Osseointegration for lower and upper-limb amputation a systematic review of clinical outcomes and complications

The conventional use of prosthetic custom-design socket is affected by discomfort related to wellknown problems: sweating, sores or skin irritation, excessive weight and harness, impaired body image, that lead to a high rate of abandonment. Osseointegrated prosthetic implants for limb amputation are progressively evolving to overcome limitations of socket. The aim of this article is to present a systematic review of the use, safety in terms of rate of infection and complications, and reported outcomes of upper and lower limb osseointegrated prosthetic implants. A systematic search was carried out for studies that evaluated outcomes of osseointegration technique in case of upper and lower limb amputees according to the PRISMA guidelines with a PRISMA checklist and algorithm. MINORS score was used for methodologic assessment. 17 articles about the treatment of patients with upper or lower limb amputation treated with an osseointegrated prostesis were included. The overall rate of infections was 32%. All the clinical outcomes reported were related to lower limb. No clinical data for upper limb was found. The postoperative mean value of MCS and PCS SF-36 and Q-TFA was 55.1, 45.4 and 73.8 respectively, while six minute walk test (6MWT) and the timed up and go (TUG) test scored an average value of 388 meters and 11.5 seconds respectively. MINORS score ranged from 5 to 13, with a median of 11 [interquartile range (IQR), 9-11]. The osseointegration is associated to a high rate of postoperative complications but, significant improvement in clinical outcomes compared to preoperative time are shown. The data available from the literature are limited but suggest good clinical outcomes and significant survivorship of the implants. Further clinical studies are needed to establish which kind of implant is associated to higher clinical performance and lower rate of postoperative complications and infections.