Establishing Consensus for Prescription of Prosthetic Components for Transfemoral Bone-Anchored Limbs: An International Delphi Method Study

Objective: To guide prosthetic componentry prescription for patients with bone-anchored limbs (BALs), we established the first international consensus on prosthetic component selection for transfemoral BALs using the Delphi method. Design: Three-round Delphi study taking place between November 2023 and September 2024. Setting: Anonymous digital surveys were distributed to delegates in the United States, Sweden, the Netherlands, Australia, and Canada. Participants: Eighteen (N=18) worldwide clinical experts in prosthetic care for patients with BAL participated as delegates. Interventions: None. Main Outcome Measures: Thematic statement consensus was defined as delegate agreement of at least 80%. Results: Thirty-four out of 48 thematic statements pertaining to individual prosthetic components and prescriptions for patients with BALs achieved general agreement consensus. There was strong agreement that prosthesis prescription should not change on the basis of sex or age, but rather on the physical ability and desired functional activities of the patient. The consensus reached aligns with current clinical practice guidelines for lower limb socket prostheses, such as the use of microprocessor knees. Other findings highlighted areas of uncertainty among experts, such as whether the implant and bone should be protected against high loads in the coronal or sagittal planes with prosthetic safety hardware. Conclusions: The themes identified here can serve to guide clinicians in the selection of prosthetic components as further evidence is created to promote safety and functional outcomes for individuals with BALs. This consensus provides a basis for structuring future clinical practice guidelines and identifying knowledge gaps for future research studies.