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Bone-Anchored Prostheses: Leveling the Playing Field for Individuals With Transfemoral Amputation-A Comparative
Enrique Alberto Vargas Meouchi1, Luis Vila Castillo2, Julen Irizar Amuchastegui3
1Department of Surgery, Universitat Autonoma de Barcelona, Barcelona; Department of Orthopaedic Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona; Vall d'Hebrón Research Institute (VHIR), Universitat Autònoma de Barcelona; Barcelona.
Objective:
To evaluate functional outcomes, prosthesis usage, pain, and quality of life (QoL) in individuals with transfemoral amputation (TFA) with severe socket-related problems undergoing single-stage osseointegration (OI) as the bone-anchored prostheses (BAP) group, compared with high-functioning socket-suspended prostheses (SSP) users.
Design:
Prospective, observational, comparative cohort study with a minimum 12-month follow-up. Before-and-after analysis in the BAP group and between-group comparison at follow-up.
Setting:
Tertiary referral center for amputee rehabilitation and limb reconstruction.
Participants:
Thirty-seven adults (N=37) with nonchronic vascular, nondiabetic TFA. Sixteen underwent single-stage OI because of severe socket-related complications. Twenty-one were functionally successful SSP users. All had ≥12 months of prosthesis use and complete datasets.
Interventions:
Single-stage transfemoral OI in the BAP group. The SSP group followed the institutional protocol and received no intervention.
Main Outcome Measures:
Prosthesis wear time (h/d), 6-minute walk test (6MWT), pain via visual analog scale (VAS), and QoL via EuroQol 5-Dimension 5-Level questionnaire and 36-Item Short Form Survey. Pre- and postoperative comparisons were performed in the BAP group; 12-month outcomes were compared between groups. OI-related complications were recorded.
Results:
BAP users showed significant improvements at 12 months: prosthesis usage increased from 0 to 13.9 h/d (P<.001), 6MWT distance improved from 307 to 411 m (P=.002), VAS pain scores decreased from 6.5 to 1.8 (P<.001), and QoL improved across multiple domains. Compared with the SSP group, BAP users had similar 6MWT distances and QoL scores at 12 months, but reported significantly lower pain (VAS 1.8 vs 3.5; P=.041). Satisfaction was high: 88% rated 10 of 10 and 94% would repeat the procedure. Complications were minimal.
Conclusions:
Single-stage OI significantly improves function, prosthesis use, and QoL in TFA with socket intolerance, achieving outcomes comparable with high-functioning SSP users. Pain reduction is a notable benefit, supporting broader consideration of OI in carefully selected individuals.
