# Non-infectious skeletal complications in the lower extremity after treatment with a transfemoral bone-anchored prosthesis: a retrospective observational study

## TL;DR

This study examines the risk of fractures and arthroplasty surgery in patients using a bone-anchored prosthesis for lower limb amputations.

## Contribution

The study provides new data on the frequency of skeletal complications in transfemoral bone-anchored prosthesis users.

## Key findings

- 16% of patients experienced fractures or arthroplasty surgery in the lower limb after BAP surgery.
- 11% of patients had femur fractures, and 6% underwent arthroplasty due to osteoarthritis.
- Prosthetic use was not affected by these complications.

## Abstract

The use of bone-anchored prostheses (BAPs) has greatly increased quality of life for lower limb amputees. However, the long-term frequency of skeletal fractures and the need for arthroplasty surgery in the lower extremities following BAP use is scarce.

The current study aimed to investigate the frequency of fractures and arthroplasties in the lower limb after BAP surgery with the Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA) system.

Retrospective cohort study using the OPRA database and medical record review for data collection.

A single-centre study at a tertiary hospital.

All patients with a transfemoral BAP (OPRA system) who underwent surgery between 1999 and 2019, and had completed at least 2 years of follow-up were included in the study. Patients with bilateral transfemoral amputations were excluded. A total of 100 patients were included.

The primary outcome measure was to identify patients who had a fracture or had undergone arthroplasty surgery in the lower extremities after BAP surgery.

Of the 100 patients included, 16 patients (16%) had an event in their lower limb. 11 patients (11%) had a fracture, all of the femur, and six patients (6%) underwent arthroplasty surgery due to osteoarthritis. Long-term prosthetic use was not affected by the occurrence of an event.

Patients with BAP may be at a higher risk for femur fractures and arthroplasty surgery than the general population. Although encouraging that prosthetic usage is not affected after a fracture or arthroplasty surgery, prospective studies on larger cohorts and control groups need to be conducted.