One lesson from arthroplasty to osseointegration in search for better fixation of in-bone implanted prosthesis

Direct transcutaneous prosthetic attachment (osseointegration) consists of implanting directly into the residuum bone a metal pylon whose external fraction connects the residuum to the external prosthesis. Since the introduction of osseointegration about 20 years ago, the obvious challenge associated with this technology has been the skin-pylon interface as a source of infections. In comparison, the bone-device interface was considered less problematic because of the knowledge and experience inherited from dental implantology and total joint replacement (arthroplasty). Current methods of pylon fixation in osseointegration follow arthroplasty’s paradigm of positioning the pylon’s shaft inside the bone’s medullary canal. However, adopting the medullary canal as a holding compartment for the pylon’s shaft creates the problem of shaft loosening, which has not yet been solved in arthroplasty.