{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T07:30:36Z","timestamp":1778916636654,"version":"3.51.4"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Office for Veterans\u00e2\u20ac\u2122 Affairs UK"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>Direct skeletal fixation (DSF) involves attaching the intramedullary portion of a prosthesis directly to the skeletal residuum, providing an alternative for amputees unable to mobilise with socket-based prostheses. This study investigates the effects of DSF on physical and mental health at 6- and 8-year follow-up for military bilateral transfemoral amputees in the UK. Eight male bilateral transfemoral military amputees who underwent implantation with the Osseointegration Group of Australia\u2013Osseointegration Prosthetic Limb prosthesis consented to participate in the study. All patients are routinely reviewed annually in a dedicated clinic, and this paper reports the 6- and 8-year follow-ups. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36). Complications data were recorded at the 8-year follow-up. The SF-36 physical component score significantly increased from preoperative levels at 6 years (median: 29 vs. 47; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.003) and 8 years (median: 29 vs. 45; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.024). The SF-36 mental health component score improved significantly at 6 years from preop (median: 39 vs. 57; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.011). Among 16 femoral residuums, there was one explantation because of infection at 8.5 years postimplantation, and two cases were managed with long-term suppressive antibiotics. A total of 17 additional procedures were performed on nine residuums: 11 for soft tissue revision, five for infection, and one for fracture repair. This research adds to the growing evidence base that DSF has the potential to enhance the health and well-being of amputee veterans and potentially the broader amputee population. Medical complications remain an important consideration.<\/jats:p>","DOI":"10.1097\/mrr.0000000000000677","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T12:00:29Z","timestamp":1752148829000},"page":"173-179","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Self-reported health outcomes and medical complications at 6- and 8-year follow-up after direct skeletal fixation in individuals with bilateral transfemoral amputations"],"prefix":"10.1097","volume":"48","author":[{"given":"Diana","family":"Toderita","sequence":"first","affiliation":[{"name":"Department of Bioengineering, Centre for Injury Studies, Imperial College London, London"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Handford","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Centre for Injury Studies, Imperial College London, London"},{"name":"Academic Department of Military Trauma and Orthopaedics"},{"name":"Queen Elizabeth Hospital Birmingham, Royal Centre for Defence Medicine, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arul","family":"Ramasamy","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Centre for Injury Studies, Imperial College London, London"},{"name":"Academic Department of Military Trauma and Orthopaedics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Hindle","sequence":"additional","affiliation":[{"name":"St Paul\u2019s Hospital, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Kendrew","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Centre for Injury Studies, Imperial College London, London"},{"name":"Queen Elizabeth Hospital Birmingham, Royal Centre for Defence Medicine, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony M.J.","family":"Bull","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Centre for Injury Studies, Imperial College London, London"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"McMenemy","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Centre for Injury Studies, Imperial College London, London"},{"name":"Academic Department of Military Trauma and Orthopaedics"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"R1-20250729","doi-asserted-by":"crossref","first-page":"2848","DOI":"10.1007\/s11999-015-4250-9","article-title":"What is the magnitude and long-term economic cost of care of the British military Afghanistan amputee cohort?","volume":"473","author":"Edwards","year":"2015","journal-title":"Clin Orthop Relat Res"},{"key":"R2-20250729","doi-asserted-by":"crossref","first-page":"178","DOI":"10.2340\/00015555-1023","article-title":"Skin problems of the stump in lower limb amputees: 2. 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