees during 
Are bone-anchored prostheses about to revolutionise the world of prosthetics? 
2014 AOPA Congress   Page 5 of 5 
walking. Med Eng Phys, 2008. 30(7): 
p. 825-833. 
34. Frossard, L., E. Haggstrom, K. 
Hagberg, and P. Branemark, Load 
applied on a bone-anchored 
transfemoral prosthesis: 
characterisation of prosthetic 
components – A case study Journal 
of Rehabilitation Research & 
Development, 2013. 50(5): p. 619–
634. 
35. Frossard, L., L. Cheze, and R. 
Dumas, Dynamic input to determine 
hip joint moments, power and work 
on the prosthetic limb of 
transfemoral amputees: ground 
reaction vs knee reaction. Prosthet 
Orthot Int, 2011. 35(2): p. 140-9. 
36. Frossard, L., N. Stevenson, J. 
Sullivan, M. Uden, and M. Pearcy, 
Categorization of Activities of Daily 
Living of Lower Limb Amputees 
During Short-Term Use of a Portable 
Kinetic Recording System: A 
Preliminary Study. JPO Journal of 
Prosthetics and Orthotics, 2011. 
23(1): p. 2-11. 
37. Frossard, L.A., Load on 
osseointegrated fixation of a 
transfemoral amputee during a fall: 
Determination of the time and 
duration of descent. Prosthet Orthot 
Int, 2010. 34(4): p. 472-87. 
38. Frossard, L., D.L. Gow, K. Hagberg, 
N. Cairns, B. Contoyannis, S. Gray, 
R. Branemark, and M. Pearcy, 
Apparatus for monitoring load 
bearing rehabilitation exercises of a 
transfemoral amputee fitted with an 
osseointegrated fixation: a proof-of-
concept study. Gait Posture, 2010. 
31(2): p. 223-8. 
39. Helgason, B., H. Palsson, T.P. 
Runarsson, L. Frossard, and M. 
Viceconti, Risk of failure during gait 
for direct skeletal attachment of a 
femoral prosthesis: a finite element 
study. Med Eng Phys, 2009. 31(5): p. 
595-600. 
40. Frossard, L., K. Hagberg, E. 
Haggstrom, and R. Branemark, 
Load-relief of walking aids on 
osseointegrated fixation: instrument 
for evidence-based practice. IEEE 
Trans Neural Syst Rehabil Eng, 
2009. 17(1): p. 9-14. 
 
 
1Laurent Frossard (1, 2, 3)
Are bone-anchored prostheses about to 
revolutionise the world of prosthetics?
Melbourne, Australia –
10/10/2014
AOPA Congress 2014
(1) University of the Sunshine Coast, 
Autralia
(2) Queensland University of Technology, 
Australia
(3) Marie-Enfant Rehabilitation Center, 
Canada
http://www.chalmers.se/en/news/Pages/Thought-controlled-prosthesis-is-changing-the-lives-of-amputees.aspx
Are bone-anchored prostheses about to 
revolutionise the world of prosthetics?
eP
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2Context
Socket
Attachment
Socket
Socket
Context
Attachment
FixationSocket
Fixation
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3ITAP
Commercial fixations
Integral Leg Prosthesis 
Orthodynamics Pty Ltd
UKILP
Dr Horst Aschoff
Lunow, C., K. Staubach, and H. Aschoff, [Endo-exo Femoral Prosthesis]. Zeitschrift Der Unfallchirug, 2010. 
