While prostheses implanted through osseointegration (OI) traditionally occur in two stages, a one-stage approach has emerged. A research team, noting that there have been no comparison studies of the outcomes of the approaches, sought to determine whether a one-stage OI procedure is associated with fewer adverse events than the two-staged approach. They found that the incidence of complications was found to be slightly lower in the one-stage cohort.
The researchers performed a comprehensive electronic search and quantitative data analysis from eligible studies. Inclusion criteria were adults with a limb amputation managed with a one- or two-stage OI procedure with follow-up reporting of complications.
Nineteen studies were included: four one-stage, 14 two-stage, and one article with both one- and two-stage groups. The studies were published between 2010 and 2020 and were conducted in Australia, the United Kingdom, Sweden, Germany, the Netherlands, and the United States.
Most patients had unilateral lower-limb amputations other sites included upper-limb, bilateral, or mixed amputation sites. Common inclusion criteria were complications with socket prosthesis, skeletal maturity, ability to comply with rehabilitation protocol, and overall good health with no ongoing chemotherapy.
Superficial infection was the most common complication (one-stage: 38 percent; two-stage: 52 percent). The researchers found a notable difference in the incidence of osteomyelitis (one-stage: nil; two-stage: 10 percent) and implant failure (one-stage: 1 percent; two-stage: 9 percent).
Fracture incidence was equivocal (one-stage: 13 percent; two-stage: 12 percent), and comparison of soft-tissue, stoma, and mechanical-related complications was not possible, according to the study.
The authors concluded that the review suggested that the one-stage approach is favorable compared to the two-stage, because the incidence of complications was slightly lower in the one-stage cohort, with a pertinent difference in the incidence of osteomyelitis and implant failure.
The open-access study, “The safety of one-stage versus two-stage approach to osseointegrated prosthesis for limb amputation a systematic review,” was published in Bone and Joint Open.
