This is the first installment of our four-part series on Osseointegration, Bionic Solutions, and Clinical Outcomes, with Dr. Laurent Frossard. Other parts include:
- Part 2: Disadvantages of Osseointegration
- Part 3: Eight Ways to Improve Osseointegration
- Part 4: Key Issues for Osseointegration Patients
You can obtain a PDF version of the transcript for this interview, complete with references, at Part_1 – Advantages of Osseointegration.pdf.
For your search convenience, we have also included a raw text transcript beneath the embedded video below.
Finally, if you like the video, don’t forget to check out our Key Contacts & Related Information section at the bottom of this article.
Hi Everyone. My name is Wayne Williams — the founder of BionicsForEveryone.com.
One of our main missions is to help those with disabilities understand the technology options available to them.
Today, I’m proud to introduce our four-part video interview called “Osseointegration, Bionic Solutions, and Clinical Outcomes.” In Part 1 of this series, we’re going to examine the advantages of osseointegration.
To help us do this, we’ll be relying on the expertise of Dr. Laurent Frossard, a leading expert on osseointegration and bionic limbs in general.
Dr. Frossard is currently an adjunct professor at Griffith University, Queensland University of Technology, and University of the Sunshine Coast, all in Australia. He is also the Chief Scientist Officer at the company, YourResearchProject Propriety Ltd.
But the thing that excites us most about talking to Dr. Frossard is that he considers treatments from an all-round perspective integrating prosthetic biomechanics, clinical benefits, health service delivery, and health economics, making his expertise quite unique.
Dr. Frossard, nice to speak with you today.
Hello Wayne, many thanks for having me today. I am very glad to talk to you and your audience at BionicsForEveryone.com. I think your website is fantastic. There is a big demand for end-users for this type of information you are providing and I’m delighted to have the chance to talk to you.
Doctor, there are a lot of buzz words in the bionic world that are used to describe prosthetic innovations. Before we get to the heart of the topic, it might be helpful to describe the terms that we are using in the title of this series.
Yes, I agree with you that the lingo we use is often rather confusing.
Let’s start with a basic definition: Bionics is the field of science that studies how mechanical systems can function like a living organism.
Human bionics is looking at how a piece of engineering can behave like a body part. Bionic limbs involve the development of artificial limbs that can, at least mimic, and possibly amplify, the functions of a missing limb.
For me, bionic solutions combine advanced components, a suitable attachment, and intuitive control. It works a little bit like a car:
- Advanced prosthetic components are the central part of a bionic solution, particularly microprocessor-controlled components that behave like robotic artificial joints. This is like the engine!
- Suitable attachment of the residuum can be achieved either through direct contact with the skin in the case of a socket prosthesis, or with osseointegrated implants in the case of a bone-anchored prosthesis. This is the chassis!
- Intuitive control of the prosthesis can be achieved using sensors recording information from the brain, nerves, or muscles. This is the power-assisted steering wheel!
Bionic limbs are physically connected with all sorts of body parts like the brain, nerves, muscles, skin, and bone. But bionic limbs also rely on what we could call a “black box” including all mathematics making the physiological information intelligible for the prosthetic components. That is the dashboard!
That’s a great analogy. That means there are a variety of bionic limb solutions?
Absolutely. There is a broad range of bionic limb solutions integrating the human body and artificial limbs.
Simple bionic solutions involve sockets or bone-anchored prostheses fitted to bionic limbs with microprocessor-controlled prosthetic joints using osseointegrated implants.
Advanced bionic solutions allow individuals themselves to control their bionic limbs. Their own salvaged nerves and muscles can be put to use through a surgical procedure called Targeted Muscle Reinnervation (TMR). These prostheses are sometimes called neuroprostheses.
Even more complex solutions allow thought-control of a robotic arm not even attached to the body!
You mentioned attaching the prosthesis to osseointegrated implants. Osseointegration is often presented as a big step forward in the development of prosthetics. Can you tell us more about osseointegration?
Osseointegration is a physiological process allowing a direct attachment between a living bone and an artificial implant.
Osseointegration solutions allow direct skeletal attachment of a prosthesis. This involves the surgical insertion of an implant into the residual bone. This is a rod of titanium that integrates with the inner part of the bone through the osseointegration process.
In some cases, the osseointegrated implant is enclosed inside the residuum between the bone and the end of the residuum, acting as an extensor. The implant is not visible from the outside. A socket is attached to the prosthesis. This is the case of the Keep-Walking implant, for example.
In other cases, the osseointegrated implant has one end inside the residual bone and the other end sticking out of the residuum through a permanent stoma. Only the visible end of the implant is used to attach the prosthesis without a socket. We call them bone-anchored prostheses.
