Rehabilitation

Radboudumc Amputee Osseointegration Rehabilitation Protocol

Start:  1 week after osseointegration surgery.

Format: Daily outpatient clinic group sessions (2-8 patients)

Rehab team:  Rehabilitation physician, physical therapists , occupational therapist and prosthetist

Aim: 1. Progressive loading to full weight bearing on the osseointegration prosthesis using parallel bars and walking aids (crutches). 2. Stoma care instructions. 3. Pain management. 4. Prosthetic alignment and fine tuning. 5. Peer to peer support in group sessions to  enable the sharing of experiences with peers and to provide a safe environment surrounded by experienced osseointegration professionals.

Limitations: In the first months after osseointegration, muscle pain is often a limiting factor of unsupported gait and walking distance. Walking without crutches may take 2 to 6 months. The rehabilitation physician will indicate the intensity of the gait training and may prescribe painkillers to relieve muscle or joint pain.

Standard program (progressive loading to full weight bearing in 6 weeks)

Day 3-10: Prosthetic fitting axial weight bearing on a scale (three times daily 30 min) until 50% body weight. Increase load based on pain (NRS <5).
Day 10-35: 50% weight bearing, walking between bars and walking with a walking aid. Muscle stretch exercises, muscle force training. Core stability training and cardio fitness
Day 35-42: Full weight bearing with a walking aid and afterwards reduce use of walking aid based on pain (NRS <5).

Slow program (progressive loading to full weight bearing in 12 weeks)

Indication: short bone length and/or poor bone quality

First 6 weeks: Prosthetic fitting and axial weight bearing on a scale (three times daily 30 min) until 50% body weight. Increase load based on pain (NRS <5). Muscle stretch exercises, muscle force training, core stability training and cardio fitness. Walking between bars and walking with a walking aid.

Week 6 to 12: Axial weight bearing until 100% body weight. Increase load based on pain (NRS <5). Muscle stretch exercises, muscle force training, core stability training and cardio fitness. Walking between bars and walking with a walking aid.