{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:55:00Z","timestamp":1791312900838,"version":"4.3.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,5]]},"abstract":"\n Background:<\/jats:title>\n For almost 30 years, bone-anchored prostheses have offered an alternative solution to prosthetic sockets by attaching the artificial limb directly to the femoral residuum by means of an osseointegration implant. Osseointegration implant surgery was introduced in our center in 2009. The aim of the present study is to report on safety, prosthesis-wearing time, and health-related quality-of-life (HRQoL) for patients with femoral bone-anchored prostheses during a 5-year follow-up period.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n All patients who underwent implantation of a press-fit osseointegration implant between May 2009 and November 2013 were eligible for the present study. Implantation was performed in 2 stages. Adverse events included infectious complications (grade 1 to 4), aseptic loosening, breakage, stoma-redundant tissue, and stoma hypergranulation. Prosthesis-wearing time and HRQoL were measured with the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) prosthetic use score and global score, respectively.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Thirty-nine of 42 eligible patients were included. Thirty patients (77%) presented with some kind of infection (156 events in total), with 148 (95%) events being classified as grade 1 or 2 and 8 events (5%) being classified as grade 3; the latter 8 events occurred in 4 patients. There were no instances of septic loosening. The intramedullary stem of the osseointegration implant broke in 2 patients. In total, soft-tissue refashioning had to be done 30 times in 14 patients. The Q-TFA median prosthetic use and global scores improved significantly from 71 to 100 and from 33 to 75, respectively (p < 0.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Despite the adverse events, patient prosthetic use and HRQoL improved significantly. Grade-1 and 2 infections were frequent but could mostly be treated with nonoperative measures. Most infections seemed to occur in the first 2 years and did not lead to deep infections. Two broken intramedullary stems were revised successfully. Current developments focus on reduction of infectious complications and prevention of osseointegration implant breakage.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level IV<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.19.01169","type":"journal-article","created":{"date-parts":[[2020,4,25]],"date-time":"2020-04-25T02:10:56Z","timestamp":1587780656000},"page":"1329-1335","source":"Crossref","is-referenced-by-count":58,"title":["Safety and Performance of Bone-Anchored Prostheses in Persons with a Transfemoral Amputation"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2673-1867","authenticated-orcid":false,"given":"D.","family":"Reetz","sequence":"first","affiliation":[{"name":"Departments of Surgery (D.R., J.M., and J.P.M.F.), Rehabilitation Medicine (H.v.d.M. and R.L.), and Orthopedics (R.A.), and Radboud Institute for Health Sciences, IQ Healthcare (R.L.), Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4127-6105","authenticated-orcid":false,"given":"R.","family":"Atallah","sequence":"additional","affiliation":[{"name":"Departments of Surgery (D.R., J.M., and J.P.M.F.), Rehabilitation Medicine (H.v.d.M. and R.L.), and Orthopedics (R.A.), and Radboud Institute for Health Sciences, IQ Healthcare (R.L.), Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1672-9571","authenticated-orcid":false,"given":"J.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Departments of Surgery (D.R., J.M., and J.P.M.F.), Rehabilitation Medicine (H.v.d.M. and R.L.), and Orthopedics (R.A.), and Radboud Institute for Health Sciences, IQ Healthcare (R.L.), Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4457-9072","authenticated-orcid":false,"given":"H.","family":"van de Meent","sequence":"additional","affiliation":[{"name":"Departments of Surgery (D.R., J.M., and J.P.M.F.), Rehabilitation Medicine (H.v.d.M. and R.L.), and Orthopedics (R.A.), and Radboud Institute for Health Sciences, IQ Healthcare (R.L.), Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7759-1350","authenticated-orcid":false,"given":"J.P.M.","family":"Fr\u00f6lke","sequence":"additional","affiliation":[{"name":"Departments of Surgery (D.R., J.M., and J.P.M.F.), Rehabilitation Medicine (H.v.d.M. and R.L.), and Orthopedics (R.A.), and Radboud Institute for Health Sciences, IQ Healthcare (R.L.), Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6158-6901","authenticated-orcid":false,"given":"R.","family":"Leijendekkers","sequence":"additional","affiliation":[{"name":"Departments of Surgery (D.R., J.M., and J.P.M.F.), Rehabilitation Medicine (H.v.d.M. and R.L.), and Orthopedics (R.A.), and Radboud Institute for Health Sciences, IQ Healthcare (R.L.), Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,4,27]]},"reference":[{"issue":"1","key":"bib1-20230810","first-page":"57","article-title":"Evaluation of problems and needs of veteran lower-limb amputees in the San Francisco Bay Area during the period 1977-1980","volume":"20","author":"Hoaglund","year":"1983","journal-title":"J Rehabil R D."