While lower-limb transcutaneous osseointegration (OI) is a rehabilitation alternative to socket-suspended prostheses, the rehabilitation process, philosophies, and routines remain under-described. A review, primarily, was conducted to identify commonalities and differences among protocols. Secondarily, strategies are proposed to streamline future research of rehabilitation after OI surgery.
Two differently phrased queries of Google Scholar, Pubmed, Embase, and Web of Science were performed.
First using either “osseointegration” or “osseointegrated” or “bone-anchored prosthesis” AND [last name]. Second, replacing author name with “physical therapy” or “rehabilitation.” Six hundred eighty-eight articles were identified describing lower-limb rehabilitation following OI. Following software-based deduplication, manual abstract and full-text review, article reference evaluation, and use of Google Scholar’s “Cited by” feature, 35 studies were fully analyzed. First, a consolidated summary was made of protocols focusing on stages, timing, and other descriptions of post-operative rehabilitation. Subsequently, strengths and limitations of protocols were considered to propose potential strategies to investigate and optimize post-operative rehabilitation.
Results showed that all articles described rehabilitation having this same order of goal progression: from surgery to gradual weight bearing and a final goal of independent ambulation. The most impactful difference influencing the stated final goal of independent ambulation was whether one or two surgical stages were performed. No articles reported patient success rate achieving proposed goals and timing, or challenges during rehabilitation. Therefore, the first research suggestion is to investigate actual success rates achieving proposed goals and timing. Second, to further explore rehabilitation of performance deficits, beyond unaided ambulation. Finally, to incorporate technology such as mobility trackers to more objectively understand prosthesis use and mobility.
