A one-year follow-up case series on gait analysis and patient-reported outcomes for persons with unilateral and bilateral transfemoral amputations undergoing direct skeletal fixation.

The paper reports only a few individual cases, so the findings cannot be generalised. There was no randomised control group; each participant was compared only with their own earlier data. Osseointegration was given with a standardised rehabilitation programme, so the contribution of surgery alone cannot be separated. Walking speed differed before and after, and walking speed can change joint loading, so some differences may not be due only to osseointegration. Some questionnaire scores were invalid because participants did not answer enough items. The biomechanical model simplified the socket-stump interface and load transfer, and only walking was tested. The study followed participants only to the reported follow-up, and the authors say adaptation may take longer.

The only funding statement supplied names the Office for Veterans' Affairs United Kingdom as funder.

Do not read this as proof that osseointegration alone improves walking or protects joints. The participants also received rehabilitation, walking speed changed between assessments, and the study reports only individual cases without a control group.