Percutaneous exposure for tibia osseointegration: reduced antibiotics, improved perioperative metrics, and greater pain reduction versus open exposure.

Abstract

Introduction: This article compared outcomes of patients who received transtibial osseointegration through percutaneous incision (Perc and existing amputation by definition), open exposure (Open) of an existing amputation, or simultaneous transtibial amputation and osseointegration (Amp).

Methods: Retrospective chart review evaluated the aims. Adverse events: subsequent antibiotic administration and additional relevant surgery. Perioperative care: length of operation, estimated blood loss, infusion volume, and length of hospital stay. Patient-reported outcomes: preoperative versus postoperative scores of the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) and PROMIS patient-reported outcome measures. Comparisons were made at short term (first 6 months) and longer term (6 months and beyond).

Results: The demographics of the 7 Amp, 15 Open, and 14 Perc patients were similar with the exception of time between amputation and osseointegration, etiology of amputation, and laterality. Perc patients had significantly lower antibiotic prescription versus Amp patients in the first 6 months (21% vs. 100%, P = 0.001) and versus Open beyond 6 months (21% vs. 66%, P = 0.025). Additional surgery for debridement or removal was minimal and similar among the 3 groups. Operative time was significantly shorter for Perc versus Amp (66.9 vs. 173.6 minutes, P < 0.001) and Perc versus Open (66.9 vs. 166.7 minutes, P < 0.001). Estimated blood loss was significantly less for Open versus Amp (87.1 vs. 257.1 mL, P = 0.001) and Perc versus Open (40.0 vs. 257.1 mL, P < 0.001). Inpatient stay was significantly shorter for Perc versus Open (2.5 vs. 3.5 days, P = 0.022). Perc patients also had significantly better improvement versus Open group for LD-SRS pain subscore (1.5 vs. 0.6, P = 0.010), PROMIS pain intensity score (-14.7 vs. -4.3, P = 0.005), and PROMIS pain interference score (-17.1 vs. -4.8, P = 0.007). Interestingly, the Amp group had a significantly better improvement in PROMIS pain intensity score versus the Open group (-21.1 vs. -4.3, P = 0.009).

Conclusions: Although a percutaneous approach may not always be possible, surgeons may want to actively consider whether their patients can have a smaller surgical approach that may confer measurable benefits.