PORT: Dr. Karolina Siwicka’s proprietary care model at the Paley European Institute

Osseointegration is a revolutionary technology for amputees that permanently improves quality of life by directly attaching the prosthesis to the bone, eliminating the pain and limitations of a traditional socket. However, surgical success alone is only half the battle toward full functionality. To ensure maximum safety and lasting results for patients, the Paley European Institute has implemented the unique PORT model. The originator and author of this comprehensive approach is Dr. Karolina Siwicka. This model provides a structured pathway for lifelong care, organizing the treatment process into four logical and sequential phases, accompanying the patient from the initial consultation throughout their entire life.

What will you read about?

• O for Osseointegration: Precision Technique and Surgical Safety
• T for Training and Term: Lifetime Support and Social Reintegration

P for Prehabilitation: Comprehensive physical and mental preparation

The first stage of the PORT model, Prehabilitation (P), focuses on optimizing the patient’s health before they even enter the operating room. The stability of the future implant, the risk of infection, and the patient’s ability to tolerate subsequent rehabilitation depend largely on their overall physical condition and endurance. During this phase, the team of specialists at the Paley European Institute conducts a rigorous medical, functional, and psychological evaluation. A key element is setting realistic expectations; the patient must fully understand the benefits and risks of the procedure, which allows them to approach the surgery with greater confidence and less anxiety. Physical preparation includes strengthening core muscle strength, learning to walk with crutches, and optimizing vitamin D3 and glucose levels. Additionally, two weeks before surgery, it is recommended to limit the use of a stoma to ensure the stump skin is completely free of abrasions and wounds, which minimizes the risk of postoperative infection.

O for Osseointegration: Precision Technique and Surgical Safety

The Osseointegration (O) pillar encompasses the surgical implantation procedure itself and the phase of early biological integration of the titanium post with the bone tissue. Performing this procedure at a specialized center such as the Paley European Institute ensures the highest technical standards and safety, thanks to the team’s extensive experience in limb reconstructive surgery. Thanks to technological advances, most procedures are now performed in a single stage (the OGAAP-2 protocol), which significantly shortens the hospital stay and minimizes the risk of complications associated with multiple surgeries. During the procedure, a titanium implant with a porous surface is precisely inserted into the bone canal, which stimulates the bone to fuse naturally and forms a single, solid unit with it. The surgeon also ensures the reorganization of soft tissues by removing neuromas and attaching muscles directly to the bone, which will enable future control of a modern prosthesis via muscle impulses.

R for Rehabilitation: Progressive Loading Under Expert Supervision

The Early Rehabilitation (R) phase typically begins as early as the first or second day after surgery and is designed to safely restore the patient’s mobility. This process is closely monitored using structured protocols for gradual weight-bearing, which are designed to protect the delicate bone-implant interface. Initially, the patient learns to apply controlled static pressure, for example by standing on a bathroom scale, which provides the necessary stimulus for the bone to remodel and strengthen. The PORT model places particular emphasis on the individual patient’s qualification for the appropriate loading pathway—“fast” or “slow” track—which effectively prevents premature overloading of the implant. The static loading phase is followed by the fitting of a lightweight training prosthesis and the start of gait training between handrails, which builds the patient’s confidence in returning to activity.

T for Training and Term: Lifetime Support and Social Reintegration

The final stage of the model combines intensive gait training (T) with lifelong long-term care, referred to as Term. This approach sets the Paley European Institute apart, as patient care does not end upon discharge from the hospital but becomes a lifelong commitment. Training focuses on learning a natural gait pattern, climbing stairs, and developing the functional mobility necessary for daily life. The Term phase includes regular clinical and radiological monitoring, including DEXA scans to monitor bone density around the implant, ensuring its safety for years to come. The PORT model also includes psychological support and assistance in returning to sports and a full social life, promoting physical activity under the supervision of physical therapists. Close collaboration with OPSA prosthetists ensures continuous optimization of the equipment and rapid servicing of the prosthesis’s mechanical components, allowing patients to enjoy a new quality of life without limitations.