Femur & Tibia Osseointegration: Similar Function, More Risks in Femur | Orthopedics Today

Osseointegration Shows Promise for Lower Extremity Amputees, But Femur Procedures Carry Higher Risk

NEW ORLEANS — Results presented at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting indicate that press-fit osseointegration can significantly improve mobility and quality of life for individuals with lower extremity amputations. However, the procedure carries a higher risk of adverse events when performed at the femur level compared to the tibia level.

“We were really encouraged by all of this data both in terms of the safety and the improvements we saw,” said Taylor J. Reif, MD, an orthopedic surgeon at the Osseointegration Limb Replacement Center at Hospital for Special Surgery. “We think osseointegration should still continue to be offered and evaluated in the tibia.”

Reif and colleagues retrospectively reviewed data from 147 patients who underwent lower extremity osseointegration with at least 1 year of follow-up. The cohort was divided into those with femur-level (n = 83) and tibia-level (n = 64) amputations. Researchers compared adverse events, changes in mobility and limb deformity-Scoliosis Research Society (LDRS) and Patient-Reported Outcome Measurement Information System (PROMIS) scores between the two groups.

The study revealed that patients receiving osseointegration at the femur experienced a higher incidence of adverse events, specifically fractures around the implant and the demand for soft tissue revision.

“There were not any standout adverse events for the tibia that made it seem like a safety issue,” Reif said. “Everything seemed very low level and not a safety concern.”

Despite the increased risk of complications with femur-level osseointegration, the study found similar improvements in function and quality of life between the two groups. Patients in both groups wore their osseointegrated prostheses for comparable durations.

“That was reassuring because we are offering the surgery that is allowing people to have the same benefits that was developed for the femur, even though they are below knee,” Reif explained. “It basically goes to show that some of these people can reach a high level of function with a tibia osseointegration.”

Reif emphasized that osseointegration is not necessarily the right choice for every patient with a tibia-level amputation.

“We are not saying this has to be for everyone, but for people who think it is the right fit for them, who maybe need a bump in their function or who are having problems with their socket,” Reif said. “I certainly expect 20 years from now we are going to see a lot more below-knee amputees with osseointegration than we do today.”

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Taylor J. Reif, MD, can be contacted through mediarelations@hss.edu.