Clinical outcome of osseointegrated prostheses for lower extremity amputations: a systematic review of the literature

Background: Extremity amputation is a common procedure for a variety of indications, including vascular problems, tumors, infections, and traumatic events. The socket prosthesis has always been the standard but has a low patient satisfaction and high skin complication rate. The aim of the present study was to evaluate the outcome of osseointegrated prostheses (those that eliminate the socket in favor of direct skeletal attachment) for lower extremity amputees. Methods: A systematic review of the literature was performed using MEDLINE (January 1946-May 2014), EMBASE (Jan 1980-May 2014), and SCOPUS (Jan 1996-May 2014). All studies evaluating the clinical outcome of an osseointegrated prosthesis for patients with a lower extremity amputation were included. All included studies were evaluated for methodological quality using the GRADE checklist. Results: Thirteen studies with a total of 540 subjects were included. Between 82-90% of patients used their prosthesis on a daily basis. Ninety-five percent of patients were happy with their osseointegrated prosthesis. Short Form (SF)-36 and Questionnaire for Persons with Transfemoral Amputation (Q-TFA) scores were satisfactory. There was a high complication rate, including skin problems (30-54%), skin infections (28-55%), implant infections (2-41%), loosening (2-6%), periprosthetic fracture (0-9%), revision surgery (8-67%), and explants (3-20%). Most of the included studies had more than one flaw in their study design, decreasing their methodological quality. Meta-analysis of the data was not possible due to publication bias. Conclusions: This systematic review showed that osseointegrated prostheses resulted in a good quality of life and patient-reported outcomes. However, skin problems and infections were common and patients often needed revision surgery.