Proof of Concept Study: Osseointegration Combined With Total Hip Replacement

Osseointegrated implants are an alternative for prosthetic attachment in individuals with a transfemoral amputation who are unable to wear a socket. However, the small bone-implant contact area, reduced muscular leverage, and osteoporosis contraindicate osseointegrated implant use in patients with transfemoral amputations who have osteoporosis and a short residual limb. A team of researchers from Australia reported on the feasibility of combining total hip replacement (THR) with an osseointegrated implant for prosthetic attachment.


X-ray images at follow-up for cases one, two, and three, courtesy of the study authors and BioMed.

The researchers retrospectively reviewed the cases of three patients with transfemoral amputations who underwent osseointegration with THR between 2013 and 2014. In a two-stage procedure, a custom-made femoral prosthesis was connected to a THR with a modular revision stem and a stoma was created. Clinical outcomes were assessed at baseline and at 1.5 to 2.5-year follow-ups using standard measures of health-related quality of life, ambulation, and activity levels including the Short Form-36 (SF-36), Questionnaire for Transfemoral Amputees (Q-TFA), Timed Up and Go test, and six-minute walk test.

The patients ranged from 35 to 65 years old. There were no major adverse events, but there was one case of superficial infection. All patients showed improved Q-TFA and SF-36 scores. Two patients who were wheelchair-bound at baseline became community ambulators, and the third patient exhibited improved ambulation.

The researchers state that this study demonstrates the feasibility of combining THR with an osseointegrated implant in patients with transfemoral amputations. It also provides preliminary evidence concerning the safety and functional benefits of the procedure, but larger prospective studies are essential to establish the safety and effectiveness of the technique.

The study was published online January 19 in the Journal of Orthopaedic Surgery and Research, an open-access publication.