JAAOS - 2026-04-15 - Journal Article
Single-Stage Press-Fit Femoral Osseointegrated Limb Replacement: A Prospective Cohort Study.
Burns DM, LoPolito AG, Glassband Z, Hoellwarth JS, Reif TJ, Rozbruch SR
Topics
Key Takeaway
Single-stage press-fit femoral osseointegrated limb replacement achieved 93.0% implant survival at 5 years but carried a 40.3% revision surgery rate, with significant functional improvements in 2MWT, 6MWT, and PROMIS scores.
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Summary
This study evaluated safety, functional, and patient-reported outcomes of single-stage press-fit femoral osseointegrated limb replacement in 67 limbs across 65 transfemoral amputees from 2017–2023. Revision surgery was required in 40.3% of cases, including 17.9% debridements, 20.9% soft-tissue revisions, and 9.0% fracture repairs, with 44.8% developing aperture drainage managed non-operatively with antibiotics. Despite high complication rates, implant survival was 98.4% at 2 years and 93.0% at 5 years, with statistically significant improvements in 2MWT, 6MWT, PROMIS, and LD-SRS scores.
Key Limitation
Absence of a concurrent socket-prosthesis comparator group prevents determination of whether functional gains represent true superiority or reflect selection of higher-functioning, motivated patients.
Original Abstract
BACKGROUND
Press-fit femoral osseointegrated limb replacement (FOLR) allows for a direct transcutaneous skeletal connection between an artificial leg and the residual femur in a single-stage procedure that can be performed open or percutaneously. A skeletally anchored prosthesis can offer enhanced mobility, balance, and proprioception to amputees, as well as eliminate problems associated with socket mounted prostheses, such as skin problems, ulcers, and pain. The purpose of this research is to describe the safety, functional, and patient-reported outcomes for this technique.
METHODS
We retrospectively reviewed all patients at our institution who underwent press-fit FOLR between January 2017 to May 2023 (at least 1 year postsurgery). The primary outcome was adverse events prompting additional surgery. Secondary outcomes were changes in mobility (timed up and go), 2-minute walk test (2MWT), 6-minute walk test (6MWT), prosthetic use, walking aids, and patient-reported quality of life surveys (Limb Deformity-Scoliosis Research Society, QTFA, and patient-reported outcomes measurement information system).
RESULTS
Sixty-seven FOLR procedures in 65 patients were included in this cohort. The total revision surgery rate was 40.3%, including 12 débridements (17.9%), six fracture repairs (9.0%), 14 soft-tissue revisions (20.9%), and two implant removals (3.0%). Thirty limbs (44.8%) developed drainage or inflammation around their aperture and were successfully treated with antibiotics alone. Implant survival was 98.4% at 1 year, 98.4% at 2 years, and 93.0% at 5 years. Large statistically significant improvements were found in mobility (2MWT, 6MWT), walking aids, and patient-reported outcomes scores (Limb Deformity-Scoliosis Research Society, patient-reported outcomes measurement information system) in patients who underwent FOLR, as well as improvements in prosthetic use in patients who initially presented with a prosthesis.
CONCLUSION
Osseointegration of the femur reliably improves function and quality of life for transfemoral amputees. There is a high rate of complications and revision surgery, but the problems encountered are manageable in most instances.