“It is moving when a patient tells you how their quality of life has improved”
Dr. Pablo S. Corona is an orthopedic surgeon, specialist in reconstructive surgery, infections and complex limb salvage. He is a pioneer in Spain in osseointegration procedures for amputees in a single surgery. Today we talk to him about this revolutionary technology that improves the quality of life of amputee patients.
What problems does the amputation of a limb involve? The amputation of a limb supposes an enormous vital impact for the patient. The loss will affect your mobility, your quality of life, and your ability to participate in work and leisure activities.
Why were osseointegration procedures developed? To provide a solution to those amputees who do not tolerate the use of conventional sockets. Osseointegration allows the prosthesis to be connected directly to the patient's skeleton, thus avoiding the need to use an interposed socket.
What does osseointegration surgery consist of in one time? The surgical procedure is relatively simple. It consists of the placement of a specially designed implant (OGAP-OPL) retrogradely in the bone remnant of the femur (or tibia) of the amputated patient. The implant is externalized through a hole in the distal skin of the stump called a stoma and is simply, quickly and safely connected to the artificial limb without the need for a classic prosthetic socket. What is revolutionary about our protocol is that these two steps (implantation and creation of the stoma) are performed in a single surgery, unlike the two surgeries required in classic protocols.
Which patients are candidates for osseointegration? Traumatic femoral amputated patients who do not tolerate conventional sockets are the ideal patients for this revolutionary surgery. It is also indicated in amputees due to cancer or even in infected cases where the disease is considered eradicated. It is important to emphasize that osseointegration is not an alternative to limb salvage. It is only indicated for patients already amputated and with severe problems with the socket, such as pain, irritation, skin infections, lack of control of the prosthesis or placement difficulty.
Are there contraindications for this type of surgery? Not all amputated patients are eligible for osseointegration. Skeletal immaturity is an absolute contraindication. Amputation for vascular causes (as in the case of diabetic patients) is a relative contraindication. In our protocol, smoking is an absolute contraindication, but if the patient stops smoking, they can be reconsidered for surgery.
What is GOE? GOE is the acronym for the Osseointegration Group of Spain, a partner of the Australian Osseointegration Group (OGAP). It is a specialized multidisciplinary team dedicated to the osseointegration of amputee patients whose objective is to offer this revolutionary technology to amputee patients with problems adapting to their traditional socket.
How did the group start? GOE arose from a combination of needs, intentions, and opportunities. In 2018 I was the invited international speaker at the annual meeting of the Australian Society for Reconstructive Surgery (ALLARS) held in Sydney. There I met Dr. Almuderis, who, interested in our work, offered me the possibility of introducing osseointegration in a time with the OGAP-OPL implant in Spain, distributed by SD-Trauma. After specific training carried out in Australia, both by myself and by Dr. Crespo, in 2019 we performed the first osseointegration surgeries in a while in Spain. After more than two years, and after obtaining absolute success in all our surgeries, we developed this project to offer this therapeutic option to amputee patients throughout Spain.
How does it make you feel to offer such a solution to your patients? The happiness expressed by the amputee patients whom we have osseointegrated is especially gratifying. It is touching when a patient tells you how it has improved her quality of life. It should not be forgotten that we only offer this technique to patients with significant socket problems and profound alterations in their quality of life. After a single surgical procedure and in a very short time interval, being able to walk autonomously, without assistance, with confidence, feeling the ground underfoot, is something incredible.