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Single-Stage Press-Fit Femoral Osseointegrated Limb Replacement: A Prospective Cohort Study
David M Burns1, Andrew G LoPolito, Zachary Glassband
1From the Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY.
The Journal of the American Academy of Orthopaedic Surgeons
|January 6, 2026
Summary
Press-fit femoral osseointegrated limb replacement (FOLR) significantly enhances mobility and quality of life for amputees. While revision surgery rates are high, complications are generally manageable, with excellent implant survival.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Rehabilitation medicine
Background:
- Press-fit femoral osseointegrated limb replacement (FOLR) offers direct skeletal connection for transfemoral amputees.
- This technique can improve mobility, balance, and proprioception, avoiding issues associated with traditional socket prostheses.
Purpose of the Study:
- To evaluate the safety, functional outcomes, and patient-reported results of press-fit FOLR.
- To assess the efficacy of a single-stage open or percutaneous procedure.
Main Methods:
- Retrospective review of 67 FOLR procedures in 65 patients (Jan 2017-May 2023).
- Primary outcome: adverse events requiring surgery. Secondary outcomes: mobility tests (2MWT, 6MWT), prosthetic use, walking aids, and quality of life surveys.
Main Results:
- 40.3% revision surgery rate (débridements, fractures, soft-tissue revisions).
- 44.8% experienced manageable aperture inflammation/drainage treated with antibiotics.
- Significant improvements in mobility, prosthetic use, and patient-reported outcomes; high implant survival (93.0% at 5 years).
Conclusions:
- Femoral osseointegration reliably enhances function and quality of life for transfemoral amputees.
- High complication and revision rates exist but are mostly manageable.
