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How To Improve Patient Selection in Individuals With Lower Extremity Amputation Using a Bone-anchored Prosthesis.
Charlotte van Vliet-Bockting1, Robin Atallah2,3, Jan Paul M Frölke4
1Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands.
Clinical Orthopaedics and Related Research
|January 24, 2025
Summary
Bone-anchored prostheses significantly improve health-related quality of life (HRQoL) for lower limb amputees, with a low risk of severe complications but a higher incidence of minor issues. This treatment offers a favorable risk-benefit profile for eligible patients.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Prosthetics
Background:
- Lower limb socket-suspended prostheses often cause pain, skin issues, and mechanical problems, negatively impacting patients' health-related quality of life (HRQoL).
- Bone-anchored prostheses offer an alternative to socket-suspended devices, potentially improving HRQoL, but carry their own set of risks.
- A validated tool is needed to assess the risk-benefit ratio for surgical candidates considering bone-anchored prostheses.
Purpose of the Study:
- To evaluate changes in HRQoL at 6, 12, and 24 months post-bone-anchored prosthesis treatment compared to preoperative socket-suspended prosthesis use.
- To identify factors associated with HRQoL changes 24 months after bone-anchored prosthesis treatment.
- To document the types and frequency of complications within 24 months of bone-anchored prosthesis treatment and identify associated risk factors.
Main Methods:
- A cohort of 206 patients undergoing lower limb bone-anchored prosthesis treatment (femoral or tibial) was studied retrospectively.
- HRQoL was assessed using generic (SF-36 MCS/PCS) and disease-specific measures preoperatively and at 6, 12, and 24 months postoperatively.
- Multivariable regression analysis was used to identify factors associated with HRQoL changes and complication occurrence.
Main Results:
- Generic HRQoL physical component summary (PCS) scores significantly improved by 25% at 6 months and were maintained at 24 months (p < 0.001).
- Disease-specific HRQoL showed substantial improvements of 72-85% at 6, 12, and 24 months (p < 0.001).
- Infections were the most common complications (116 events), primarily soft tissue infections; severe complications were rare, though minor complications were frequent and often managed non-surgically.
Conclusions:
- Bone-anchored prostheses lead to significant improvements in both generic and disease-specific HRQoL for lower limb amputees.
- While severe complications are infrequent, minor complications like infections are common but generally manageable.
- The findings support the use of bone-anchored prostheses for select patients with a favorable risk-benefit ratio, aiding clinical decision-making.
