You can ask your GP or medical specialist for support or a referral for osseointegration surgery prosthesis treatment at the AOFE Clinics in Utrecht. You will also be asked to register using the general registration form on this website. For this, see also “who qualifies for an osseointegration (click) prosthesis” on this website.

After your referral, AOFE Clinics will send you a questionnaire with questions about your amputation and your medical history. This questionnaire will be assessed by the osseointegration team and, based on this pre-screening, it will be determined whether you may be eligible for osseointegration surgical procedure. You will be informed about this and, depending on your situation, you will receive an invitation for an initial interview at the AOFE Clinics in Utrecht. For practical accessibility, this first meeting is preferably done via video call.

The intake takes place at the multidisciplinary intake clinic. During this meeting, the surgeon and rehabilitation doctor will give you all the information you need about osseointegration treatment and you can meet an experience expert. The experience expert will talk about experiences with the osseointegration (click) prosthesis and show you how the prosthesis works. Prior to this appointment, X-rays may be taken and, if necessary, a CT scan. On the basis of this intake, we will discuss with you whether you can be considered for direct surgery and make follow-up appointments to carry out your treatment.

Once it has been decided that you can be treated with us, you will be given an appointment with the anaesthesiologist for pre-operative screening (POS). At AOFE Clinics, you can be treated only if your medical history allows it. You can discuss your preference for general anaesthesia or an epidural with the anesthesiologist. Information to prepare for surgery will be sent to you.

Upon discharge from the clinic, you will receive a connector prescribed by the surgeon, which will then be fitted by the prosthetist.

During the recovery phase after surgery, your prosthetist has the opportunity to adjust your prosthesis. Make sure you get the prosthesis to your prosthetist on time.

This way, you can start rehabilitation in good time.

We always recommend using a connector which is certified for the respective implant system.

If for some reason it does not work out with your own instrument maker/prosthetist, AOFE Clinics collaborates with MRC-Aardenburg. They can help you further.

On the day of surgery, you will report to the AOFE Clinics reception desk at the appointed time. As you will not be able to wear a prosthesis for several weeks after the operation, we ask you to bring a wheelchair or crutches. During surgery, you will be under constant supervision of the surgery team. The operating team consists of the (orthopaedic) surgeon, anaesthesiologist, operating assistants and anaesthesia staff. During surgery, an implant is inserted into the bone of your stump and the stump is closed again over the adapter protruding out through the stoma. In some cases, the stump bone needs to be shortened slightly and sometimes excess skin, subcutaneous fat and muscle are removed. After surgery, you will stay in the recovery room briefly until you are fully conscious and will then be transferred to the nursing ward.

AOFE Clinics uses the Dutch OTN Implants osseointegration system. This system consists of a pressfit titanium implant, a titanium adapter inserted through the skin into the implant and a connector used to connect the adapter to the prosthesis. The titanium implant inserted into the stump bone has a rough surface for maximum osseointegration capacity. The exact size of the implant is chosen by the surgeon based on the anatomy of the stump bone. In people with a short upper or lower leg stump, the implants are usually sized based on a CT scan of the bone.

Once you are fully awake, you will return to the nursing ward to recover further from surgery. You can stay at our location at Annatommie Utrecht for a maximum of two nights. Doctors, nurses, carers and administrative staff work in this ward. They ensure an optimal stay. Your (orthopaedic) surgeon keeps in close contact with the treatment team in the nursing ward and will also visit you immediately after surgery. Before you are discharged, a check-up X-ray will be taken and you will receive an appointment for rehabilitation. The stitches may be removed after two to three weeks at our outpatient clinic or by your GP.

The first phase of rehabilitation takes place at the MRC rehabilitation centre in Doorn (see “Rehabilitation” on this website). This starts 3-6 weeks after surgery depending on bone quality and ingrowth. You may be advised to start rehabilitation later than discussed with you prior to surgery. This will be coordinated with you individually.