Lower limb osseointegrated prosthetics: are we standing on the edge of a new era?

The advent of osseointegrated prosthetic systems marks a significant milestone in the evolution of limb reconstruction and rehabilitation. Osseointegration implants are a direct skeletal interface for artificial limbs, introduced as bone-anchored limb prostheses that may improve many limitations of traditional socket-based prosthetics, such as discomfort, poor fit, skin irritation, and limited range of motion.

Since the discovery of the osseointegration phenomenon in 1940, several osseointegrated implant systems, such as OPRA, ILP, OPL, and ITAP, with varying biomechanical structures and surgical protocols, have been developed. Regardless of the system types, they have overall demonstrated better outcomes compared to socket-type prostheses. Although osseointegrated systems are not without complications, they are an optimum option if surgically and functionally possible for lower limb amputees, as they improve quality of life.

This review provides a comparative analysis of current osseointegrated prosthetic systems for lower limb amputees, encompassing both commercially available devices and those under clinical investigation, with a focus on their biomechanical structures, surgical techniques, and reported clinical outcomes. It is hypothesized that these outcomes will continue to improve with newer designs and advancements.