Life-changing osseointegration procedure for amputees

New technology is offering greater comfort, control and freedom of movement to people who live with prostheses.

A new approach to limb replacement surgery

For an amputee, a prosthetic limb can restore mobility and independence. But for some, this can come with a frustrating list of challenges: pressure, pain, sweating, skin irritation, and an uncomfortable sense that the artificial limb is always something separate from the body.

Now, an innovative surgical approach is changing that relationship – by connecting the prosthesis directly to the patient’s skeleton.

At the forefront of this development in South Africa is orthopaedic limb reconstruction specialist Dr Franz Birkholtz, who has established the country’s first dedicated osseointegration service, Team Osseo Stellies, at the Institute of Orthopaedics and Rheumatology in Stellenbosch. Launched as Africa’s first dedicated centre for advanced osseointegration limb replacement surgery, it represents a significant step forward in amputee care, with specialists operating from Mediclinic Winelands Orthopaedic Hospital.

When socket prostheses are no longer enough

For decades, the traditional prosthetic limb has relied on a socket that fits around the residual limb. Modern socket prostheses can provide excellent function, but they don’t work for everyone.

Changes in the volume of the residual limb, pressure on the skin, swelling, and sweating can all make socket use difficult. For some amputees, these problems significantly affect comfort and their ability to use their prosthesis for extended periods.

Osseointegration offers a fundamentally different approach. Instead of securing a prosthesis through a socket, a specially designed implant is inserted into the bone of the residual limb. An attachment, or abutment, extends through the skin and allows the prosthesis to connect directly to the implant.

In simple terms, the artificial limb becomes anchored to the skeleton rather than held against the body by a socket. For patients who are suitable candidates, this can transform the experience of using a prosthesis.

The benefits of bone-anchored prostheses

One of the most remarkable aspects of osseointegration is the potential to create a much more natural connection between the patient and their artificial limb.

Because the prosthesis is attached directly to the bone, forces are transferred through the skeleton. Patients can develop a sensation known as osseoperception – effectively allowing them to gain a greater awareness of their artificial limb and its interaction with the ground.

This can contribute to improved control, stability, and confidence while walking. Patients may also avoid many of the problems associated with traditional sockets.

But osseointegration is not simply a surgical procedure. Its success depends on what happens before and after the operation.

A multidisciplinary approach to amputee rehabilitation

Dr Birkholtz’s approach has been to develop osseointegration as a multidisciplinary service rather than an isolated surgical intervention.

Team Osseo Stellies brings together orthopaedic surgery, specialised nursing, physiotherapy, occupational therapy, psychology, dietetics, orthotics and prosthetics, engineering, and rehabilitation expertise. International collaboration has also played an important role, including mentorship from the Rotterdam Osseointegration Centre in the Netherlands.

This comprehensive approach recognises that receiving an implant is only the beginning.

Patients need to progressively load the limb, rebuild strength, learn new movement patterns, and adapt to their prosthesis. This means rehabilitation is an integral part of the osseointegration journey.

Bringing osseointegration expertise to more patients

The development of Team Osseo Stellies builds on South Africa’s growing expertise in osseointegration. Professor Nando Ferreira performed the country’s first osseointegration procedure, while Dr Birkholtz subsequently established the first dedicated service focused on making the approach available through a structured, multidisciplinary programme.

That programme is now opening the door to increasingly complex cases.

In 2026, Dr Birkholtz and Professor Ferreira performed a landmark bilateral osseointegration procedure, implanting custom-designed titanium stems into both femurs of an amputee. The procedure was supported by an international surgical team from Erasmus University Medical Center in Rotterdam and was followed by a structured rehabilitation programme through Team Osseo Stellies.

The case demonstrates what can happen when specialist expertise, public and private healthcare collaboration, and multidisciplinary rehabilitation come together.

For Dr Birkholtz, the significance of osseointegration extends beyond the technology itself. It’s about changing the way amputees interact with their prostheses – and ultimately changing what they believe is possible.

“As Mediclinic’s dedicated osseointegration expertise continues to develop, the hope is that more carefully selected amputees will have access to a technology that can offer greater comfort, control, and freedom of movement,” he says.

“It’s a powerful example of how innovation in orthopaedic surgery can move beyond the operating theatre, helping people not simply to walk again, but to reconnect with movement in an entirely new way.”