Outcome of Percutaneous Osseointegrated Prostheses for Patients With Unilateral Transfemoral Amputation at Two-Year Follow-Up

  • Kerstin Hagberg
    Corresponding author Kerstin Hagberg, RPT, PhD, Associate Professor, Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Falkenbergsg 3, SE-412 85 Gothenburg, Sweden.
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Elisabeth Hansson
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • Rickard Brånemark
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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      To report outcomes regarding general and specific physical health-related quality of life of treatment with percutaneous osseointegrated prostheses.


      Prospective 2-year case-control study.


      University hospital.


      Individuals (N=39; mean age, 44±12.4y) with unilateral transfemoral amputation as a result of trauma (n=23), tumor (n=11), or other cause (n=5). At baseline, 33 of the 39 participants used socket-suspended prostheses.


      Osseointegrated prosthesis.

      Main Outcome Measures

      Questionnaire for Persons with Transfemoral Amputation (Q-TFA), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical functioning (PF) and physical component summary (PCS), SF-6D, and Physiological Cost Index (PCI).


      At 2 years postimplantation, 6 of 7 Q-TFA scores improved (P<.0001) compared with baseline (prosthetic use, mobility, problem, global, capability, walking habits). The walking aid subscore did not improve (P=.327). Of the 39 participants, increased prosthesis use was reported by 26, same amount of use by 11, and less use by 2. Improvement was reported in 16 of the 30 separate problem items (P<.05). Unchanged items included problems regarding phantom limb pain and pain from the back, shoulders, and contralateral limb. The PF, PCS, and SF-6D improved a mean of 24.1±21.4 (P<.0001), 8.5±9.7 (P<.0001), and .039±.11 (P=.007) points, respectively. Walking energy cost decreased (mean PCI at baseline, .749; mean PCI at follow-up, .61; P<.0001).


      Two years after intervention, patients with a unilateral TFA treated with an OPRA implant showed important improvements in prosthetic function and physical quality of life. However, walking aids used and the presence of phantom limb pain and pain in other extremities were unchanged. This information is valuable when considering whether percutaneous osseointegrated prostheses are a relevant treatment option.


      List of abbreviations:

      HRQOL (health-related quality of life), PCI (Physiological Cost Index), PCS (physical component summary), PF (physical functioning), Q-TFA (Questionnaire for Persons with Transfemoral Amputation), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), TFA (transfemoral amputation)
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