In Poland, between 10,000 and 12,000 amputations are performed each year. This figure rarely comes up in public debate, yet it represents thousands of stories of people who have lost a limb and find themselves without a roadmap, without support, and often without any idea of what comes next. Dr. Agnieszka Wnuk from the “Znowu w Biegu” Rehabilitation Center and Dr. Karolina Siwicka from the Paley European Institute discuss what happens before and after an amputation, as well as the technologies that can completely transform patients’ quality of life today.

Diabetic Foot: Amputations That Could Be Avoided

The leading cause of amputation in people over 60 is diabetic foot. The problem lies not only in the disease itself, but in the lack of multidisciplinary care that would involve a diabetologist, a vascular surgeon, an orthopedist, and a physical therapist working together. In Poland, this model of care is still the exception rather than the standard. As a result, limbs are lost in cases where, with proper intervention, they could have been saved.

The statistics are alarming. Up to 30% of patients die within 6 months of undergoing an amputation due to diabetic foot. Within 5 years, that percentage rises to 60%. These figures are comparable to those for some types of cancer, yet the issue remains on the margins of public awareness.

Loss of a limb as a form of mourning

An amputation is not just a surgical procedure. It is the loss of a body part, which for the patient means going through a genuine grieving process, with all its stages: shock, denial, and sadness. Yet many patients leave the hospital without any preparation for what lies ahead. They don’t know how to apply for financial assistance from the National Health Fund (NFZ), how to perform a basic transfer from a bed to a wheelchair, or where to go to get a prosthesis.

Educating patients and their families after an amputation is one of the key—yet still neglected—aspects of care. Without it, even the best prosthetic technology will not fulfill its purpose.

Phantom and Neuropathic Pain: A Problem Deeper Than It Seems

Pain following an amputation is not just postoperative pain, which subsides within weeks after the procedure. Phantom and neuropathic pain originate in the nervous system and are much more difficult to manage. Dr. Siwicka compares the exposed nerve endings after an amputation to an unruly teenager who, left with nothing to do, starts getting into trouble.

Modern amputation surgery goes a step beyond simply removing a limb. During the procedure, microsurgical reconstructions are performed to provide the nerves with new pathways, thereby preventing neuropathic pain in the future. This approach requires an experienced team, but it can dramatically improve the patient’s quality of life in the years to come.

Rehabilitation and Prehabilitation: The Sooner, the Better

Rehabilitation after an amputation should begin as soon as possible after surgery. In the case of elective surgery, it is advisable to start even before the procedure. Prehabilitation—that is, preparing the body for surgery through strengthening exercises—is crucial, because walking with a prosthesis requires a tremendous amount of energy and demands a much stronger body than walking on one’s own two feet.

Alongside physical therapy, the stump is being shaped through drainage and bandaging, which prepare the limb for a proper fit of the prosthetic socket. This is a tedious but essential process that determines how comfortable the prosthesis will be to wear in the months and years to come.

Funnel denture: effective, but not for everyone

The classic socket prosthesis has been the standard solution for amputees for decades. However, its effectiveness depends on the stump volume remaining constant, whereas the stump swells and shrinks depending on temperature, time of day, physical activity, and many other factors. A poorly fitting socket leads to pain, chafing, and, as a result, the abandonment of the prosthesis in favor of a wheelchair. It is estimated that a significant percentage of amputees give up walking for this very reason.

Osseointegration: a direct bond with the bone

Osseointegration is a method that completely eliminates the need for a denture base. It involves implanting a titanium implant directly into the bone, to which an external abutment and the prosthesis are then attached. There is no base, no fitting issues, and no pain caused by pressure.

The method is not experimental. It has its roots in dental implantology and has been used in orthopedics worldwide for over 35 years; its pioneer is Prof. Al Muderis, with whom Dr. Karolina Siwicka collaborates.

Patients with osseointegration gain something that no overdenture can provide: osseoperception. Through vibrations transmitted directly to the bone, they can feel the ground they walk on—sand, grass, stones, and parquet floors. They also have significantly better proprioception—that is, an awareness of the position of their limbs in space—which allows them to walk backward confidently, move around in the dark, and navigate terrain that would pose a serious challenge for a user of a cast prosthesis.

A partnership that provides comprehensive care

The care model developed between the Paley European Institute and the “Znowu w Biegu” Rehabilitation Center demonstrates what modern care for amputees should look like. Evaluation for osseointegration and the surgical procedure itself take place in Warsaw, while intensive post-operative rehabilitation is conducted in Kraków. The patient is under the care of both centers simultaneously, which ensures support at every stage: from the initial consultation to a return to full activity.

FAQ: Osseointegration—What You Should Know Before Your Consultation

Who is a candidate for osseointegration?
This method is intended for amputees for whom socket-based prosthetics have failed or are not an option. The qualification process includes a thorough assessment of bone condition, overall health, and the patient’s expectations.

Is there an age limit?
Osseointegration can be performed in both young and older patients. The decisive factors are bone condition and overall health, not chronological age alone.

What are the contraindications?
Absolute contraindications include active mental illness that prevents cooperation in the rehabilitation process, bone necrosis following radiation therapy at the planned implant site, and active infections or untreated chronic diseases that significantly impair bone healing.

Is this a safe method?
Yes. Osseointegration originated in dental implantology, where it has been used for several decades. In orthopedics, it has a history of over 35 years and is performed at leading centers around the world.

How long does rehabilitation take after the procedure?
The process of loading the implant is gradual and takes several months. Full activity is possible after rehabilitation is complete; the duration of rehabilitation depends on the patient’s individual condition and the condition of the bone.

Don't try to deal with this problem on your own

If you’re experiencing pain caused by an ill-fitting socket prosthesis, if wearing a prosthesis has become impossible, or if you’re facing the decision to undergo amputation and want to explore all your options, consult a specialist. Both the Paley European Institute and the Znowu w Biegu Rehabilitation Center offer consultations for patients who want to find out whether osseointegration or modern rehabilitation might be a solution for them. You don’t have to make this decision alone, and you don’t have to put up with limitations that may no longer be necessary.