Improvements in disability and function in people with lower-limb amputation one year after prosthesis osseointegration

Background:People with lower-limb amputation (LLA) are routinely prescribed a socket prosthesis; however, many socket prosthesis users experience severe complications with the fit of their prosthesis including residual limb wounds and pain. Osseointegration is a procedure that creates a direct connection between the bone and prosthetic limb through a bone-anchored prosthesis, eliminating the need for a socket interface. It is offered as a secondary procedure to people with LLA who experience significant complications with socket prostheses. Objectives:To evaluate change in disability and function 1 year postosseointegration compared with preosseointegration in people with LLA. Study design:Single group, pretest, and post-test.Methods:Twelve participants (9 transfemoral and 3 transtibial amputations, age: 44 10 years, 7 female participants, 14 12 years since amputation) with unilateral LLA underwent osseointegration with press-fit implants. Disability was measured with the World Health Organization Disability Assessment Schedule 2.0, and function was measured with both Prosthetic Limb Users Mobility Survey and the Activities-Specific Balance Confidence Scale. Questionnaires were administered preosseointegration and 1 year postosseointegration. Paired t tests assessed change in outcomes between time points. Results:Postosseointegration, participants demonstrated reduced disability measured with World Health Organization Disability Assessment Schedule 2.0 (%Delta = -52.6, p = 0.01), improved mobility measured with Prosthetic Limb Users Mobility Survey (%Delta = 21.8, P < 0.01), and improved balance confidence measured with the Activities-Specific Balance Confidence Scale (%Delta = 28.4, P < 0.01). Conclusions:Participants report less disability and greater function in their prosthesis postosseointegration. Osseointegration is a novel procedure for people experiencing complications with their socket prosthesis, and this study is the first to show improvements in disability postosseointegration.