OLP
ITAP
Commercial fixations
Dr Munjed Al 
Muderis
Osseointegrated Prosthesis Limb 
Med-Italia Biomedica SRL, Italy
Sydney, Australia
http://www.osseointegrationaustralia.com.au/eP
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4ILP/OPL
ITAP
Commercial fixations
Osseointegrated Prosthesis for Rehabilitation of 
Amputees 
Integrum AB
Sweden
OPRA
Dr Rickard 
Branemark
http://opraosseointegration.com/
ILP/OPL
ITAP
Commercial fixations
Nebergall, A., C. Bragdon, A. Antonellis, J. Kärrholm, R. Brånemark, and H. Malchau, Stable fixation of an 
osseointegated implant system for above-the-knee amputees. Acta Orthopaedica, 2012. 83(2): p. 121-128
OPRA
X-rays
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ITAP
Commercial fixations
OPRA
Residuum post-op
OPRA
ILP/OPL
ITAP
Commercial fixations
Overview
ILP OPL OPRA
Interface fixation - bone Press-fit Press-fit Screw
eP
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6OPRA
ILP/OPL
ITAP
Commercial fixations
Overview
ILP OPL OPRA
Interface fixation - bone Press-fit Press-fit Screw
Nb of surgeries 2 2 2
Stage 
1
Stage 
2
OPRA
ILP/OPL
ITAP
Commercial fixations
Overview
ILP OPL OPRA
Interface fixation - bone Press-fit Press-fit Screw
Nb of surgeries 2 2 –> 1 2
Stage 
1
Stage 
2
eP
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7OPRA
ILP/OPL
ITAP
Commercial fixations
Overview
ILP OPL OPRA
Interface fixation - bone Press-fit Press-fit Screw
Nb of surgeries 2 2 2
Duration rehabilitation * 4 mth 4 mth 9-12 mth
* Estimation
Stage 
1
Stage 
2
2 months
OPRA
ILP/OPL
ITAP
Commercial fixations
Overview
ILP OPL OPRA
Interface fixation - bone Press-fit Press-fit Screw
Nb of surgeries 2 2 2
Duration rehabilitation * 4 mth 4 mth 9-12 mth
* Estimation
Stage 
1
Stage 
2
6 months
eP
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8OPRA
ILP/OPL
ITAP
Commercial fixations
Overview
ILP OPL OPRA
Interface fixation - bone Press-fit Press-fit Screw
Nb of surgeries 2 2 2
Duration rehabilitation * 4 mth 4 mth 9-12 mth
Nb of years since first S1 * 8 2 15
* Estimation
OPRA
ILP/OPL
ITAP
Commercial fixations
Overview
ILP OPL OPRA
Interface fixation - bone Press-fit Press-fit Screw
Nb of surgeries 2 2 2
Duration rehabilitation * 4 mth 4 mth 9-12 mth
Nb of years since first S1 * 8 2 15
Nb of patients *
100 80
500
180
* Estimation
Most published and acknowledged
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9Hagberg, K. and R. Branemark, One hundred patients treated with osseointegrated transfemoral amputation prostheses-
-rehabilitation perspective. J Rehabil Res Dev, 2009. 46(3): p. 331-44.
Screening -6 mth0 12 186
Exclusion 
criteria
Pre-op
Treatment with OPRA 
• Diabetes
• Smoking
• Severe vascular disease
• Peripheral vascular disease
• Growing skeleton 
• Severe learning disability
• Lack of compliance
• Chemotherapy treatment
• Inability to adhere program / pregnancy
• Arteriosclerosis
• Mental illness
Treatment with OPRA 
Hagberg, K. and R. Branemark, One hundred patients treated with osseointegrated transfemoral amputation prostheses-
-rehabilitation perspective. J Rehabil Res Dev, 2009. 46(3): p. 331-44.
Screening -6 mth0 12 186
Pre-op
Inclusion 
criteria
• Socket-related problems
• Inability to use a conventional prosthesis
• Use of prosthesis limited significantly
• Short residual limb
• Dimension of residual bone
• Quality of residual bone
• Bilateral amputation
• Understanding the risks of complications
• Willing to comply with treatment protocol
• Following the rehabilitation protocol
• Acceptance of disability
K0 to K2
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Screening
Treatment with OPRA 
Surgery
-6 mth0 12 186
Residuum pre-op
Screening
Treatment with OPRA 
Surgery
-6 mth0 12 186
Stage 1 – Insertion medullar part
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Screening
Treatment with OPRA 
Surgery
-6 mth0 12 186
Stage 2 – Insertion percutaneous parts
Screening
Surgery
Treatment with OPRA 
Vertriest S, Coorevits P, Brånemark R, Hagberg K, Brånemark R, Vanderstraeten G, Frossard L. Static load bearing 
exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: Reliability of kinetic 
data. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2014. Accepted minor revisions. 
