Cumulative loading increases and loading asymmetries persist during walking for people with a transfemoral bone-anchored limb.

Only eight participants were analysed, and the paper states inferential statistics were not used because of the sample size. The design was a retrospective convenience case series. Only people who could walk unaided for four minutes were included, so results may not apply to those needing an assistive device. Data were collected as part of routine clinical care, with no control for factors such as gait speed, time between amputation and implantation, or pain during activity. Walking speed did not meaningfully change, but it remained below normative speeds for healthy adults. The researchers could not confirm whether participants used an assistive device during free-living step-count monitoring. Cumulative loading combined laboratory gait measures with daily step counts, so the limb and joint load inputs still came from a limited number of laboratory trials. The marker set may have limited sensitivity for transverse-plane hip loading because of skin movement and marker placement variability.

The authors declared no known conflicting financial or personal interests. The article metadata lists NIH extramural research support.

Do not conclude that the bone-anchored limb alone improves joint health or corrects gait symmetry. Participants also had staged surgery, rehabilitation, and prosthetic alignment, so the contribution of any single component cannot be separated, and intact-limb overloading persisted or worsened.