{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:27:55Z","timestamp":1784129275479,"version":"3.55.0"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background Osseointegrative implantation after amputation of the lower extremity is a special treatment option. Physiotherapeutic treatment is important for the functional outcome.\n          This study systematically evaluated existing follow-up treatment protocols to establish a literature-based recommendation for postoperative rehabilitation procedures.<\/jats:p><jats:p>\n          Methodology A PubMed literature search was conducted on December 10, 2020, using the following search terms: (osseo-integrat* OR endo-exo OR boneanchored OR bone anchored) AND\n          (prosthe*) AND (leg OR lower limb* OR lower extremit* OR transfem* OR transtib*) AND (rehabilitation). 113 publications were found in this context. 10 of them met inclusion criteria. The\n          Cochrane risk of bias tool was used to determine the publications\u02bc quality.<\/jats:p><jats:p>\n          Results Three systematic rehabilitation protocols have been described: Osseointegrated Prostheses for the Rehabilitation of Amputees protocol, Osseointegration Group of Australia\n          Accelerated protocol and Radboud Amputation: rehabilitation protocol for endo-exo femoral prosthesis. There are clear differences in the duration of the rehabilitation protocols. The quality\n          of published studies is limited due to the high risk of bias and low evidence levels (mainly III\u200a\u2013\u200aV). A concept for long-term rehabilitation has not been described yet.<\/jats:p><jats:p>\n          Conclusions There are various protocols for rehabilitation after treatment with osseointegrative prosthesis. Gradually increasing axial weight bearing started shortly after surgery;\n          step-by-step gait training, adaptation of the prosthesis to the new biomechanics and critical patient selection and pre-operative training have been proven useful for successful\n          rehabilitation. Controlled comparative studies, standardised outcome measurements or comparative studies between different protocols are not available. Models for multi-level long-term care\n          have not been described in the literature so far.<\/jats:p>","DOI":"10.1055\/a-1545-5486","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T02:40:36Z","timestamp":1632451236000},"page":"318-327","source":"Crossref","is-referenced-by-count":5,"title":["Rehabilitation of Patients with Osseointegrated Prosthesis after Transfemoral Amputation \u2013 Literature-based Recommendation for Postoperative Rehabilitative\n          Procedure"],"prefix":"10.1055","volume":"161","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0199-0283","authenticated-orcid":false,"given":"Philipp Georg","family":"Schnadthorst","sequence":"additional","affiliation":[{"name":"Bundeswehr Centre of Sports Medicine, Warendorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Lison","sequence":"additional","affiliation":[{"name":"Bundeswehr Centre of Sports Medicine, Warendorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schulze","sequence":"additional","affiliation":[{"name":"Bundeswehr Centre of Sports Medicine, Warendorf, Germany"},{"name":"University Medicine Rostock, Department of Orthopaedic Surgery, Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1682\/JRRD.2008.06.0080","article-title":"One hundred patients treated with osseointegrated transfemoral amputation prostheses \u2013 rehabilitation perspective","volume":"46","author":"K Hagberg","year":"2009","journal-title":"J Rehabil Res Dev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s00132-015-3117-9","article-title":"Endo-Exo-Prothesen nach Gliedma\u00dfenamputation","volume":"44","author":"D L 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\u00d6rgel","year":"2021","journal-title":"Orthop\u00e4de"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1007\/s00113-017-0351-0","article-title":"Anschlussadapter zur Ankopplung der Exoprothese an den Endostiel: Anforderungen an den Orthop\u00e4dietechniker hinsichtlich Planung und Anwendung","volume":"120","author":"H Grundei","year":"2017","journal-title":"Unfallchirurg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1007\/s00064-011-0039-5","article-title":"Oberschenkelamputation. 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J Respir Crit Care Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u201cUp & Go\u201d: a test of basic functional mobility for frail elderly persons","volume":"39","author":"D Podsiadlo","year":"1991","journal-title":"J Am Geriatr Soc"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2174","DOI":"10.1016\/j.apmr.2013.05.020","article-title":"Walking ability and quality of life in subjects with transfemoral amputation: a comparison of osseointegration with socket prostheses","volume":"94","author":"H Van de Meent","year":"2013","journal-title":"Arch Phys Med Rehabil"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1080\/09593985.2016.1265620","article-title":"Gait rehabilitation for a patient with an osseointegrated prosthesis following transfemoral amputation","volume":"33","author":"R A Leijendekkers","year":"2017","journal-title":"Physiother Theory 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