[Treatment with TOPS for short femoral stump].

Abstract

Objective: Treatment with transcutaneous osseointegrated prosthesis systems (TOPS) for short femoral amputation stumps aims to restore independent walking ability after proximal femoral amputation by direct bone-guided prosthesis anchorage. This cannot be safely achieved with conventional socket prostheses due to the mechanically inadequate socket contact surface.

Indications: Treatment of patients with short transfemoral stumps who cannot be mobilized sufficiently with conventional socket prostheses.

Contraindications: Known contraindications as with standard TOPS fittings.

Surgical technique: Special features already arise during positioning with correct orthograde adjustment of the short femoral stump under X‑ray fluoroscopy. The prosthesis is anchored using the specified technique, taking into account the central insertion of the femoral neck screw with the aid of the aiming arm under X‑ray fluoroscopy in two planes.

Postoperative management: In most cases, step 1 and 2 treatment is primarily possible, i.e., insertion of the double-cone adapter and passing through the skin by the intraoperatively created stoma (skin opening on the amputation stump). This requires patient compliance and hygiene with twice daily showering of the stoma and dressing. After the exoprosthesis components have been fitted by the patient's orthopedic technician, weight-bearing with the new adapted prosthesis is possible.

Results: A total of 14 TOPS procedures were performed at Rostock University Medical Center between 2022 and 2024, including 9 patients with short femoral stumps. A prolonged rehabilitation phase compared to patients with "standard" TOPS restorations is not recognizable, but a significant gain in quality of life is evident.