Highlights
- •Osseointegration prosthesis following transfemoral amputation is both cost effective and quality of life enhancing in appropriately selected patients.
- •Those who have performed poorly with traditional prosthetics, reflected by a EQ5D-HUV <0.60, should be offered osseointegration.
- •A strong argument exists for osseointegration to be commissioned within publicly funded healthcare systems as a second line prosthetic treatment in transfemoral amputees.
Abstract
Aim
Some amputees are unable to adequately ambulate using conventional socket prosthetics,
osseointegrated prosthetics have been described as an alternative strategy in this
patient group. This paper aims to assess the effect of osseointegrated prosthetics,
commonly simply referred to as osseointegration, in transfemoral amputees on health-related
quality of life and cost analysis.
Methods
Two centre analysis of patients receiving transcutaneous femoral osseointegration
using The Osseointegration Group of Australia Osseointegration Prosthetic Limb (OGAP-OPL)
implant. Retrospective health utility and cost analysis of prospectively collected
patient reported health outcome data. Osseointegration cost was compared with the
yearly cost of a poorly fitting conventional prosthetic determining cost/Quality Adjusted
Life Year.
Results
Eighty amputees received osseointegration. Mean age was 39 years (range 20–57) and
66% were male (n = 53). The majority of subjects underwent unilateral (n = 62, 77.5%) rather than bilateral surgery (n = 18, 22.5%). Trauma was the most common indication (n = 59, 74%). Maximum follow up was 10.5-years. Mean preoperative EQ5D HUV in pooled
data was 0.64 (SEM 0.025) increasing to 0.73 (0.036) at 5-years and 0.78 (0.051) at
6 years with continued improvement up to 10.5-years. In subgroup analysis those with
a starting EQ5D HUV <0.60 reached a cost/QALY of <£30,000 at 5-years postoperatively
and show statistically significant improvement in EQ5D HUV.
The UK military experience was wholly positive with a mean starting EQ5D HUV of 0.48
(0.017) with significant (p < 0.05) improvement in EQ5D HUV at each time point and a resultant reducing cost/QALY
at each time point being £28,616.89 at 5 years.
Conclusion
There is both a quality of life and financial argument in favour of osseointegration
in select patients with above transfemoral amputations. In those unable to mobilise
satisfactorily with traditional prostheses and a pre-intervention score of <0.60,
a consistent cost effectiveness and quality of life benefit can be seen. Such patients
should be considered for osseointegration as these patients reap the maximum benefit
and cost effectiveness of the device. This evidence lends strongly to the debate advocating
the use of osseointegration through centrally funded resources, including the NHS.
Keywords
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Article info
Publication history
Published online: October 14, 2022
Accepted:
October 7,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
