The Clinical History and Basic Science Origins of Transcutaneous Osseointegration for Amputees

Figure 10

Notable designs by Charles William Hall. (a) Sketch of a 1975 attempt to preserve muscle-tendon control of the distal joint via a percutaneous artificial tendon. The inevitable artificial tendon rupture and issues with infection coming from the skin-bone interface led to this design’s abandonment. (b) The final design proposed by the Hall team featured an intramedullary central titanium textured nail with three perpendicular lug attachments. The bone end was mortised to match the implant junction in order to prevent rotation before osseointegration occurred. The skin was closed over the triflanged lugs. These three lugs were later connected to an external prosthesis yoke. A key design element was that the transcutaneous bolts that connected the internal implant to the yoke was at right angle to the skin, which Hall believed would minimize tension on the skin with limb movement and thus minimize irritation, inflammation, and eventual infection (figures adapted from public domain articles. (a) Hall, C. W. Permanently attached artificial limbs. Bull Pros Res. 1975 BPR 10–42 23: 321–327. (b) Hall, C. W. A future prosthetic limb device. J Rehab Res. July 1985; BPR 10–42 22(3):99–102).

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