},{"issue":"3","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1080\/03093640108726601","article-title":"Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems","volume":"25","author":"Hagberg","year":"2001","journal-title":"Prosthet Orthot Int."},{"issue":"9","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1080\/0963828031000090434","article-title":"Health related quality of life and related factors in 539 persons with amputation of upper and lower limb","volume":"25","author":"Demet","year":"2003","journal-title":"Disabil Rehabil."},{"issue":"8","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1053\/apmr.2001.24295","article-title":"The prevalence and risk factors of falling and fear of falling among lower extremity amputees","volume":"82","author":"Miller","year":"2001","journal-title":"Arch Phys Med Rehabil."},{"issue":"2","key":"bib5-20230810","first-page":"175","article-title":"Osseointegration in skeletal reconstruction and rehabilitation: a review","volume":"38","author":"Br\u00e5nemark","year":"2001","journal-title":"J Rehabil Res Dev."},{"issue":"2","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1080\/03093640500238014","article-title":"Socket versus bone-anchored trans-femoral prostheses: hip range of motion and sitting comfort","volume":"29","author":"Hagberg","year":"2005","journal-title":"Prosthet Orthot Int."},{"issue":"11","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1016\/j.apmr.2014.07.009","article-title":"Outcome of percutaneous osseointegrated prostheses for patients with unilateral transfemoral amputation at two-year follow-up","volume":"95","author":"Hagberg","year":"2014","journal-title":"Arch Phys Med Rehabil."},{"issue":"3","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1177\/0269215518815215","article-title":"Functional performance and safety of bone-anchored prostheses in persons with a transfemoral or transtibial amputation: a prospective one-year follow-up cohort study","volume":"33","author":"Leijendekkers","year":"2019","journal-title":"Clin Rehabil."},{"issue":"11","key":"bib9-20230810","doi-asserted-by":"crossref","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":"Van de Meent","year":"2013","journal-title":"Arch Phys Med Rehabil."},{"issue":"2","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1097\/BOT.0000000000001031","article-title":"Clinically relevant outcome measures following limb osseointegration; systematic review of the literature","volume":"32","author":"Al Muderis","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1007\/s00113-016-0296-8","article-title":"Osseointegrated Prosthetic Limb for the treatment of lower limb amputations: experience and outcomes","volume":"120","author":"Al Muderis","year":"2017","journal-title":"Unfallchirurg."},{"issue":"11","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"900","DOI":"10.2106\/JBJS.15.00808","article-title":"Safety of osseointegrated implants for transfemoral amputees: a two-center prospective cohort study","volume":"98","author":"Al Muderis","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1007\/s00113-017-0329-y","article-title":"[Transcutaneous osseointegration after limb amputation: a review over 27 years]","volume":"120","author":"Aschoff","year":"2017","journal-title":"Unfallchirurg."},{"issue":"8","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"e0201821","DOI":"10.1371\/journal.pone.0201821","article-title":"Complications of bone-anchored prostheses for individuals with an extremity amputation: a systematic review","volume":"13","author":"Atallah","year":"2018","journal-title":"PLoS One."},{"issue":"11","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1080\/09638288.2016.1186752","article-title":"Comparison of bone-anchored prostheses and socket prostheses for patients with a lower extremity amputation: a systematic review","volume":"39","author":"Leijendekkers","year":"2017","journal-title":"Disabil Rehabil."