Rehab
-6 mth0 12 186
Load bearing exercises
Bone remodelling 
= 
Right load 
+ 
Right time
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Screening
Surgery
Treatment with OPRA 
Frossard, L., D.L. Gow, K. Hagberg, N. Cairns, B. Contoyannis, S. Gray, R. Brånemark, and M. Pearcy, Apparatus for 
monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation: A 
proof-of-concept study. Gait and Posture, 2010. 31(2): p. 223-228
Rehab
-6 mth0 12 186
Load bearing exercises - Static
Screening
Surgery
Treatment with OPRA 
Hagberg, K. and R. Brånemark, One hundred patients treated with osseointegrated transfemoral amputation 
prostheses - the rehabilitation perspective. Journal of Rehabilitation Research & Development, 2009. 43(3): p. 331-
344
Rehab
-6 mth0 12 186
Load bearing exercises - Dynamic
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13
Screening
Surgery
Treatment with OPRA 
Rehab
-6 mth0 12 186
Walking aids
Frossard, L., K. Hagberg, E. Haggstrom, and R. Branemark, Load-relief of walking aids on osseointegrated fixation: 
instrument for evidence-based practice. NSRE, IEEE Transactions on, 2009. 17(1): p. 9-14
Rehab
Screening
Surgery
Treatment with OPRA 
-6 mth0 12 186
Choice of components
Frossard, L., E. Haggstrom, K. Hagberg, and P. Branemark, Load applied on a bone-anchored transfemoral prosthesis: 
characterisation of prosthetic components – A case study Journal of Rehabilitation Research & Development, 2013. 
50(5): p. 619–634.
Fitting
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Benefits
Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous 
prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. 
Bone Joint J, 2014. 96(1): p. 106-113. Errata : Haddad, Bone Joint J: 2014,  96-B 106-113
Benefits
Health-related quality of life: SF 36
Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous 
prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. 
Bone Joint J, 2014. 96(1): p. 106-113. Errata : Haddad, Bone Joint J: 2014,  96-B 106-113
Benefits
Benefits
Health-related quality of life: SF 36
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Benefits
Benefits
Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous 
prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. 
Bone Joint J, 2014. 96(1): p. 106-113.
Health-related quality of life: Q-TFA
Benefits
Benefits
Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous 
prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. 
Bone Joint J, 2014. 96(1): p. 106-113.
Health-related quality of life: Q-TFA
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Benefits
Benefits
Sitting 
http://www.sahlgrenska.se/su/osseointegrationhttp://osseointeg.ning.com/profile/ErikAx
Benefits
Benefits
Lundberg, M., K. Hagberg, and J. Bullington, My prosthesis as a part of me: a qualitative analysis of living with an 
osseointegrated prosthetic limb. Prosthetics and Orthotics International, 2011. 35(2): p. 207-214
Body representation
N=13
‘‘ The prosthesis (OI-
prosthesis) is a part of 
me since it works so 
well, and you don’t have 
to think that it’s a 
problem and that it 
should be hard and so 
forth . . . it’s more like 
a substitute, my ¨
pretend leg ¨ ’’
http://news.bme.com/tag/amputation/
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Benefits
Benefits
Hagberg, K., E. Häggström, S. Jönsson, B. Rydevik, and R. Brånemark, Osseoperception and Osseointegrated Prosthetic 
Limbs, P. Gallagher, D. Desmond, and M. MacLachlan, Editors. 2008, Springer London. p. 131-140
Osseoperception
Benefits
Benefits
Hagberg, K., E. Häggström, S. Jönsson, B. Rydevik, and R. Brånemark, Osseoperception and Osseointegrated Prosthetic 
Limbs, P. Gallagher, D. Desmond, and M. MacLachlan, Editors. 2008, Springer London. p. 131-140
Doning and doffing
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Benefits
Benefits
Hip range of movement
http://osseointeg.ning.com/pro
file/ErikAx
Tranberg, R., R. Zügner, and J. Kärrholm, Improvements in hip- and 
pelvic motion for patients with osseointegrated trans-femoral 
prostheses. Gait & Posture, 2011. 33(2): p. 165-168
N=19 N=57
Benefits
Benefits
Frossard, L., K. Hagberg, E. Haggstrom, D. Lee Gow, R. Branemark, and M. Pearcy, Functional outcome of transfemoral 
amputees fitted with an osseointegrated fixation: Temporal gait characteristics. Journal of Prosthetics and 
Orthotics, 2010. 22(1): p. 11-20
Walking abilities and functional outcomes
N=12
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Risks
Infections
Risks
[1] Tillander, J., K. Hagberg, L. Hagberg, and R. Branemark, Osseointegrated Titanium Implants for Limb Prostheses 
Attachments: Infectious Complications. Clinical Orthopaedic Related Research, 2010. 468(10): p. 2781-2788
[2] Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous 
prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. 
