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Bone-anchored prosthesis treatment for individuals with a long transfemoral amputation has been in use for more than three decades and has proven to be comparatively safe. The technique requires a metal implant (osseointegration implant) to be implanted in the bone, protruding through the skin, to which an artificial limb can be attached. However, the majority of individuals currently referred for treatment either have a very short transfemoral, or a transtibial amputation.
Researchers Robin Atallah, Elmer Rutjes, Jan Paul Frölke and Ruud Leijendekkers investigated the mid-term feasibility, safety, and changes in functional outcomes after implantation of a press-fit titanium osseointegration implant in individuals with a short and long transfemoral amputation, and transtibial amputation. The research group, led by Associate Professor Ruud Leijendekkers from the Department of Rehabilitation Medicine published the results in the Bone And Joint Journal on 1 April 2025.
An implant survival of 98.9% and 94.2% was measured at 2- and 5-years follow-up respectively, showing no significant differences comparing the 3 different treatment groups. These results were superior to previous publications of older generation implant designs, and comparable to certain reports of hip arthroplasty survival. Major adverse events were rare, however minor adverse events such as soft tissue infections or complaints were frequent. A significant improvement in functional outcomes such as prosthesis wearing time and health-related quality of life was measured both for the entire cohort, as well as stratified by amputation level. Remarkably, individuals with a short transfemoral amputation and transtibial amputation seem to benefit more from the bone-anchored prosthesis treatment than individuals with a long transfemoral amputation. Most likely because these individuals experience the most issues using a socket-suspended prosthesis, prior to bone-anchored prosthesis treatment. These initial promising results in patients treated at the short transfemoral or transtibial level justify continuing this form of treatment in these cohorts. Soft tissue infections are still too common, so new studies are required to further increase safety, optimize patient selection, and assess longer term follow-up results.
This research is part of Radboudumc Research Program: Value Based Networked Care
About the publication
R. Atallah, E. Rutjes, JPM. Frölke, R. Leijendekkers. Safety and performance of contemporary press-fit titanium osseointegration implants in lower extremity amputation: a five-year follow-up study.
The Bone and Joint Journal. 2025 Apr 1;107-B(4):486-494. Doi: 10.1302/0301-620X.107B4.BJJ-2024-0754.R1
