{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:55:15Z","timestamp":1793332515303,"version":"4.5.0"},"reference-count":22,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Mil Health"],"accepted":{"date-parts":[[2019,4,3]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This paper examines the pain management, from surgery to specialist rehabilitation, of the first seven military transfemoral amputee patients treated in the UK with femoral osseointegration. All the patients had sustained complex ballistic injuries on the battlefield. The patients were characterised by long-standing problems with functional rehabilitation due to limitations with conventional prostheses, including stump soft tissue issues and impaired biomechanics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective service investigation was undertaken to evaluate the effectiveness of the pain management of patients undergoing osseointegration. Data were collected by daily direct patient contact, supplemented by a focused review of perioperative and rehabilitation case notes. Physiological and medication details were recorded with specific reference to systemic and regional analgesia and the impact of postoperative complications, including infection and accidental injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven patients underwent femoral osseointegration and were followed up for a period of up to 3\u2009years following surgery. The perioperative recovery was associated with significant escalation of analgesic requirements. Postoperative systemic inflammatory response syndrome was identified in six patients, with wound infection persisting in some cases into the rehabilitation phase. Three patients suffered femoral fractures following accidental injuries secondary to increased mobilisation following surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Successful surgical outcomes were achieved in a difficult patient cohort disadvantaged by previously restricted functional recovery from complex injuries. The importance of supporting the operative and recovery phases with a multidisciplinary pain service is emphasised. We offer this data and the lessons learnt to assist clinicians contemplating the establishment and service development of osseointegration services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jramc-2019-001185","type":"journal-article","created":{"date-parts":[[2019,5,17]],"date-time":"2019-05-17T10:15:31Z","timestamp":1558088131000},"page":"294-301","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Perioperative and early rehabilitation outcomes following osseointegration in UK military amputees"],"prefix":"10.1136","volume":"166","author":[{"given":"Paul","family":"Wood","sequence":"first","affiliation":[{"name":"Anaesthetics, Queen Elizabeth Hospital Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8338-7658","authenticated-orcid":false,"given":"C","family":"Small","sequence":"additional","affiliation":[{"name":"Anaesthetics, Queen Elizabeth Hospital Birmingham, Birmingham, UK"},{"name":"School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Anaesthetics, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,17]]},"reference":[{"key":"2026052804352043000_166.5.294.1","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":"2026052804352043000_166.5.294.2","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s10439-017-1976-4","article-title":"Biomechanical characterisation of bone-anchored implant systems for amputation limb prostheses: a systematic review","volume":"46","author":"Thesleff","year":"2018","journal-title":"Ann Biomed Eng"},{"key":"2026052804352043000_166.5.294.3","doi-asserted-by":"publisher","DOI":"10.1097\/JPO.0b013e3181ccc53d"},{"key":"2026052804352043000_166.5.294.4","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":"Hagberg","year":"2009","journal-title":"JRRD"},{"key":"2026052804352043000_166.5.294.5","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1302\/0301-620X.96B1.31905","article-title":"A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation","volume":"96-B","author":"Br\u00e5nemark","year":"2014","journal-title":"The Bone & Joint Journal"},{"key":"2026052804352043000_166.5.294.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-013508","article-title":"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","volume":"7","author":"Al Muderis","year":"2017","journal-title":"BMJ Open"},{"key":"2026052804352043000_166.5.294.7","unstructured":"Rapid review of osseointegration\/direct skeletal fixation: A report for NHS England . 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