Osseointegration’s effect on balance and perceived function in lower leg amputees: A critically appraised topic

Clinical Scenario: Lower extremity amputees commonly experience socket prosthesis (SP) complications that interfere with their perceived function and quality of life. Osseointegration (OI) is a new technique that requires implantation of the prosthesis directly into the intramedullary shaft of the residual limb. This alternative may be an answer for amputees who struggle with their SP and desire to regain comfortable and confident function with their prosthesis.
Clinical Question: Does OI provide better functional and balance outcomes in lower extremity amputees than socket-prosthesis users?

Summary of Findings: Participants with OI prostheses showed improvements in perceived balance and disability. There was little to no improvement in spatiotemporal measures during the 10-meter walk tests. However, all studies showed clinically important differences in ABC scores (d=-1.36 p=0.01)¹⁰ and 8.86 point improvement (MCID= 5.36)⁹.

Clinical Bottom Line: Patients with lower extremity amputations may explore the option of OI as an alternative to SP. The outcomes measured show that OI produces the same functional ability as those with an SP, however it provides an increase in perceived balance and function which may positively affect their quality of life. OI does have its risks, but depending on the patient those risks may still be an improvement from the difficulties experienced with their SP.

Strength of Recommendation: Consistent CEBM Level 3 findings support OI is an appropriate alternative to SP in providing increase perceived balance and function in lower extremity amputees.