This is the final installment of our four-part series on Osseointegration, Bionic Solutions, and Clinical Outcomes, with Dr. Laurent Frossard. Other parts include:
- Part 1: Advantages of Osseointegration
- Part 2: Disadvantages of Osseointegration
- Part 3: Eight Ways to Improve Osseointegration
You can obtain a PDF version of the transcript for this interview, complete with references, at Part_4 – Key Issues for Osseointegration Patients.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.
Welcome back to our series on Osseointegration, Bionic Solutions, and Clinical Outcomes, Part 4, Key Issues for Osseointegration Patients, with our guest, Dr. Laurent Frossard.
Dr. Frossard, beyond the question of efficacy and safety, your work addresses several issues that are not commonly presented to the public. One of these was the suitability of candidates for osseointegration. What are the factors that make a patient suitable or not suitable for this procedure?
Well, comorbidity, such as obesity, smoking, diabetes, and other vascular issues are strong contraindications. They are quite common issues faced by people living with limb loss. In fact, these contraindications limit immensely access to a wide population. Regularly, clinicians tried to perform osseointegration of patients with these conditions. However, there is strong evidence that it might not be the right thing to do.
Anyone without these conditions could technically be eligible for the surgery. However, there are strong indications. One of them is overwhelming challenges to tolerate a socket, making a prosthesis impossible to use. This might be because of the shape of the residuum (too short, too bulbous) as well as problems with the skin, like allergies to liners.
If you look at the data, it seems like the potential benefits outweigh the risks for young and active individuals with high traumatic transfemoral amputation.
If I were a suitable candidate, is it already at the stage where I should rush out to get this procedure or would it be wiser for me to exercise considerable caution?
Well, beyond the contraindications and indications, it is difficult for me to tell someone whether bionic and osseointegrated solutions are advisable.
What I can do is what I do now: explaining as simply as I can what are the most likely benefits and harms. Basically, it means explaining what I call the 20/20 dilemma. At best, the quality of life can improve by 17 to 20%. This biggest risk of failure is about 20%. So, it belongs to each individual to decide if the risks outweigh the benefits or vice-versa.
In my view, the decision to choose bionic and osseointegrated solutions depends primarily on personal life goals and objectives. Using a bone-anchored prosthesis might not mean the same thing for an active father-to-be truck driver spending a lot of hours sitting behind the wheel for work, compared to a nearly-retired lady facing high risks of osteoporosis.
Do you believe there is an element of taking risks in the decision to choose bionic solutions?
Completely! I believe that ultimately choosing bionic solutions comes down to the individual’s willingness to take risks. This 20/20 dilemma might be tackled very differently by people who are more or less favorable or advert to risks.
In all cases, I think it is critical to highlight that people are literally buying into a piece of technology. What is different to most other pieces of technology is that it will live with the users for the rest of their lives.
In some ways, it is a little bit like a buying computer. You know that whatever and whenever you buy one, there will be a better one available in six months. The development of bionic technology is not as fast. It only improves slowly over time as we know more about material proprieties, loading requirements, management of infections.
However, the principle remains the same. The real key questions are often: Do I really need it? Do I need it right now? Can I wait?
Do you think timing should play a critical part in that decision?
Well, I think it must be considered. It is always challenging to defer potential opportunities, particularly when improving the lifestyle for people with a disability. We also live in a culture in which instant rewarding is very much constantly stimulated. Also, people living without a limb are subjected to very clever online marketing campaigns promising a wonderful life socket-free!
Of course, people of a certain age might be less inclined to factor the potential for upcoming technological developments and the long-term side effects of the intake of antibiotics.
The thinking process is more challenging for younger persons, particularly if they are non-prosthetic users. They could wait a few years to have the procedure done with the hope of being better off later. They could also choose current bionic solutions, as they are currently available, because it is likely that it could help them to fully enjoy a more active and fulfilling life here and there!
So, timing must also be balanced with other expectations and aspirations. And, to be honest, I think this could really make the decisions mindboggling in many cases!
You do a fantastic job of explaining some of these very complex issues, but to simplify things a bit further, how would you describe the short-term future of bionic solutions involving osseointegration?
Well, as I mentioned in the previous interviews, there are many attainable areas of development for bionic and osseointegrated solutions.
I believe that the “low hanging fruit”, so to speak, is the development of a pain-free rehabilitation program using a new monitoring tool. I am really hopeful with the development of new mathematical models of the residuum that will allow us to simulated biological changes before treatment.
Another big step will be to reduce infections and intake of antibiotics altogether. This will require us to improve the recording and reporting of the true infection rate. I am also very hopeful with current developments in basic science in antibiotics, stem cells, and biomaterials. It seems possible that implants could be coated with antibacterial films, for example, and that will make lots of good changes.
Another big area of development is around the use of remaining nerves and muscles to activate the prosthesis. A surgical procedure called Targeted Muscle Reinnervation (TMR) is gaining strong momentum.
Basically, the salvage nerves are reattached to the residual muscles that stimulate electrodes placed inside the muscles and activate the prosthesis. So, TMR and osseointegration combined should improve functions. New neuroprostheses will reverse the current dynamics between the users and their prostheses.
At the moment, despite advanced in microprocessors controlling the prosthesis, users must adapt to the functions of their prostheses. It will work the other way around with the neuroprostheses. The prostheses will respond to the individual command of the users. TMR is also a good way to reduce phantom pain.
Finally, the big game-changer, what investors called the BHAG, the Big Hairy Audacious Goal, is to make any bionic and osseointegrated solutions safely accessible to patients with vascular issues, including diabetics. This means making a viable solution available to the widest population suffering from limb loss.
This will be unbelievably awesome!
Many thanks, Dr. Frossard. Our audience has enjoyed you sharing your thoughts on these highly technical issues of bionic solutions involving osseointegration. You have also taken into consideration the very human aspects of these issues.
Wayne, it has been a real pleasure for me. Many thanks for giving me the chance to talk to you and your audience. I really enjoyed our interviews and I hope your audience will find that helpful. I’m sure people can contact you if they’ve got any questions.
In the meantime, I look forward to talking to you again soon. Thank you!
For more information on Dr. Laurent Frossard, please visit his website.