Systematic review of the safety and efficacy of osseointegration prosthesis after limb amputation

Setor Kunutsor, David Gillatt, Ashley Blom

Research output: Contribution to journalArticle (Academic Journal)peer-review

26 Citations (Scopus)
465 Downloads (Pure)


Background: Osseointegration, an approach for direct skeletal attachment of a prosthesis to an amputated limb, may address many of the socket-related problems associated with socket prosthesis. However, the safety issues and adverse events associated with osseointegration is uncertain. This study aimed to summarize evidence on functional and clinical outcomes, as well as adverse effects of osseointegration for patients with amputated limbs.

Methods: MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched to April 2018. Eligible studies were observational, case, and qualitative studies, and randomized controlled trials (RCTs) conducted in patients with limb amputations, who were managed with osseointegrated prostheses, and had follow-up data.

Results: Twenty-two eligible articles comprising 13 unique studies were included. No RCT was identified. Sample sizes ranged from 11 to 100 participants. All relevant studies reported improvement in functional outcomes (walking ability, prosthetic use, and mobility), satisfaction, and quality of life following osseointegration compared with their preoperative status or when using conventional socket prosthesis. Infection rates (95% confidence intervals) ranged from 1.0% (0.2-5.4) to 76.7% (59.1-88.2). Majority of these infections were described as low-grade soft tissue or superficial infections related to the skin-implant interface, which were effectively treated with antibiotics. None of the studies reported additional amputation or death as a result of osseointegration.

Conclusion: Osseointegration of limb amputations confers increased prosthetic use, better sitting comfort, improved walking ability, mobility, gait, and quality of life. However, it is associated with an increased risk of soft tissue infections. Robust evidence from definitive trial designs are warranted.
Original languageEnglish
Pages (from-to)1731-1741
Number of pages11
JournalBritish Journal of Surgery
Issue number13
Early online date11 Oct 2018
Publication statusPublished - Dec 2018

Structured keywords

  • Centre for Surgical Research


  • osseointegrated prosthesis
  • limb amputation
  • function
  • quality of life
  • infection


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