Surgery
How does the operation work?
The implantation of the EEP is usually done in two steps, either in general or local anesthesia. You will be educated about the different aspects and special risks of the narcosis separately.
During the first step the skin and soft tissue covering the lower end of the remaining bone is opened using the old scars. Sometimes the soft tissue is remodeled to get rid of scar tissue and to position the bone in a desirable way. The bone is then uncovered and shortened to an extend that is calculated before surgery. After that, the implant stem is inserted into the bone, a drain is put into the stump and the soft tissue coat is closed again.
In the following weeks osseoingeration takes place which means the bone grows into the implant and forms a stable bond with it.
During a second stage operation about 6 weeks later the circular skin opening (stoma) is created using a core-cutter. With this step, the skin perforating opening from inside to the outside of the body is performed. Then the exo-module of the prosthesis is attached to the internal implant stem via a dual cone which serves as the “bridging connector”.
In accordance with the stability of the soft tissue as well as x-ray follow-ups partial weight bearing can then be started together with physiotherapists and prosthetists.
Further prosthetic fitting of the knee- and/or lower leg prosthesis is then done under guidance of a prosthetist. The aim is to make it possible to use an artificial exo-prosthesis like the so-called "C-Leg®1".
This means that only a few days after the second step procedure partial weight-bearing can usually be achieved and prosthetic alignment can be started. This all happens together with the surgeon, the prosthetist as well as physiotherapists.
Hygiene and Care
To avoidcomplications associated with the stoma area a disciplined stump- and stoma care are inevitable. We advise to clean the stoma as well as the exo-modules using fresh water and non-perfumed soap at least twice daily. Using a non-shedding shaving brush or a shower stream can be useful as well.
For skin care we recommend non-perfumed skin protection crèmes. Altogether this care takes about 10 minutes each day and can be done together with daily routine body care.
Disinfection of the stoma or regular treatment with antiseptic fluids cannot prevent the natural bacterial flora from colonizing this area and should not be done because we know nowadays that it does not help to prevent any ascending infection and may on the contrary even lead to more irritation. We want the skin’s normal flora to grow in the stoma region to create a healthy, stable and homeostatic surrounding, which we believe is the best shield against infection.
What do I need to consider?
An excessive rotational move (torque) of the prosthesis should be avoided as a matter of principle. If an immoderate force is nevertheless applied, a shear pin at the inner part of the dual cone adaptor breaks off and therefore prevents the bone from taking up too much load and fracturing. So this system saves and relieves the bone from too much burden. The implants are made of a casted cobalt-chromium-molybdenum-alloy (CoCrMo) and have a titan-niobium coating (TiNb). This material prevents allergic reactions. An EEP does therefore not require any permanent medication.
