{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:47:50Z","timestamp":1781322470828,"version":"3.54.1"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Skeletal Radiol"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Osseointegrated implants have been developed to allow direct skeletal fixation of a prosthesis as an alternative to traditional socket-fitted prostheses for patients who have suffered from a major limb amputation. The implants contribute to improvements in functional outcome and quality of life and radiological evaluation plays a crucial role in pre- and post-operative assessment. This article acts as a guide for radiologists who may be tasked with providing the radiological information required by surgeons and prosthetists. We also look at the radiological appearances of complications that may arise in patients treated with an osseointegrated implant. Plain X-rays are used to screen patients who wish to undergo treatment. Limb-length X-rays are then used to measure the length of any residual bone, and comparisons can be made with the normal side (if present). From this, decisions about the likely size of the implant and the need for further amputation can be made. CT scans enable accurate assessment of the medullary cavity and cortical thickness. Post-operatively, plain X-rays form the mainstay of the routine monitoring of the bone-implant interface. Potential complications include infection, aseptic loosening, mechanical fracture of the implant and periprosthetic fracture. Infection and aseptic loosening can be seen as a lucency at the bone-implant interface which (if left untreated) can lead to loss of the implant. Implant and periprosthetic fractures are radiographically obvious. Radiologists involved in the care of patients undergoing treatment with an osseointegrated implant should become familiar with the imaging requirements so they can contribute to optimal patient outcomes.<\/jats:p>","DOI":"10.1007\/s00256-023-04524-z","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T04:10:52Z","timestamp":1701663052000},"page":"1033-1043","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Radiological evaluation before and after treatment with an osseointegrated bone-anchor following major limb amputation\u2014a guide for radiologists"],"prefix":"10.1007","volume":"53","author":[{"given":"Norbert","family":"Kang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazan","family":"Al-Ajam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0738-398X","authenticated-orcid":false,"given":"Phyllis","family":"Keen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Woollard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Steinitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Farrant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Chow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,12,4]]},"reference":[{"key":"4524_CR1","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1002\/ar.23135","volume":"298","author":"B Brier","year":"2015","unstructured":"Brier B, Vinh P, Schuster M, Mayforth H, Chapin EJ. A radiologic study of an ancient Egyptian mummy with a prosthetic toe. Anat Rec (Hoboken). 2015;298:1047\u201358. 2015\/05\/23. https:\/\/doi.org\/10.1002\/ar.23135.","journal-title":"Anat Rec (Hoboken)"},{"key":"4524_CR2","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s00113-017-0331-4","volume":"120","author":"Y Li","year":"2017","unstructured":"Li Y, Br\u00e5nemark R. Osseointegrated prostheses for rehabilitation following amputation: the pioneering Swedish model. Unfallchirurg. 2017;120:285\u201392. 2017\/02\/24. https:\/\/doi.org\/10.1007\/s00113-017-0331-4.","journal-title":"Unfallchirurg"},{"key":"4524_CR3","doi-asserted-by":"publisher","first-page":"e0043","DOI":"10.2106\/jbjs.Rvw.19.00043","volume":"8","author":"JS Hoellwarth","year":"2020","unstructured":"Hoellwarth JS, Tetsworth K, Rozbruch SR, Handal MB, Coughlan A, Al Muderis M. Osseointegration for amputees: current implants, techniques, and future directions. JBJS Rev. 2020;8:e0043. 2020\/04\/01. https:\/\/doi.org\/10.2106\/jbjs.Rvw.19.00043.","journal-title":"JBJS Rev"},{"key":"4524_CR4","doi-asserted-by":"publisher","first-page":"2174","DOI":"10.1016\/j.apmr.2013.05.020","volume":"94","author":"H Van de Meent","year":"2013","unstructured":"Van de Meent H, Hopman MT, Fr\u00f6lke JP. Walking ability and quality of life in subjects with transfemoral amputation: a comparison of osseointegration with socket prostheses. Arch Phys Med Rehabil. 2013;94:2174\u20138. 2013\/06\/19. https:\/\/doi.org\/10.1016\/j.apmr.2013.05.020.","journal-title":"Arch Phys Med Rehabil"},{"key":"4524_CR5","doi-asserted-by":"publisher","first-page":"900","DOI":"10.2106\/jbjs.15.00808","volume":"98","author":"M Al Muderis","year":"2016","unstructured":"Al Muderis M, Khemka A, Lord SJ, Van de Meent H, Fr\u00f6lke JPM. Safety of osseointegrated implants for transfemoral amputees: a two-center prospective cohort study. J Bone Joint Surg Am. 2016;98:900\u20139. 2016\/06\/03. https:\/\/doi.org\/10.2106\/jbjs.15.00808.","journal-title":"J Bone Joint Surg Am"},{"key":"4524_CR6","doi-asserted-by":"publisher","first-page":"e013508","DOI":"10.1136\/bmjopen-2016-013508","volume":"7","author":"M Al Muderis","year":"2017","unstructured":"Al Muderis M, Lu W, Tetsworth K, Bosley B, Li JJ. Single-stage osseointegrated reconstruction and rehabilitation of lower limb amputees: the Osseointegration Group of Australia Accelerated Protocol-2 (OGAAP-2) for a prospective cohort study. BMJ Open. 2017;7:e013508. 2017\/03\/25. https:\/\/doi.org\/10.1136\/bmjopen-2016-013508.","journal-title":"BMJ Open"},{"key":"4524_CR7","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1055\/a-1223-3205","volume":"59","author":"A Ranker","year":"2020","unstructured":"Ranker A, \u00d6rgel M, Beck JP, Krettek C, Aschoff HH. Transcutaneous Osseointegrated prosthetic systems (TOPS) for transfemoral amputees - a six-year retrospective analysis of the latest prosthetic design in Germany. Rehabilitation (Stuttg). 2020;59:357\u201365. 2020\/09\/02. https:\/\/doi.org\/10.1055\/a-1223-3205.","journal-title":"Rehabilitation (Stuttg)"},{"key":"4524_CR8","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.2106\/jbjs.19.01169","volume":"102","author":"D Reetz","year":"2020","unstructured":"Reetz D, Atallah R, Mohamed J, Van de Meent H, Fr\u00f6lke JPM, Leijendekkers R. Safety and performance of bone-anchored prostheses in persons with a transfemoral amputation: a 5-year follow-up study. J Bone Joint Surg Am. 2020;102:1329\u201335. 2020\/08\/10. https:\/\/doi.org\/10.2106\/jbjs.19.01169.","journal-title":"J Bone Joint Surg Am"},{"key":"4524_CR9","doi-asserted-by":"publisher","first-page":"e0230027","DOI":"10.1371\/journal.pone.0230027","volume":"15","author":"R Atallah","year":"2020","unstructured":"Atallah R, Van de Meent H, Verhamme L, Fr\u00f6lke JP, Leijendekkers RA. Safety, prosthesis wearing time and health-related quality of life of lower extremity bone-anchored prostheses using a press-fit titanium osseointegration implant: a prospective one-year follow-up cohort study. PLoS One. 2020;15:e0230027. 2020\/03\/10. https:\/\/doi.org\/10.1371\/journal.pone.0230027.","journal-title":"PLoS One"},{"key":"4524_CR10","doi-asserted-by":"publisher","first-page":"e303","DOI":"10.1097\/bot.0000000000001488","volume":"33","author":"S Thomson","year":"2019","unstructured":"Thomson S, Thomson A, Tetsworth K, Lu W, Zreiqat H, Al Muderis M. Radiographic evaluation of bone remodeling around osseointegration implants among transfemoral amputees. J Orthop Trauma. 2019;33:e303\u20138. 2019\/04\/12. https:\/\/doi.org\/10.1097\/bot.0000000000001488.","journal-title":"J Orthop Trauma"},{"key":"4524_CR11","doi-asserted-by":"publisher","first-page":"e097","DOI":"10.5435\/JAAOSGlobal-D-18-00097","volume":"3","author":"Y Li","year":"2019","unstructured":"Li Y, Kulbacka-Ortiz K, Caine-Winterberger K, Br\u00e5nemark R. Thumb amputations treated with osseointegrated percutaneous prostheses with up to 25 years of follow-up. J Am Acad Orthop Surg Glob Res Rev. 2019;3:e097. 2019\/02\/23. https:\/\/doi.org\/10.5435\/JAAOSGlobal-D-18-00097.","journal-title":"J Am Acad Orthop Surg Glob Res Rev"}],"container-title":["Skeletal Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00256-023-04524-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00256-023-04524-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00256-023-04524-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T03:42:12Z","timestamp":1712634132000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00256-023-04524-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,4]]},"references-count":11,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["4524"],"URL":"https:\/\/doi.org\/10.1007\/s00256-023-04524-z","relation":{},"ISSN":["0364-2348","1432-2161"],"issn-type":[{"value":"0364-2348","type":"print"},{"value":"1432-2161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,4]]},"assertion":[{"value":"10 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 November 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 November 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 December 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Fully informed written consent was obtained from all the patients whose images are included in this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"NK and AW are both owners of Relimb Distribution Ltd, a company which distributes the OPL bone-anchor in the United Kingdom. The OPL bone-anchor is one of the implants mentioned in this article. HS, GC, JF, YA and PK declare that they have no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}