Abstract
Background Osseointegrative implantation after amputation of the lower extremity is a special
treatment option. Physiotherapeutic treatment is important for the functional outcome.
This study systematically evaluated existing follow-up treatment protocols to establish
a literature-based recommendation for postoperative rehabilitation procedures.
Methodology A PubMed literature search was conducted on December 10, 2020, using the following
search terms: (osseo-integrat* OR endo-exo OR boneanchored OR bone anchored) AND
(prosthe*) AND (leg OR lower limb* OR lower extremit* OR transfem* OR transtib*) AND
(rehabilitation). 113 publications were found in this context. 10 of them met inclusion
criteria. The
Cochrane risk of bias tool was used to determine the publicationsʼ quality.
Results Three systematic rehabilitation protocols have been described: Osseointegrated Prostheses
for the Rehabilitation of Amputees protocol, Osseointegration Group of Australia
Accelerated protocol and Radboud Amputation: rehabilitation protocol for endo-exo
femoral prosthesis. There are clear differences in the duration of the rehabilitation
protocols. The quality
of published studies is limited due to the high risk of bias and low evidence levels
(mainly III – V). A concept for long-term rehabilitation has not been described yet.
Conclusions There are various protocols for rehabilitation after treatment with osseointegrative
prosthesis. Gradually increasing axial weight bearing started shortly after surgery;
step-by-step gait training, adaptation of the prosthesis to the new biomechanics and
critical patient selection and pre-operative training have been proven useful for
successful
rehabilitation. Controlled comparative studies, standardised outcome measurements
or comparative studies between different protocols are not available. Models for multi-level
long-term care
have not been described in the literature so far.
Key words transfemoral amputation - transcutaneous osseointegrated prosthesis - OPRA-protocol
- OGAAP - RAp-EEFP
