Abstract
Direct skeletal fixation (DSF) involves attaching the intramedullary portion of a prosthesis directly to the skeletal residuum, providing an alternative for amputees unable to mobilise with socket-based prostheses. This study investigates the effects of DSF on physical and mental health at 6- and 8-year follow-up for military bilateral transfemoral amputees in the UK. Eight male bilateral transfemoral military amputees who underwent implantation with the Osseointegration Group of Australia-Osseointegration Prosthetic Limb prosthesis consented to participate in the study. All patients are routinely reviewed annually in a dedicated clinic, and this paper reports the 6- and 8-year follow-ups. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36). Complications data were recorded at the 8-year follow-up. The SF-36 physical component score significantly increased from preoperative levels at 6 years (median: 29 vs. 47; P = 0.003) and 8 years (median: 29 vs. 45; P = 0.024). The SF-36 mental health component score improved significantly at 6 years from preop (median: 39 vs. 57; P = 0.011). Among 16 femoral residuums, there was one explantation because of infection at 8.5 years postimplantation, and two cases were managed with long-term suppressive antibiotics. A total of 17 additional procedures were performed on nine residuums: 11 for soft tissue revision, five for infection, and one for fracture repair. This research adds to the growing evidence base that DSF has the potential to enhance the health and well-being of amputee veterans and potentially the broader amputee population. Medical complications remain an important consideration.