Comparison of Quality of Life in Transfemoral Amputee Using Bone-Anchored Prostheses vs. Socket Prostheses: A Systemic Review and Meta-Analysis

Abstract

Amputation has a profound impact on an individual's quality of life (QoL) and functional ability. While socket prostheses are the current first-line treatment, they often cause socket-related issues. Bone-anchored prostheses (BAP) have been introduced to address these problems and improve the amputee experience. This systematic review and meta-analysis aim to compare the QoL between bone-anchored and socket prostheses in transfemoral amputees. A systematic review and meta-analysis were conducted from November 2023 to July 2024, following PRISMA guidelines. Databases including PUBMED, EMBASE, Scopus, Cochrane, and Web of Science were searched. Studies of single-arm trial design comparing pre- and post-operative outcomes were selected based on specific inclusion and exclusion criteria. Statistical analysis was performed using inverse variance with a random effect model. The primary outcome was QoL, measured using the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and 36-Item Short Form Survey (SF-36), and the secondary outcome was mobility, assessed by the 6-Minute Walk Test (6MWT). Subgroup analyses compared different types of BAP (Press-fit vs. Screw-type) on QoL. Thirteen NRCTs with 398 participants were included. Significant improvements in QoL were observed in all Q-TFA domains and the SF-36 Physical Component Score (PCS), but not in the SF-36 Mental Component Score (MCS). Mobility improved significantly as measured by the six-minute walk test (6MWT). No significant differences in QoL were found between Press-fit and Screw-type BAP implants. Overall, BAP significantly improve both QoL and mobility, but study limitations currently restrict their use to individuals with socket-related complications. As such, it cannot yet be universally recommended as a first-line intervention.

Keywords: bone‐anchored; mobility; quality of life; socket‐suspended; transfemoral amputation.

FIGURE 1

Socket prosthesis (left), Bone‐anchored prostheses (BAP) (right) [4].

FIGURE 2

PRISMA chart flow diagram.

FIGURE 3

The ROBINS‐I risk of bias assessment of included studies. (A) Risk of bias graph for included studies; (B) Risk of bias summary for included studies. ROBINS‐I; Risk of Bias in Non‐randomized Studies—of Interventions.

FIGURE 4

Forest Plot comparing Q‐TFA scores in BAP vs. Socket Prostheses in transfemoral amputee. (A) Q‐TFA Global Score; (B) Q‐TFA Prosthetic Mobility Score; (C) Q‐TFA Problem Score; (D) Q‐TFA Prosthetic Use Score. Q‐TFA, Questionnaire for a Persons with a Transfemoral Amputation; BAP, bone‐anchored prostheses; SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom.

FIGURE 5

Forest Plot comparing SF‐36 (PCS) in BAP vs. Socket Prostheses in transfemoral amputee. SF‐36, 36‐Item Short Form Health Survey; PCS, Physical Component Score; BAP, bone‐anchored prostheses; SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom.

FIGURE 6

Sensitivity analyses comparing Q‐TFA scores in BAP vs. Socket Prostheses in transfemoral amputee. This was carried out by removing studies including non‐socket users. (A) Q‐TFA Global Score; (B) Q‐TFA Prosthetic Mobility Score; (C) Q‐TFA Prosthetic Use Score. Q‐TFA, Questionnaire for a Persons with a Transfemoral Amputation; BAP, bone‐anchored prostheses; SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom.