{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:23:08Z","timestamp":1791289388879,"version":"4.3.0"},"reference-count":54,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"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":["Musculoskelet Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Bone-anchored prostheses (BAPs) are an alternative option for lower-limb amputees with problematic suspended socket prostheses (SSPs). We sought to meta-analytically quantify complication burden and revision-free survival for BAPs, whilst investigating possible differences in complication rates between common screw-fit (OPRA) and press-fit (ILP\/OPL) designs. A multi-database search of PubMed, EMBASE, CiNAHL, Cochrane Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus and Web of Science from inception to September 2025 was conducted. Proportions were pooled using a random-effects model. This review was registered in PROPSPERO (ID: CRD42024507070). A total of 22 studies reporting 979 patients were included. An overall complication rate of 65% (95% CI: 0.53\u20130.75, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200969%) was found. The most common complication was breakage of the abutment or dual-cone adaptor (DCA) (0.38, 95% CI: 0.19\u20130.62, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200997%), which constituted 94% of all mechanical failures (95% CI: 0.87\u20130.98, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200951%). Second was infection (0.36, 95% CI: 0.25\u20130.50, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200992%) with 72% of infections being grade I (95% CI: 0.57\u20130.83, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200972%). Estimated revision-free survival was 89% (95% CI: 0.84\u20130.93, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%) at five years and 77% (95% CI: 0.70\u20130.82, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%) at ten years. The largest difference between implant designs was for overall proportion of mechanical failure, OPRA at 68% (95% CI: 0.34\u20130.90, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200998%), ILP\/OPL at 19% (0.09\u20130.36, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200985%). BAPs do carry appreciable risks for superficial infection and mechanical (abutment\/DCA) breakage, with screw-fit designs appearing to have a higher mechanical failure rate. However, the revision-free survival rate overall remains acceptable up to 10\u00a0years demonstrating the viability of BAPs in lower-limb amputees.\n                  <\/jats:p>","DOI":"10.1007\/s12306-026-00946-9","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T12:58:18Z","timestamp":1768395498000},"page":"287-301","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Meta-analytic evaluation of complications and longevity of bone-anchored prostheses in lower extremity amputees: does design matter?"],"prefix":"10.1007","volume":"110","author":[{"given":"Hugh","family":"Milchem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmine J.","family":"Khair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maamoun","family":"Adra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayndhan S.","family":"Sivanathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreehari","family":"Suresh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilip K.","family":"Vankayalapati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aslam Mohamed","family":"Haroon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian A.","family":"Than","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadim","family":"Tarazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Nakanishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Smitham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"946_CR1","doi-asserted-by":"publisher","first-page":"1258853","DOI":"10.3389\/fpubh.2023.1258853","volume":"11","author":"B Yuan","year":"2023","unstructured":"Yuan B, Hu D, Gu S, Xiao S, Song F (2023) The global burden of traumatic amputation in 204 countries and territories. Front Public Health 11:1258853. https:\/\/doi.org\/10.3389\/fpubh.2023.1258853","journal-title":"Front Public Health"},{"issue":"1","key":"946_CR2","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.pmr.2009.08.003","volume":"21","author":"JZ Laferrier","year":"2010","unstructured":"Laferrier JZ, Gailey R (2010) Advances in lower-limb prosthetic technology. Phys Med Rehabil Clin N Am 21(1):87\u2013110. https:\/\/doi.org\/10.1016\/j.pmr.2009.08.003","journal-title":"Phys Med Rehabil Clin N Am"},{"issue":"1","key":"946_CR3","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.apmr.2008.07.015","volume":"90","author":"HE Meulenbelt","year":"2009","unstructured":"Meulenbelt HE, Geertzen JH, Jonkman MF, Dijkstra PU (2009) Determinants of skin problems of the stump in lower-limb amputees. Arch Phys Med Rehabil 90(1):74\u201381. https:\/\/doi.org\/10.1016\/j.apmr.2008.07.015","journal-title":"Arch Phys Med Rehabil"},{"issue":"2","key":"946_CR4","doi-asserted-by":"publisher","first-page":"173","DOI":"10.2340\/00015555-1040","volume":"91","author":"HE Meulenbelt","year":"2011","unstructured":"Meulenbelt HE, Geertzen JH, Jonkman MF, Dijkstra PU (2011) Skin problems of the stump in lower limb amputees: 1. a clinical study. Acta Derm Venereol 91(2):173\u2013177. https:\/\/doi.org\/10.2340\/00015555-1040","journal-title":"Acta Derm Venereol"},{"issue":"4","key":"946_CR5","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/j.jphys.2014.09.003","volume":"60","author":"CE Roffman","year":"2014","unstructured":"Roffman CE, Buchanan J, Allison GT (2014) Predictors of non-use of prostheses by people with lower limb amputation after discharge from rehabilitation: development and validation of clinical prediction rules. J Physiother 60(4):224\u2013231. https:\/\/doi.org\/10.1016\/j.jphys.2014.09.003","journal-title":"J Physiother"},{"key":"946_CR6","doi-asserted-by":"publisher","first-page":"7960559","DOI":"10.1155\/2022\/7960559","volume":"2022","author":"JS Hoellwarth","year":"2022","unstructured":"Hoellwarth JS, Tetsworth K, Akhtar MA, Al Muderis M (2022) The clinical history and basic science origins of transcutaneous osseointegration for amputees. Adv Orthop 2022:7960559. https:\/\/doi.org\/10.1155\/2022\/7960559","journal-title":"Adv Orthop"},{"issue":"3","key":"946_CR7","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 (2020) Osseointegration for amputees: current implants, techniques, and future directions. JBJS Rev 8(3):e0043. https:\/\/doi.org\/10.2106\/JBJS.RVW.19.00043","journal-title":"JBJS Rev"},{"issue":"2","key":"946_CR8","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1080\/03093640500238014","volume":"29","author":"K Hagberg","year":"2005","unstructured":"Hagberg K, Haggstrom E, Uden M, Branemark R (2005) Socket versus bone-anchored trans-femoral prostheses: hip range of motion and sitting comfort. Prosthet Orthot Int 29(2):153\u2013163. https:\/\/doi.org\/10.1080\/03093640500238014","journal-title":"Prosthet Orthot Int"},{"issue":"11","key":"946_CR9","doi-asserted-by":"publisher","first-page":"2120","DOI":"10.1016\/j.apmr.2014.07.009","volume":"95","author":"K Hagberg","year":"2014","unstructured":"Hagberg K, Hansson E, Branemark R (2014) Outcome of percutaneous osseointegrated prostheses for patients with unilateral transfemoral amputation at two-year follow-up. Arch Phys Med Rehabil 95(11):2120\u20132127. https:\/\/doi.org\/10.1016\/j.apmr.2014.07.009","journal-title":"Arch Phys Med Rehabil"},{"issue":"3","key":"946_CR10","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1177\/0269215518815215","volume":"33","author":"RA Leijendekkers","year":"2019","unstructured":"Leijendekkers RA, van Hinte G, Fr\u00f6lke JP, van de Meent H, Atsma F, van der Nijhuis- Sanden MW et al (2019) Functional performance and safety of bone-anchored prostheses in persons with a transfemoral or transtibial amputation: a prospective one-year follow-up cohort study. Clin Rehabil 33(3):450\u2013464. https:\/\/doi.org\/10.1177\/0269215518815215","journal-title":"Clin Rehabil"},{"issue":"11","key":"946_CR11","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1080\/09638288.2016.1186752","volume":"39","author":"RA Leijendekkers","year":"2017","unstructured":"Leijendekkers RA, van Hinte G, Frolke JP, van de Meent H, van der Nijhuis- Sanden MW, Staal JB (2017) Comparison of bone-anchored prostheses and socket prostheses for patients with a lower extremity amputation: a systematic review. Disabil Rehabil 39(11):1045\u20131058. https:\/\/doi.org\/10.1080\/09638288.2016.1186752","journal-title":"Disabil Rehabil"},{"key":"946_CR12","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https:\/\/doi.org\/10.1136\/bmj.n71","journal-title":"BMJ"},{"key":"946_CR13","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","volume":"355","author":"JA Sterne","year":"2016","unstructured":"Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https:\/\/doi.org\/10.1136\/bmj.i4919","journal-title":"BMJ"},{"issue":"11","key":"946_CR14","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, de Van Meent H, Frolke JP (2016) Safety of osseointegrated implants for transfemoral amputees: a two-center prospective cohort study. J Bone Joint Surg Am 98(11):900\u2013909. https:\/\/doi.org\/10.2106\/JBJS.15.00808","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"946_CR15","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1302\/0301-620X.102B1.BJJ-2019-0611.R1","volume":"102","author":"K Hagberg","year":"2020","unstructured":"Hagberg K, Ghassemi Jahani SA, Kulbacka-Ortiz K, Thomsen P, Malchau H, Reinholdt C (2020) A 15-year follow-up of transfemoral amputees with bone-anchored transcutaneous prostheses: mechanical complications and patient-reported outcomes. Bone Joint J 102(1):55\u201363. https:\/\/doi.org\/10.1302\/0301-620X.102B1.BJJ-2019-0611.R1","journal-title":"Bone Joint J"},{"issue":"5","key":"946_CR16","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/j.otsr.2019.05.010","volume":"105","author":"RL Hansen","year":"2019","unstructured":"Hansen RL, Langdahl BL, J\u00f8rgensen PH, Petersen KK, S\u00f8balle K, Stilling M (2019) Does migration of osseointegrated implants for transfemoral amputees predict later revision? A prospective 2-year radiostereometric analysis with 5-years clinical follow-up. Orthop Traumatol Surg Res 105(5):1013\u20131020. https:\/\/doi.org\/10.1016\/j.otsr.2019.05.010","journal-title":"Orthop Traumatol Surg Res"},{"issue":"6","key":"946_CR17","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s00132-015-3117-9","volume":"44","author":"DL Juhnke","year":"2015","unstructured":"Juhnke DL, Aschoff HH (2015) [Endo-exo prostheses following limb-amputation]. Orthopade 44(6):419\u2013425. https:\/\/doi.org\/10.1007\/s00132-015-3117-9","journal-title":"Orthopade"},{"issue":"3","key":"946_CR18","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.injury.2020.01.006","volume":"51","author":"L McMenemy","year":"2020","unstructured":"McMenemy L, Ramasamy A, Sherman K, Mistlin A, Phillip R, Evriviades D et al (2020) Direct skeletal fixation in bilateral above knee amputees following blast: 2 year follow up results from the initial cohort of UK service personnel. Injury 51(3):735\u2013743. https:\/\/doi.org\/10.1016\/j.injury.2020.01.006","journal-title":"Injury"},{"issue":"12","key":"946_CR19","doi-asserted-by":"publisher","first-page":"3100","DOI":"10.1007\/s11999-017-5507-2","volume":"475","author":"J Tillander","year":"2017","unstructured":"Tillander J, Hagberg K, Berlin \u00d6, Hagberg L, Br\u00e5nemark R (2017) Osteomyelitis risk in patients with transfemoral amputations treated with osseointegration prostheses. Clin Orthop Relat Res 475(12):3100\u20133108. https:\/\/doi.org\/10.1007\/s11999-017-5507-2","journal-title":"Clin Orthop Relat Res"},{"issue":"11","key":"946_CR20","doi-asserted-by":"publisher","first-page":"2174","DOI":"10.1016\/j.apmr.2013.05.020","volume":"94","author":"H de Van Meent","year":"2013","unstructured":"de Van Meent H, Hopman MT, Frolke JP (2013) Walking ability and quality of life in subjects with transfemoral amputation: a comparison of osseointegration with socket prostheses. Arch Phys Med Rehabil 94(11):2174\u20132178. https:\/\/doi.org\/10.1016\/j.apmr.2013.05.020","journal-title":"Arch Phys Med Rehabil"},{"key":"946_CR21","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1471-2288-12-9","volume":"12","author":"P Guyot","year":"2012","unstructured":"Guyot P, Ades AE, Ouwens MJ, Welton NJ (2012) Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves. BMC Med Res Methodol 12:9. https:\/\/doi.org\/10.1186\/1471-2288-12-9","journal-title":"BMC Med Res Methodol"},{"issue":"5","key":"946_CR22","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s00113-016-0175-3","volume":"119","author":"HH Aschoff","year":"2016","unstructured":"Aschoff HH, Juhnke DL (2016) Endo-exo prostheses: osseointegrated percutaneously channeled implants for rehabilitation after limb amputation. Unfallchirurg 119(5):421\u2013427. https:\/\/doi.org\/10.1007\/s00113-016-0175-3","journal-title":"Unfallchirurg"},{"issue":"4","key":"946_CR23","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1682\/JRRD.2014.11.0280","volume":"52","author":"D-L Juhnke","year":"2015","unstructured":"Juhnke D-L, Beck JP, Jeyapalina S, Aschoff HH (2015) Fifteen years of experience with integral-leg-prosthesis: cohort study of artificial limb attachment system. J Rehabil Res Dev 52(4):407\u2013419. https:\/\/doi.org\/10.1682\/JRRD.2014.11.0280","journal-title":"J Rehabil Res Dev"},{"issue":"Suppl 1","key":"946_CR24","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/sap.0000000000002329","volume":"85","author":"AA Marano","year":"2020","unstructured":"Marano AA, Modiri O, Rozbruch SR, Otterburn DM (2020) Soft tissue contouring at the time of osseointegrated implant reconstruction for lower extremity amputation. Ann Plast Surg 85(Suppl 1):33\u201336. https:\/\/doi.org\/10.1097\/sap.0000000000002329","journal-title":"Ann Plast Surg"},{"issue":"1","key":"946_CR25","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1177\/0309364618791616","volume":"43","author":"DJ Matthews","year":"2019","unstructured":"Matthews DJ, Arastu M, Uden M, Sullivan JP, Bolsakova K, Robinson K et al (2019) UK trial of the osseointegrated prosthesis for the rehabilitation for amputees: 1995\u20132018. Prosthet Orthot Int 43(1):112\u2013122. https:\/\/doi.org\/10.1177\/0309364618791616","journal-title":"Prosthet Orthot Int"},{"issue":"4","key":"946_CR26","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1097\/corr.0000000000002074","volume":"480","author":"J Mohamed","year":"2022","unstructured":"Mohamed J, Reetz D, van de Meent H, Schreuder H, Fr\u00f6lke JP, Leijendekkers R (2022) What are the risk factors for mechanical failure and loosening of a transfemoral osseointegrated implant system in patients with a lower-limb amputation? Clin Orthop Relat Res 480(4):722\u2013731. https:\/\/doi.org\/10.1097\/corr.0000000000002074","journal-title":"Clin Orthop Relat Res"},{"issue":"15","key":"946_CR27","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 (2020) Safety and performance of bone-anchored prostheses in persons with a transfemoral amputation: a 5-year follow-up study. J Bone Joint Surg Am 102(15):1329\u20131335. https:\/\/doi.org\/10.2106\/jbjs.19.01169","journal-title":"J Bone Joint Surg Am"},{"key":"946_CR28","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.OA.21.00072","author":"TJ Reif","year":"2021","unstructured":"Reif TJ, Khabyeh-Hasbani N, Jaime KM, Sheridan GA, Otterburn DM, Robert Rozbruch S (2021) Early experience with femoral and tibial bone-anchored osseointegration prostheses. JBJS Open Access. https:\/\/doi.org\/10.2106\/JBJS.OA.21.00072","journal-title":"JBJS Open Access"},{"issue":"1","key":"946_CR29","doi-asserted-by":"publisher","first-page":"56","DOI":"10.34239\/ajops.v4n1.199","volume":"4","author":"S Sreedharan","year":"2021","unstructured":"Sreedharan S, Gray S, Bruscino-Raiola F (2021) Osseointegrated prostheses for lower limb amputees. Australas J Plast Surg 4(1):56\u201362. https:\/\/doi.org\/10.34239\/ajops.v4n1.199","journal-title":"Australas J Plast Surg"},{"issue":"2","key":"946_CR30","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1007\/s00590-023-03738-0","volume":"34","author":"C Thouvenin","year":"2024","unstructured":"Thouvenin C, Bertrand-Marchand M, Klotz R, Puges M, Fabre T, Delgove A (2024) Bone-anchored prostheses for lower limb amputation in a French cohort with 1\u201315\u00a0years of follow-up: implant survival rates, mechanical complications, and reported outcomes. Eur J Orthop Surg Traumatol 34(2):885\u2013892. https:\/\/doi.org\/10.1007\/s00590-023-03738-0","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"5","key":"946_CR31","doi-asserted-by":"publisher","first-page":"44","DOI":"10.31080\/asor.2021.04.0307","volume":"4","author":"C Rojas","year":"2021","unstructured":"Rojas C, Laso J, Valiente D, Olivieri R, Gaggero N (2021) Outcome of percutaneous osseointegrated prostheses for patients with transfemoral amputation at 5-year follow-up. Acta Sci Orthop 4(5):44\u201350. https:\/\/doi.org\/10.31080\/asor.2021.04.0307","journal-title":"Acta Sci Orthop"},{"key":"946_CR32","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000003369","author":"C van Vliet-Bockting","year":"2025","unstructured":"van Vliet-Bockting C, Atallah R, Frolke JPM, Leijendekkers RA (2025) How to improve patient selection in individuals with lower extremity amputation using a bone-anchored prosthesis. Clin Orthop Relat Res. https:\/\/doi.org\/10.1097\/CORR.0000000000003369","journal-title":"Clin Orthop Relat Res"},{"issue":"16","key":"946_CR33","doi-asserted-by":"publisher","first-page":"e743","DOI":"10.5435\/jaaos-d-17-00621","volume":"27","author":"RP Br\u00e5nemark","year":"2019","unstructured":"Br\u00e5nemark RP, Hagberg K, Kulbacka-Ortiz K, Berlin \u00d6, Rydevik B (2019) Osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: a prospective five-year follow-up of patient-reported outcomes and complications. J Am Acad Orthop Surg 27(16):e743\u2013e751. https:\/\/doi.org\/10.5435\/jaaos-d-17-00621","journal-title":"J Am Acad Orthop Surg"},{"key":"946_CR34","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.jot.2022.09.004","volume":"38","author":"K Hagberg","year":"2023","unstructured":"Hagberg K, Ghasemi Jahani SA, Omar O, Thomsen P (2023) Osseointegrated prostheses for the rehabilitation of patients with transfemoral amputations: a prospective ten-year cohort study of patient-reported outcomes and complications. J Orthop Translat 38:56\u201364. https:\/\/doi.org\/10.1016\/j.jot.2022.09.004","journal-title":"J Orthop Translat"},{"issue":"11","key":"946_CR35","doi-asserted-by":"publisher","first-page":"2092","DOI":"10.1016\/j.apmr.2022.06.008","volume":"103","author":"S Sinclair","year":"2022","unstructured":"Sinclair S, Beck JP, Webster J, Agarwal J, Gillespie B, Stevens P et al (2022) The first FDA approved early feasibility study of a novel percutaneous bone anchored prosthesis for transfemoral amputees: a prospective 1-year follow-up cohort study. Arch Phys Med Rehabil 103(11):2092\u20132104. https:\/\/doi.org\/10.1016\/j.apmr.2022.06.008","journal-title":"Arch Phys Med Rehabil"},{"issue":"4","key":"946_CR36","doi-asserted-by":"publisher","first-page":"111424","DOI":"10.1016\/j.injury.2024.111424","volume":"55","author":"PS Corona","year":"2024","unstructured":"Corona PS, Vargas Meouchi EA, Garcia Hernandez JM, Soriano RF, Crespo-Fresno A, Issa-Benitez D et al (2024) Single-stage transcutaneous osseointegrated prosthesis for above-knee amputations including an antibiotic-loaded hydrogel. Preliminary results of a new surgical protocol. Injury 55(4):111424. https:\/\/doi.org\/10.1016\/j.injury.2024.111424","journal-title":"Injury"},{"issue":"3","key":"946_CR37","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1097\/CORR.0000000000003267","volume":"483","author":"BK Potter","year":"2025","unstructured":"Potter BK, Rivera JA, Anderson AB, Souza JM, Forsberg JA (2025) What functional outcomes can be expected with osseointegrated prostheses in transfemoral amputations? Clin Orthop Relat Res 483(3):513\u2013523. https:\/\/doi.org\/10.1097\/CORR.0000000000003267","journal-title":"Clin Orthop Relat Res"},{"key":"946_CR38","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.artd.2022.04.008","volume":"16","author":"MA Akhtar","year":"2022","unstructured":"Akhtar MA, Hoellwarth JS, Tetsworth K, Oomatia A, Al Muderis M (2022) Osseointegration following transfemoral amputation after infected total knee replacement: a case series of 10 patients with a mean follow-up of 5\u00a0years. Arthroplast Today 16:21\u201330. https:\/\/doi.org\/10.1016\/j.artd.2022.04.008","journal-title":"Arthroplast Today"},{"issue":"1","key":"946_CR39","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1186\/s13018-023-04060-5","volume":"18","author":"ZJ Zeng","year":"2023","unstructured":"Zeng ZJ, Yao FM, He W, Wei QS, He MC (2023) Incidence of periprosthetic joint infection after primary total hip arthroplasty is underestimated: a synthesis of meta-analysis and bibliometric analysis. J Orthop Surg Res 18(1):610. https:\/\/doi.org\/10.1186\/s13018-023-04060-5","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"946_CR40","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 (2020) 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 15(3):e0230027. https:\/\/doi.org\/10.1371\/journal.pone.0230027","journal-title":"PLoS ONE"},{"issue":"7","key":"946_CR41","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1302\/2633-1462.47.BJO-2022-0117.R1","volume":"4","author":"E Banducci","year":"2023","unstructured":"Banducci E, Al Muderis M, Lu W, Bested SR (2023) The safety of one-stage versus two-stage approach to osseointegrated prosthesis for limb amputation. Bone Jt Open 4(7):539\u2013550. https:\/\/doi.org\/10.1302\/2633-1462.47.BJO-2022-0117.R1","journal-title":"Bone Jt Open"},{"key":"946_CR42","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1093\/milmed\/usx185","volume":"183","author":"M Al Muderis","year":"2018","unstructured":"Al Muderis M, Lu W, Glatt V, Tetsworth K (2018) Two-stage osseointegrated reconstruction of post-traumatic unilateral transfemoral amputees. Mil Med 183:496\u2013502. https:\/\/doi.org\/10.1093\/milmed\/usx185","journal-title":"Mil Med"},{"issue":"4","key":"946_CR43","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1007\/s00113-016-0296-8","volume":"120","author":"M Al Muderis","year":"2017","unstructured":"Al Muderis M, Lu W, Li JJ (2017) Osseointegrated prosthetic limb for the treatment of lower limb amputations: experience and outcomes. Unfallchirurg 120(4):306\u2013311. https:\/\/doi.org\/10.1007\/s00113-016-0296-8","journal-title":"Unfallchirurg"},{"issue":"2","key":"946_CR44","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1302\/0301-620X.102B2.BJJ-2019-0697.R2","volume":"102-B","author":"JS Hoellwarth","year":"2020","unstructured":"Hoellwarth JS, Tetsworth K, Kendrew J, Kang NV, van Waes O, Al-Maawi Q et al (2020) Periprosthetic osseointegration fractures are infrequent and management is familiar. Bone Joint J 102-B(2):162\u2013169. https:\/\/doi.org\/10.1302\/0301-620X.102B2.BJJ-2019-0697.R2","journal-title":"Bone Joint J"},{"key":"946_CR45","doi-asserted-by":"publisher","DOI":"10.3390\/app10228263","author":"AI Mirulla","year":"2020","unstructured":"Mirulla AI, Di Paolo S, Di Simone F, Ingrassia T, Nigrelli V, Zaffagnini S et al (2020) Biomechanical analysis of two types of osseointegrated transfemoral prosthesis. Appl Sci. https:\/\/doi.org\/10.3390\/app10228263","journal-title":"Appl Sci"},{"key":"946_CR46","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.artd.2022.05.012","volume":"16","author":"AM Negm","year":"2022","unstructured":"Negm AM, Beaupre LA, Goplen CM, Weeks C, Jones CA (2022) A scoping review of total hip arthroplasty survival and reoperation rates in patients of 55\u00a0years or younger: health services implications for revision surgeries. Arthroplast Today 16:247\u201358 