Meta-analytic evaluation of complications and longevity of bone-anchored prostheses in lower extremity amputees: does design matter?
Hugh Milchem, Yasmine J Khair, Maamoun Adra et al.
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In 30 seconds
This meta-analysis evaluated complications and revision-free survival of bone-anchored prostheses (BAPs) in lower-limb amputees, including differences between screw-fit OPRA and press-fit ILP/OPL designs. Across 22 studies reporting 979 patients, the pooled overall complication rate was 65% (95% CI: 0.53-0.75). Estimated revision-free survival was 89% (95% CI: 0.84-0.93) at five years and 77% (95% CI: 0.70-0.82) at ten years. Mechanical failure was more frequent with OPRA than ILP/OPL designs, although estimates were heterogeneous.
Key findings
- Overall complications occurred at a pooled rate of 65% (95% CI: 0.53-0.75, I 2 = 69%).
- Estimated revision-free survival was 89% (95% CI: 0.84-0.93) at five years and 77% (95% CI: 0.70-0.82) at ten years.
- Mechanical failure was 68% with OPRA (95% CI: 0.34-0.90) versus 19% with ILP/OPL (0.09-0.36); estimates showed substantial heterogeneity.
- Abutment or dual-cone adaptor breakage was the most common complication, while infection occurred at a pooled rate of 0.36 (95% CI: 0.25-0.50).
Why it matters
BAPs may offer an alternative for lower-limb amputees who have problems with suspended socket prostheses, but the pooled findings indicate a substantial complication burden. The reported survival estimates and design-specific mechanical failure differences help frame discussions of durability and potential complications, while the heterogeneity across studies warrants caution in interpreting pooled rates.
What to keep in mind
The meta-analysis pooled studies with substantial heterogeneity for overall complications and several complication outcomes, limiting the precision and generalisability of pooled estimates.