Bone-anchored prostheses for transfemoral amputation: a systematic review of outcomes, complications, patient experiences, and cost-effectiveness.
Mayank Rehani, Tania Stafinski, Jeff Round and 2 others
PMID 38628292WHAT IT FOUND
Bone-anchored prostheses significantly improve mobility and quality of life for transfemoral amputees who cannot tolerate socket prostheses.
Infections are common but usually managed with antibiotics. The procedure is most cost-effective for patients who currently struggle the most with their existing prosthetics.
Key findings
01Patients with bone-anchored prostheses showed significant improvements in health-related quality of life and mobility compared to their pre-surgical condition with socket prostheses.
02Superficial skin infections are the most common complication, occurring in 11% to two-thirds of patients, but are typically managed with antibiotics.
03Cost-effectiveness analyses suggest the procedure offers the greatest benefit to individuals with poor preoperative health utility, while those doing well with sockets may not see compelling gains.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
No randomized controlled trials were included; most studies were single-arm pre-/post-designs or non-randomized cohorts, which limits causal inference. Meta-analysis was not possible due to heterogeneity in outcome measures and follow-up durations. Many studies did not report external prosthetic components, which could confound mobility results. Selection bias is likely, as patients are typically chosen for BAP only after failing socket prostheses, meaning results may not generalize to all amputees. Inconsistent reporting of missing data and dropouts across studies.
Declared interests
Several included studies were funded by commercial entities or had authors with financial conflicts of interest with implant manufacturers. The review itself was funded by non-profit hospital foundations in Canada.
The easy way to misread this
Do not assume bone-anchored prostheses are superior for all transfemoral amputees. The evidence strongly supports their use only for patients who have failed or cannot tolerate socket prostheses. For patients currently doing well with sockets, the risks of surgery and infection may outweigh the potential benefits.