e6. https:\/\/doi.org\/10.1016\/j.artd.2022.05.012","journal-title":"Arthroplast Today"},{"issue":"4","key":"946_CR47","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1503\/cjs.013118","volume":"62","author":"XY Mei","year":"2019","unstructured":"Mei XY, Gong YJ, Safir O, Gross A, Kuzyk P (2019) Long-term outcomes of total hip arthroplasty in patients younger than 55\u00a0years: a systematic review of the contemporary literature. Can J Surg 62(4):249\u2013258. https:\/\/doi.org\/10.1503\/cjs.013118","journal-title":"Can J Surg"},{"issue":"11","key":"946_CR48","doi-asserted-by":"publisher","first-page":"2197","DOI":"10.1007\/s00264-012-1614-6","volume":"36","author":"P Sadoghi","year":"2012","unstructured":"Sadoghi P, Schroder C, Fottner A, Steinbruck A, Betz O, Muller PE et al (2012) Application and survival curve of total hip arthroplasties: a systematic comparative analysis using worldwide hip arthroplasty registers. Int Orthop 36(11):2197\u20132203. https:\/\/doi.org\/10.1007\/s00264-012-1614-6","journal-title":"Int Orthop"},{"issue":"10172","key":"946_CR49","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/S0140-6736(18)31665-9","volume":"393","author":"JT Evans","year":"2019","unstructured":"Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A (2019) How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15\u00a0years of follow-up. Lancet 393(10172):647\u2013654. https:\/\/doi.org\/10.1016\/S0140-6736(18)31665-9","journal-title":"Lancet"},{"issue":"4","key":"946_CR50","doi-asserted-by":"publisher","first-page":"e23","DOI":"10.2106\/JBJS.ST.23.00005","volume":"14","author":"JP Frolke","year":"2024","unstructured":"Frolke JP, Atallah R (2024) Revision of press-fit bone-anchored prosthesis after implant failure. JBJS Essent Surg Tech 14(4):e23. https:\/\/doi.org\/10.2106\/JBJS.ST.23.00005","journal-title":"JBJS Essent Surg Tech"},{"key":"946_CR51","unstructured":"COMET Initiative, (2025). https:\/\/www.comet-initiative.org\/Studies\/Details\/3435"},{"key":"946_CR52","unstructured":"Br\u00e5nemark R, Frolke JP, Frossard L, Grant M, Leijendekkers R, Geada M, et al. (2024) Bone Anchored Limbs. https:\/\/www.ispoint.org\/special-interest-groups\/bone-anchored-limbs\/. Accessed"},{"issue":"5","key":"946_CR53","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.3390\/prosthesis6050091","volume":"6","author":"K Ahmed","year":"2024","unstructured":"Ahmed K, Ortiz-Catalan M (2024) A real time delphi study on the challenges and adverse events to percutaneous osseointegrated implant integration and long-term fixation in limb amputation. Prosthesis 6(5):1262\u20131280. https:\/\/doi.org\/10.3390\/prosthesis6050091","journal-title":"Prosthesis"},{"issue":"3","key":"946_CR54","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s12283-016-0196-8","volume":"19","author":"MA Muderis","year":"2016","unstructured":"Muderis MA, Aschoff HH, Bosley B, Raz G, Gerdesmeyer L, Burkett B (2016) Direct skeletal attachment prosthesis for the amputee athlete: the unknown potential. Sports Eng 19(3):141\u2013145. https:\/\/doi.org\/10.1007\/s12283-016-0196-8","journal-title":"Sports Eng"}],"container-title":["MUSCULOSKELETAL SURGERY"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-026-00946-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12306-026-00946-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-026-00946-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:42:37Z","timestamp":1786632157000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12306-026-00946-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,14]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["946"],"URL":"https:\/\/doi.org\/10.1007\/s12306-026-00946-9","relation":{},"ISSN":["2035-5114"],"issn-type":[{"value":"2035-5114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,14]]},"assertion":[{"value":"18 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This systematic review and meta-analysis did not require ethical approval.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}