Osseointegration for amputees: Current state of direct skeletal attachment of prostheses

Osseointegration (OI): for amputees refers to the direct, transcutaneous attachment of a terminal prosthesis to bone. Once the purview of conceptual designs and case reports, OI has dramatically increased in frequency and associated advancements over the last decade. Compelling evidence now demonstrates consistent and significant improvements in patient reported outcomes and quality of life as well as functional outcome measures and performance testing following OI for transfemoral. Amputations: While minor complications remain both frequent and manageable, major complications have been reported at an acceptable and gradually decreasing frequency, suggesting that OI is not a realistic and reasonable consideration for both many surgeons and many patients living with limb loss. Herein, we review the current state of the art for amputation osseointegration including different implants and techniques, outcomes, complications, and adjunctive procedures, as well as discussing future directions and promising technologies on the near horizon.