},{"issue":"13","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1002\/bjs.11005","article-title":"Systematic review of the safety and efficacy of osseointegration prosthesis after limb amputation","volume":"105","author":"Kunutsor","year":"2018","journal-title":"Br J Surg."},{"issue":"16","key":"bib17-20230810","doi-asserted-by":"crossref","first-page":"e743","DOI":"10.5435\/JAAOS-D-17-00621","article-title":"Osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: a prospective five-year follow-up of patient-reported outcomes and complications","volume":"27","author":"Br\u00e5nemark","year":"2019","journal-title":"J Am Acad Orthop Surg."},{"issue":"4","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1682\/JRRD.2014.11.0280","article-title":"Fifteen years of experience with Integral-Leg-Prosthesis: cohort study of artificial limb attachment system","volume":"52","author":"Juhnke","year":"2015","journal-title":"J Rehabil Res Dev."},{"issue":"1","key":"bib19-20230810","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: a prospective study of 51 patients","volume":"96-B","author":"Br\u00e5nemark","year":"2014","journal-title":"Bone Joint J."},{"issue":"7","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1302\/0301-620X.98B7.37547","article-title":"The Osseointegration Group of Australia Accelerated Protocol (OGAAP-1) for two-stage osseointegrated reconstruction of amputated limbs","volume":"98-B","author":"Muderis","year":"2016","journal-title":"Bone Joint J."},{"issue":"1","key":"bib21-20230810","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1177\/0309364618791616","article-title":"UK trial of the Osseointegrated Prosthesis for the Rehabilitation for Amputees: 1995-2018","volume":"43","author":"Matthews","year":"2019","journal-title":"Prosthet Orthot Int."},{"issue":"5","key":"bib22-20230810","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1682\/JRRD.2003.11.0167","article-title":"Questionnaire for Persons with a Transfemoral Amputation (Q-TFA): initial validity and reliability of a new outcome measure","volume":"41","author":"Hagberg","year":"2004","journal-title":"J Rehabil Res Dev."},{"issue":"2","key":"bib23-20230810","doi-asserted-by":"crossref","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":"Leijendekkers","year":"2017","journal-title":"Physiother Theory Pract."},{"issue":"4","key":"bib24-20230810","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s00113-016-0302-1","article-title":"Osseointegrated prosthesis for patients with an amputation: multidisciplinary team approach in the Netherlands","volume":"120","author":"Fr\u00f6lke","year":"2017","journal-title":"Unfallchirurg."},{"issue":"Suppl 5","key":"bib25-20230810","doi-asserted-by":"crossref","first-page":"S777","DOI":"10.21037\/jtd.2018.12.54","article-title":"Learning curve and postoperative outcomes of minimally invasive esophagectomy","volume":"11","author":"Claassen","year":"2019","journal-title":"J Thorac Dis."},{"issue":"9695","key":"bib26-20230810","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/S0140-6736(09)61116-8","article-title":"No surgical innovation without evaluation: the IDEAL recommendations","volume":"374","author":"McCulloch","year":"2009","journal-title":"Lancet."},{"issue":"5","key":"bib27-20230810","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s00113-016-0175-3","article-title":"[Endo-exo prostheses: osseointegrated percutaneously channeled implants for rehabilitation after limb amputation]","volume":"119","author":"Aschoff","year":"2016","journal-title":"Unfallchirurg."},{"issue":"4","key":"bib28-20230810","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1016\/j.arth.2017.11.040","article-title":"Rate and risk factors for periprosthetic joint infection among 36,494 primary total hip arthroplasties","volume":"33","author":"Triantafyllopoulos","year":"2018","journal-title":"J Arthroplasty."},{"issue":"9","key":"bib29-20230810","first-page":"B5397","article-title":"Prosthetic joint infection following total hip arthroplasty - incidence, mortality and validation of the diagnosis in the Danish Hip Arthroplasty Register","volume":"64","author":"Gundtoft","year":"2017","journal-title":"Dan Med J."},{"issue":"3","key":"bib30-20230810","doi-asserted-by":"crossref","first-page":"e013508","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."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.01169","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:37:49Z","timestamp":1787751469000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.01169"}},"subtitle":["A 5-Year Follow-up Study"],"short-title":[],"issued":{"date-parts":[[2020,4,27]]},"references-count":30,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.19.01169","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,27]]}}}