Functional performance and safety of bone-anchored prostheses in persons with a transfemoral or transtibial amputation: a prospective one-year follow-up cohort study.

This was a before-and-after cohort study with no control group, so it cannot show how much of the change was due to the bone-anchored prosthesis rather than rehabilitation or other factors. The participants were adults already having socket-related problems and selected for surgery, so results may not apply to all people with amputation. The treating physiotherapist collected outcomes, and a blinded assessor was not possible, which may introduce measurement bias. Self-reported outcomes may have been biased by response shift, and patient-reported improvements were not always matched by performance-test improvements. Minor adverse events treated outside the medical centre, such as low-grade infections by a general practitioner, may have been missed. Subgroups were small after stratification by amputation level and wheelchair-boundedness, so these results were descriptive only. The back pain measure was crude, so intensity and functional impact were not captured.

The authors declared no conflicts of interest. The paper acknowledges grants from Stichting Amputatie and Stichting Nederlands Amputee Fonds.

Do not conclude that the implant alone caused the improvements. Every participant also received a predefined rehabilitation programme, and there was no comparison group using a socket prosthesis, so the effect of the implant alone cannot be separated.