1231 - Integration of Total Hip Arthroplasty Following Osseointegration in an Above-Knee Amputee

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

RA

Ryane E. Adams, N/A, MD

Resident
University of Texas at Houston Health and Science Center
Houston, Texas, United States
OE

Ovie Enaohwo, MD

Resident
University of Texas at Houston Health and Science Center
Houston, Texas, United States

Co-Author(s)

PV

Peter Vu, MD

Fellow
Beth Israel Deaconess Medical Center - Harvard Medical School
Houston, Texas, United States

Submitter(s)

RA

Ryane E. Adams, N/A, MD

Resident
University of Texas at Houston Health and Science Center
Houston, Texas, United States

Case Diagnosis: Integration of Total Hip Arthroplasty Following Osseointegration in an Above-Knee Amputee

Case Description: A 64-year old female presents with a past medical history of right above-knee amputation thirteen years ago following sarcoma radiation therapy. Eight years ago, she underwent an osseointegration (OI) procedure secondary to difficulty ambulating with traditional socket fit prosthesis. Patient was able to return to independent and active lifestyle, ambulating over 15K steps a day. Due to worsening hip osteoarthritis, she underwent a right total hip arthroplasty (THA) and OI revision several months after her initial OI procedure, producing a complex bio-mechanical scenario.

Discussions:

The direct skeletal attachment in femur OI fundamentally alters force transmission patterns, creating a rigid system where impact forces transmit directly to the proximal femur and hip joint. This can influence biomechanical discrepancies. In normal bone, stress is gradually transferred along the femur length. With an osseo-integrated implant, stress shielding occurs where the metallic implant bears a greater proportion of weight compared to the surrounding bone tissue.

The addition of a THA femoral head and stem alone can change the force distribution and gait pattern. With both the THA and OI, the proximal femur must then accommodate two distinct load patterns: the axial and torsional forces from the OI implant traveling longitudinally through the femoral shaft, and the multi-directional forces from the hip joint.

This dual-implant system demands careful muscle function consideration of both the pre-existing biomechanical alterations from OI and the new forces introduced by THA.

Conclusions:

This case uniquely illustrates the combination of THA with an osseointegrated prosthesis in the same limb, raising important clinical considerations for those who care for the amputee population as OI becomes more prevalent in amputee care.