Bone Anchored Prostheses: Levelling the Playing Field for Individuals With Transfemoral Amputation-A Comparative Cohort Study of Patients Undergoing Single-Stage Osseointegration Versus High-Functioning Users of Socket-Suspended Prostheses.

Abstract

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. Prospective, observational, comparative cohort study with a minimum 12-month follow-up. Before-after analysis in the BAP group; between-group comparison at follow-up. Tertiary referral center for amputee rehabilitation and limb reconstruction. Thirty-seven adults with non-chronic vascular, non-diabetic TFA. Sixteen underwent single-stage OI due to severe socket-related complications. Twenty-one were functionally successful SSP users. All had ≥12 months of prosthesis use and complete datasets. Single-stage transfemoral osseointegration in the BAP group. The SSP group followed the institutional protocol and received no intervention. Prosthesis wear time (hours per day), 6-Minute Walk Test (6MWT), pain via Visual Analogue Scale (VAS), and QoL via EQ-5D-5L and SF-36. Pre- and postoperative comparisons were performed in the BAP group; 12-month outcomes were compared between groups. OI-related complications were recorded. BAP users showed significant improvements at 12 months: prosthesis usage increased from 0 to 13.9 hours/day (p<0.001), 6MWT distance improved from 307m to 411m (p=0.002), VAS pain scores decreased from 6.5 to 1.8 (p<0.001), and QoL improved across multiple domains. Compared to the SSP group, BAP user had similar 6MWT distances and QoL scores at 12 months, but reported significantly lower pain (VAS 1.8 vs. 3.5, p=0.041). Satisfaction was high: 88% rated 10/10 and 94% would repeat the procedure. Complications were minimal. Single-stage OI significantly improves function, prosthesis use, and QoL in TFA with socket intolerance, achieving outcomes comparable to high-functioning SSP users. Pain reduction is a notable benefit, supporting broader consideration of OI in carefully selected individuals.