Bone Joint J, 2014. 96(1): p. 106-113.
Overview - Deep infections
Inclusion Follow-up
(2-3 yrs) (S2-2 yrs)
Reference [1] [2] [1] [2]
Number of participants in study 39 51 39 51
Definite implant infection / Deep implant 
infection 5% 11% 15% 6%
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Risks
[1] Tillander, J., K. Hagberg, L. Hagberg, and R. Branemark, Osseointegrated Titanium Implants for Limb Prostheses 
Attachments: Infectious Complications. Clinical Orthopaedic Related Research, 2010. 468(10): p. 2781-2788
[2] Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous 
prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. 
Bone Joint J, 2014. 96(1): p. 106-113.
Infections Overview - Deep infections
Inclusion Follow-up
(2-3 yrs) (S2-2 yrs)
Reference [1] [2] [1] [2]
Number of participants in study 39 51 39 51
Definite implant infection / Deep implant 
infection 5% 11% 15% 6%
Short course of antibiotics
Risks
[1] Tillander, J., K. Hagberg, L. Hagberg, and R. Branemark, Osseointegrated Titanium Implants for Limb Prostheses 
Attachments: Infectious Complications. Clinical Orthopaedic Related Research, 2010. 468(10): p. 2781-2788
[2] Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous 
prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. 
Bone Joint J, 2014. 96(1): p. 106-113.
Infections Overview – Superficial infections
Inclusion Follow-up
(2-3 yrs) (S2-2 yrs)
Reference [1] [2] [1] [2]
Number of participants in study 39 51 39 51
Local soft tissue infection in the skin 
penetration area / Superficial infection 17% 11% 29% 80%
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Risks
[1] Tillander, J., K. Hagberg, L. Hagberg, and R. Branemark, Osseointegrated Titanium Implants for Limb Prostheses 
Attachments: Infectious Complications. Clinical Orthopaedic Related Research, 2010. 468(10): p. 2781-2788
[2] Branemark, R., O. Berlin, K. Hagberg, P. Bergh, B. Gunterberg, and B. Rydevik, A novel osseointegrated percutaneous 
prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. 
Bone Joint J, 2014. 96(1): p. 106-113.
Infections Overview – Superficial infections
Inclusion Follow-up
(2-3 yrs) (S2-2 yrs)
Reference [1] [2] [1] [2]
Number of participants in study 39 51 39 51
Local soft tissue infection in the skin 
penetration area / Superficial infection 17% 11% 29% 80%
Cleaning
Risks
Pitkin, M., On the way to total integration of prosthetic pylon with residuum. Journal of Rehabilitation Research & 
Development, 2009. 46(3): p. 345-360
Infections Discharge
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Infections
Risks
Thompson M. Mechanical analysis of osseointegrated transfemoral implant systems. 2009. Master Thesis. Queen’s 
University Kingston, Ontario, Canada
Breakage
Activity 
of daily 
living
High-impact activities / Falls
Breakage
Infections
Risks
Titel RSA and radiographic
Nebergall, A., C. Bragdon, A. Antonellis, J. Kärrholm, R. Brånemark, and H. Malchau, Stable fixation of an 
osseointegated implant system for above-the-knee amputees. Acta Orthopaedica, 2012. 83(2): p. 121-128
Loosening
N=55
1, 2, 5, 7, 10 years post-op
Strong bonding
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Risks vs Benefits
Benefits Risks
Future developments
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Future developments
Kang, N.V., C. Pendegrass, L. Marks, and G. Blunn, Osseocutaneous integration of an intraosseous transcutaneous 
amputation prosthesis implant used for reconstruction of a transhumeral amputee: Case report. The Journal of Hand 
Surgery, 2010. 35(7): p. 1130-1134.