Can osseointegration and bionic solutions work together?
Yes, both approaches complement very much each other. This is particularly true for individuals experiencing overwhelming challenges with a socket attachment.
Osseointegration solutions alone tend to be used predominantly to restore the capacity of lower limbs to bear at least the bodyweight during daily activities. However, targeted muscle reinnervation procedures for transtibial and transfemoral amputations are emerging.
Bionic solutions are more used for upper limbs to increase fine motor control and dexterity. However, direct skeletal attachment is now regularly considered alongside targeted muscle reinnervation procedures.
No doubt that bone-anchored bionic prostheses are promising options for both lower and upper limbs. They can integrate advanced prosthetic components with better attachment and better control. Bone-anchored protheses have tremendous potential to
improve function, mobility, and quality of life.
However, the benefits of both approaches can be added…so as the adverse events! The more technologies involved, the more risks of complications. So, these options alone or together must be considered very carefully.
In one of our earlier articles, we attempted to describe the main advantages and disadvantages of osseointegration. However, after reading a few of your scientific papers, we realized that we didn’t do a very good job. Can you describe the main advantages of osseointegration for the patient?
The direct attachment of a prosthesis through an osseointegrated implant has immediate benefits. First, it eliminates the usual problems associated with a socket, particularly all the residuum’s skin problems.
It eases attachment and removal of the prosthesis. It provides a much more comfortable sitting position. Imagine how it can change the life of a truck driver, for example. And realizing that no more toilet seats might be broken!
An osseointegrated implant allows a much larger range of movement of the prosthetic knee and hip. And users of osseointegrated implants report that they “feel” that their prosthesis is more like a part of their body. This is essentially due to a phenomenon called osseoperception. Practically, this means that people can feel more vibrations. This helps to feel where the prosthetic foot is on the ground and the type of surface the person is walking on.
So how do these basic benefits translate in daily life?
Well, there is overwhelming evidence that bone-anchored prostheses significantly improve mobility. Users walk faster for longer periods of daily and recreational activities. This is particularly obvious for young and active individuals with short transfemoral amputation.
However, it is important to highlight that these outcomes are affected by the fact that users are not only fitted with osseointegrated implants but also with advanced prosthetic components. This includes microprocessor-controlled knees (MPK) and energy-storing-and-return (ESAR) feet. So, the improvements in mobility are due to the cumulated benefits provided by both the implant and advanced prosthetic components.
Overall, would you say that this method of attachment makes people happier?
Yes, absolutely! Well-defined metrics were used to measure users’ health-related quality of life. Basically, these are measures of how amputation affects well-being.
All the studies demonstrated that the use of bone-anchored prostheses improved noticeably the quality of life. Indeed, I have published studies about the health economic benefits of bone-anchored prostheses showing that the quality of life with osseointegration improved by about 17% compared to socket prostheses.
These studies did not consider the placebo effect nor other possible biases due to the preconceived favorable incline of patients involved in these studies.
What do you mean by preconceived favorable incline?
I am referring to a phenomenon well-known in the field of clinical research. Simply, this means that participants tend to answer favorably to a question about treatment if they have been told previously that this treatment works. This effect is even stronger if patients have been treated by someone with prestigious status, and someone they completely believe, trust and respect.
So, I guess, it will take a long time before we actually know how much these effects impact favorably the reports of the benefits.
In all cases, I must say that I have met well over a hundred users and I have never met anyone who said that the procedure did not change his or her life for the best!
So the outlook on the benefits of osseointegration is positive?
Oh, I think it is a fair statement. This is true for the users themselves, but it could also be true for healthcare administrators because there is early evidence of the cost-effectiveness of bone-anchored prostheses compared to other conventional attachments.
This means that healthcare systems could have a “bang for their buck”, at least when considering the costs for the provision of prosthetic care.
The cost-effectiveness might be less favorable if we were to consider all the surgical, medical, and prosthetic care costs. But there are only very few healthcare systems that look at these costs altogether.
Anyway, I know this might not be directly relevant to your audience, but it is important because it can facilitate the broad acceptance and, more importantly, the creation of relevant reimbursement schemes. Ultimately, this means less out-of-pocket expenses for the users!
Are osseointegration and advanced bionics the ultimate solutions?
I wish I could say yes. However, the prospect of having a life socket-free also comes with an increased exposure to health risks. And these risks could be significantly more damaging than issues experienced with a socket.
So, the benefits of osseointegration do not always outweigh the risks.
It is important to inform potential users that osseointegration comes with the good…as well as the bad and the ugly!
Let’s discuss that in Part 2 of this series.
For more information on Dr. Laurent Frossard, please visit his website.