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The clinical, radiological, microbiological and molecular profile of the skin-penetration site of transfemoral amputees treated with bone-anchored prostheses.

Journal article
Authors Maria Lennerås
Georgios Tsikandylakis
Margarita Trobos
Omar Omar
Forugh Vazirisani
Anders Palmquist
Örjan Berlin
Rickard Brånemark
Peter Thomsen
Published in Journal of Biomedical Materials Research
Volume 105
Issue 2
Pages 578–589
ISSN 0021-9304
Publication year 2017
Published at Institute of Clinical Sciences, Department of Biomaterials
Institute of Clinical Sciences, Department of Orthopaedics
Pages 578–589
Language en
Subject categories Biomaterials Science, Orthopedics


The breach of the skin barrier is a critical issue associated with the treatment of individuals with transfemoral amputation (TFA) using osseointegrated, percutaneous titanium implants. Thirty TFA patients scheduled for abutment exchange or removal were consecutively enrolled. The aims were to determine the macroscopic skin signs, the presence of bacteria and the gene expression in abutment-adherent cells and to conduct correlative and comparative analyses between the different parameters. Redness and a granulation ring were present in 47% of the patients. Bacteria were detected in 27/30 patients, commonly in the bone canal. Staphylococcus aureus, coagulase-negative staphylococci, streptococci, and Enterococcus faecalis were the most common. A positive correlation was found between TNF-α expression and the detection of S. aureus. Staphylococcus aureus together with other bacterial species revealed a positive relationship with MMP-8 expression. A negative correlation was demonstrated between the length of the residual femur bone and the detection of a granulation ring and E. faecalis. A positive correlation was revealed between fixture loosening and pain and the radiological detection of endosteal bone resorption. Fixture loosening was also correlated with the reduced expression of interleukin-10 and osteocalcin. It is concluded that several relationships exist between clinical, radiological, microbiological, and molecular assessments of the percutaneous area of TFAs. Further long term studies on larger patient cohorts are required to determine the precise cause-effect relationships and unravel the role of host-bacteria interactions in the skin, bone canal and on the abutment for the longevity of percutaneous implants as treatment of TFA. © 2016 Wiley Periodicals, Inc. J

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