ITAP, Stanmore Implant, UKFixation
NHS
Clinical 
trial
Future developments
http://www.healio.com/orthotics-prosthetics/prosthetics/news/online/%7Bbf5a0e16-eb8c-4e89-aa8b-
0e2941bc31fb%7D/researcher-announces-plans-for-fda-study-of-osseointegrated-implants
University of Utah - Orthopaedics DepartmentFixation
FDA
Clinical 
trial
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TeamsFixation
Future developments
http://www.chalmers.se/en/news/Pages/Thought-controlled-prosthesis-is-changing-the-lives-of-amputees.aspx
Neuromuscular control of prosthesis
Focus
Focus
TeamsFixation
Future developments
Accessible to population with diabetes
Challenges
K. Ziegler-Graham, E. J. MacKenzie, P. L. Ephraim, T. G. Travison, and R. Brookmeyer, "Estimating the prevalence of 
limb loss in the United States: 2005 to 2050," Arch Phys Med Rehabil, vol. 89, pp. 422-9, Mar 2008.eP
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Focus
TeamsFixation
Future developments
High impact activities
Challenges
http://www.tulsaworld.com/
Focus
TeamsFixation
Future developments
Accessible to low income countries
Challenges
http://projecthopeinthefield.blogspot.ca/2010_04_01_archive.htmleP
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Focus
TeamsFixation
Future developments
Pediatric applications
Challenges
http://www.dailymail.co.uk/news/article-1160954/With-pairs-legs-I-feel-10-feet-tall-The-boy-7-doesnt-let-double-
amputation-hold-back.html
Australia : leader worldwide
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Australia : leader worldwide
Clinical 
know-how
• 3rd largest population worldwide
• largest population outside Europe
• Fastest growing population worldwide
OPRA
500 cases
15 years
≈
33 cases/year
ILP/OPL
80 cases
2 years
≈
40 cases/year
Population
Population
Australia : leader worldwide
Clinical 
know-how
Several world firsts
• Broadest range of case-mix
Case-mix
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Population
Case-mix
Australia : leader worldwide
Clinical 
know-how
• Only two countries where patients 
have 2 choices of implants
OPRA ILP OPL
• Only country where patients have 3 
choices of implants
Choice
Population
Case-mix
Choice
Australia : leader worldwide
• State (QLD) looking at fair and 
equitable reimbursement scheme
Support 
government
15K for kit Otto Bock 
prosthesis
Support
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Population
Case-mix
Choice
Support
Australia : leader worldwide
Unique Clinical Outcome Registry
=
Evidence-based treatment
Scientific 
expertise
Research
Population
Case-mix
Choice
Support
Research
Australia : leader worldwide
• Biggest demand is in Australia
Heat + sweat
=
Poor socket fit 
=
Poor quality of life
Demand 
Patients
Clinical 
know-how
Support 
government
QLD
NT
Demand
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Are bone-anchored prostheses about to 
revolutionise the world of prosthetics?
• BAP works!
• It is happening!
• It is happening now in Australia!
Just some 
thoughts!
Not yet!
Eligibility 
criteria
Exclusion
• Diabetes
• Smoking
• Severe vascular disease
• Peripheral vascular disease
• Growing skeleton 
Safe
No major loss 
of incomeseP
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Soon, it might!
Eligibility 
criteria Change
Inclusion
• Diabetes
• Smoking
• Severe vascular disease
• Peripheral vascular disease
• Growing skeleton 
Possible loss of 
incomes
Inclusion
Soon, it might!
• Revisiting the use of K-Levels for choice 
of components
o All patients = K4 regardless of 
functional outcomes
• Manufacturing of purposely designed 
components (e.g., knee)
o Larger ROM
o Safer (e.g., fall)
o Capitalising more on osseoperception
o Better monitoring of ADL and usage
Developt
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Inclusion
Developt
Soon, it might!
• Before surgery
o Referral of patients
o Participate to screening
• After surgery
o Fitting limb
 Minimise risks of fall
 Loading profile
 Fixing / Replacing fixation parts
o Primary care for infection prevention
 Diagnosis
 Treatment (e.g., Referral GP, surgeon)
CPO Role
Inclusion
Developt
Soon, it might!
• Assistance from supporting bodies:
o E.g. QALS in QLD
 23 hours
 $15K for componentsCPO Role
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Laurent Frossard (1, 2, 3)
Are bone-anchored prostheses about to 
revolutionise the world of prosthetics?
Melbourne, Australia –
10/10/2014
AOPA Congress 2014
(1) University of the Sunshine Coast, 
Autralia
(2) Queensland University of Technology, 
Australia
(3) Marie-Enfant Rehabilitation Center, 
Canada
Website
www.YourResearchProject.com
www.laurentfrossard.com
LinkedIn
www.ca.linkedin.com/pub/laurent-frossard/5/4b4/b59/
Google+
www.plus.google.com/#113083134851353167716/about
Facebook
www.facebook.com/YourResearchProjecteP
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