Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 2:5:1336042.
doi: 10.3389/fresc.2024.1336042. eCollection 2024.

Bone-anchored prostheses for transfemoral amputation: a systematic review of outcomes, complications, patient experiences, and cost-effectiveness

Mayank Rehani  1 , Tania Stafinski  2 , Jeff Round  3 , C Allyson Jones  4 , Jacqueline S Hebert  1   5
Affiliations

Bone-anchored prostheses for transfemoral amputation: a systematic review of outcomes, complications, patient experiences, and cost-effectiveness

Mayank Rehani et al. Front Rehabil Sci. .

Abstract

Introduction: Bone-anchored prostheses (BAP) are an advanced reconstructive surgical approach for individuals who had transfemoral amputation and are unable to use the conventional socket-suspension systems for their prostheses. Access to this technology has been limited in part due to the lag between the start of a new procedure and the availability of evidence that is required before making decisions about widespread provision. This systematic review presents as a single resource up-to-date information on aspects most relevant to decision makers, i.e., clinical efficacy, safety parameters, patient experiences, and health economic outcomes of this technology.

Methods: A systematic search of the literature was conducted by an information specialist in PubMed, MEDLINE, Embase, CINAHL, Cochrane Library, the Core Collection of Web of Science, CADTH's Grey Matters, and Google Scholar up until May 31, 2023. Peer-reviewed original research articles on the outcomes of clinical effectiveness (health-related quality of life, mobility, and prosthesis usage), complications and adverse events, patient experiences, and health economic outcomes were included. The quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and ROBINS-I, as appropriate.

Results: Fifty studies met the inclusion criteria, of which 12 were excluded. Thirty-eight studies were finally included in this review, of which 21 reported on clinical outcomes and complications, 9 case series and 1 cohort study focused specifically on complications and adverse events, and 2 and 5 qualitative studies reported on patient experience and health economic assessments, respectively. The most common study design is a single-arm trial (pre-/post-intervention design) with varying lengths of follow-up.

Discussion: The clinical efficacy of this technology is evident in selected populations. Overall, patients reported increased health-related quality of life, mobility, and prosthesis usage post-intervention. The most common complication is a superficial or soft-tissue infection, and more serious complications are rare. Patient-reported experiences have generally been positive. Evidence indicates that bone-anchored implants for prosthesis fixation are cost-effective for those individuals who face significant challenges in using socket-suspension systems, although they may offer no additional advantage to those who are functioning well with their socket-suspended prostheses.

Keywords: bone-anchored prosthesis; cost-effectiveness analysis; lower extremity; osseointegration; patient experience; postoperative complications; transfemoral; treatment outcome.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for the selection of studies for this review.
Figure 2
Figure 2
Lengths of follow-up of outcomes and complications and years of publication (by implant type).
See this image and copyright information in PMC

References

    1. Penn-Barwell JG. Outcomes in lower limb amputation following trauma: a systematic review and meta-analysis. Injury. (2011) 42(12):1474–9. 10.1016/j.injury.2011.07.005 - DOI - PubMed
    1. Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil. (2005) 86(10):1910–9. 10.1016/j.apmr.2005.03.031 - DOI - PubMed
    1. de Godoy JMP, Braile DM, Buzatto SHG, Longo O, Fontes OA. Quality of life after amputation. Psychol Health Med. (2002) 7(4):397–400. 10.1080/1354850021000015212 - DOI
    1. Sinha R, Van Den Heuvel WJA. A systematic literature review of quality of life in lower limb amputees. Disabil Rehabil. (2011) 33(11):883–99. 10.3109/09638288.2010.514646 - DOI - PubMed
    1. Horgan O, MacLachlan M. Psychosocial adjustment to lower-limb amputation: a review. Disabil Rehabil. (2004) 26(14–15):837–50. 10.1080/09638280410001708869 - DOI - PubMed

Publication types