A computational model for stress reduction at the skin-implant interface of osseointegrated prostheses

Osseointegrated implants (OI)s for transfemoral prosthetic attachment offer amputees an alternative to the traditional socket attachment. Potential benefits include a natural transfer of loads directly to the skeleton via the percutaneous abutment, relief of pain and discomfort of residual limb soft tissues by eliminating sockets, increased sensory feedback, and improved function. Despite the benefits, the skin-implant interface remains a critical limitation, as it is highly prone to bacterial infection. One approach to improve clinical outcomes is to minimize stress concentrations at the skin-implant interface due to shear loading, reducing soft tissue breakdown and subsequent risk of infection. We hypothesized that broadening the bone base at the distal end of the femur would provide added surface area for skin adhesion and reduce stresses at the skin-implant interface. We tested this hypothesis using finite element models of an OI in a residual limb. Results showed a dramatic decrease in stress reduction, with up to ∼90% decrease in stresses at the skin-implant interface as cortical bone thickness increased from 2 to 8 mm. The findings in this study suggests that surgical techniques could stabilize the skin-implant interface, thus enhancing a skin-to-bone seal around the percutaneous device and minimizing infection.