LOS ANGELES — Three years ago, Robert Johnson, 28, had his right leg amputated above the knee due to bone cancer. He was fitted with a prosthetic leg that connected to his residual limb with a cuplike shell or “socket,” traditionally the only type of prosthesis available.
However, the socket didn’t fit well, resulting in painful skin irritations. The leg was difficult to walk on or even stand on, and sometimes fell off.
The husband and father could not work, exercise or even pick up his young daughter for fear he would fall and drop her.
But thanks to an innovative procedure known as osseointegration, performed by Lawrence Menendez, MD, an orthopaedic oncologist with Keck Medicine of USC and a professor of clinical orthopaedic surgery at the Keck School of Medicine of USC, life has opened up for Robert.
“There’s new hope for me now,” he said. “I can finally hold my daughter safely in my arms and do so many other things I couldn’t before the surgery.”
A groundbreaking new surgery
Osseointegration is a new surgical procedure that permanently anchors an artificial limb into the bone. It is currently offered at only 10-15 medical centers across the United States, including Keck Medicine. Menendez is one of only a few surgeons in the country to have extensively trained in the surgery.
The technique was developed in Sweden some 25 years ago, and has been performed there for many years. Osseointegration for adults with above-the-knee amputations was approved by the U.S. Food & Drug Administration in December 2020.
During a two-part procedure, a metal implant is inserted into the bone of the residual limb remaining after the amputation. The bone grows into the implant until the implant is secure and fully integrated. Next, an additional device is attached to the implant, which protrudes from the skin and attaches to the prosthesis. Patients take up to a year to heal from the surgeries and require physical therapy.
The benefit of osseointegration is that it eliminates the need for a socket, which solves the fit problem that Robert, and many others who wear a prosthetic limb, experience.
Typically, said Menendez, socket prosthetics either fit too tightly or too loosely around the stump, causing skin irritations and infections and putting people at constant risk of falling.
Osseointegration allows for a stable attachment of the artificial limb, improving mobility, range of motion and avoiding skin irritations. It also gives patients an increased sense of proprioception, the awareness of the position and movement of the body, according to Menendez.
“The end result is that patients are out of pain, better able to stand, walk and climb stairs, and can get back to more physical activities they enjoyed before the amputation,” he said. “We hope that this procedure can improve the quality of life for patients who have undergone an above-the-knee amputation such as veterans, bone cancer patients and people who have been in accidents. We believe that Robert is just one of many we can help.”
Robert’s pre-osseointegration life
In 2016, Robert was a healthy, active 22-year-old when his right leg began to hurt. Over the next year, a bump formed above his knee. Robert visited several doctors to see what might be wrong, but no one had an answer.
The lump continued to grow, and in 2019, Robert decided to seek more specialized help at Keck Medicine’s USC Musculoskeletal Oncology Center. Menendez diagnosed Robert with osteosarcoma, an invasive type of bone cancer most common in people under 30.
Menendez removed the tumor, and surgery went well. However, Menendez and his team realized that to stop the cancer from spreading further and save Robert’s life, they would have to amputate his right leg above the knee.
After the wound healed and six months of chemotherapy, Robert was cancer-free and fitted with a socket prosthesis. He tried to return to normal life, but the ill-fitting prosthetic leg would not let him.
A new procedure and hope
In early 2021, Robert learned that his doctor, Menendez, was offering osseointegration to patients. Robert was immediately interested.
Menendez determined that Robert would be an excellent candidate for osseointegration, and Robert finished the second surgery in June 2021. He healed well, and is amazed at how much his life has improved.
Relieved of socket issues, he can stand for relatively long periods of time on his prosthetic leg and is able to work out at the gym for the first time in three years. When he walks on the treadmill, he is thrilled that when he sets his foot onto a surface, he can feel the sensation.
One day, he hopes to run. He also looks forward to eventually going back to work and even starting his own business.
But for now, he is savoring the small joys, such as being able to pick up and hold his daughter.
To learn more about osseointegration surgery with Keck Medicine, please call 323-442-5860 or email Sherry.Quinteros@med.usc.edu.
For more information about Keck Medicine of USC, please visit
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