{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:53:06Z","timestamp":1785775986347,"version":"3.56.0"},"reference-count":51,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100023392","name":"NIHR Barts Biomedical Research Centre, Queen Mary University of London","doi-asserted-by":"publisher","award":["NIHR203330"],"award-info":[{"award-number":["NIHR203330"]}],"id":[{"id":"10.13039\/501100023392","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Bone\u2010anchored prostheses (BAP) provide an alternative to traditional socket\u2010suspended prostheses (SSP) for individuals with transfemoral amputation (TFA) by addressing socket\u2010related complications. While most previous studies, primarily single\u2010arm trials, report positive outcomes with BAP, these findings may be overestimated due to lower preoperative baseline function among individuals using SSP prior to BAP implantation. This review aims to offer a more balanced comparison of functional and clinical outcomes between BAP and SSP by focusing exclusively on two\u2010arm comparative studies. A systematic review and meta\u2010analysis was conducted from December 2024 to May 2025, following PRISMA guidelines. Databases including PUBMED, EMBASE, Scopus, Cochrane, and Web of Science were searched. All studies meeting the inclusion criteria were cross\u2010sectional in design. Primary outcomes included mobility (Timed Up and Go [TUG]; Activities\u2010specific Balance Confidence [ABC]) and quality of life (Q\u2010TFA domains). Secondary outcomes: gait parameters, hip range of motion (ROM), osseoperception, and costs. Risk of bias was assessed using ROBINS\u2010I adapted for observational designs. Random\u2010effects meta\u2010analyses pooled mean differences (MD) or standardized mean differences (SMD) with 95% CIs. Twelve studies (BAP\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009200; SSP\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009244) met criteria. Pooled analyses showed no significant differences for TUG (MD 0.16\u2009s, 95% CI \u22122.09 to 2.41;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%), ABC (MD 0.05, 95% CI \u221222.19 to 22.29;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200976.3), Q\u2010TFA Global (MD 1.14, 95% CI \u221222.02 to 24.30), Q\u2010TFA Prosthetic Mobility (MD 0.37, 95% CI \u22129.93 to 10.68), Q\u2010TFA Problems (MD \u20136.29, 95% CI \u201318.77 to 6.19), Q\u2010TFA Prosthesis Use (MD 1.18, 95% CI \u22122.36 to 4.71), and gait speed (MD \u22120.03\u2009m\/s, 95% CI \u22120.31 to 0.25). Hip ROM tended to be higher with BAP in two studies; osseoperception favored BAP in two studies; one study reported on lower long\u2010term cost with BAP. No comparative studies of infection were identified. While BAP is a promising alternative for individuals experiencing complications with SSP, its benefits for functional SSP users remain uncertain. The lack of comparative studies evaluating infection rates highlights an important area for future research.\n                  <\/jats:p>","DOI":"10.1111\/os.70369","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:43:14Z","timestamp":1783006994000},"page":"1545-1562","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes of Bone\u2010Anchored Versus Socket\u2010Suspended Prostheses in Individuals With Transfemoral Amputation: A Systematic Review and Meta\u2010Analysis of Two\u2010Arm Comparative Studies"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8953-7239","authenticated-orcid":false,"given":"Janice","family":"Tan Sue Wei","sequence":"first","affiliation":[{"name":"Barts and the London School of Medicine and Dentistry Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen Xian","family":"Low","sequence":"additional","affiliation":[{"name":"East Suffolk and North Essex NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Bretherton","sequence":"additional","affiliation":[{"name":"Bone and Joint Health, Blizard Institute Queen Mary University London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-021-00944-x"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.2340\/17453674.2024.40996"},{"issue":"3","key":"e_1_2_14_4_1","first-page":"e0043","article-title":"Osseointegration for Amputees: Current Implants, Techniques, and Future Directions","volume":"8","author":"Hoellwarth J.","year":"2020","journal-title":"Journal of Bone and Joint Surgery Reviews"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13191-013-0252-z"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-19-00016"},{"issue":"7","key":"e_1_2_14_7_1","first-page":"1","article-title":"Osseointegrated Prosthetic Implants for People With Lower\u2010Limb Amputation: A Health Technology Assessment","volume":"19","author":"Ontario Health (Quality)","year":"2019","journal-title":"Ontario Health Technology Assessment Series"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2021.105457"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2020.08.005"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.23352"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.33137\/cpoj.v8i2.45790"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/17434440.2020.1704623"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biomaterials.2021.120836"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000003477"},{"issue":"11","key":"e_1_2_14_15_1","first-page":"900","article-title":"Safety of Osseointegrated Implants for Transfemoral Amputees: A Two\u2010Center Prospective Cohort Study","volume":"98","author":"Al Muderis M.","year":"2016","journal-title":"Journal of Bone and Joint Surgery. 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