Three studies from the Hospital for Special Surgery (HSS) presented at the 2026 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in New Orleans examined the safety and effectiveness of osseointegration (OI) for people with limb amputations. Osseointegration is a surgical technique that allows a prosthetic limb to be attached directly to the bone, removing the need for a traditional socket prosthesis.
The first study compared outcomes between patients who had above-the-knee (femur-level) and below-the-knee (tibia-level) osseointegration. Taylor J. Reif, MD, an orthopedic surgeon at HSS, said, "There are no studies in the scientific literature focusing on differences in safety and outcomes of patients who underwent transfemoral osseointegration as compared to those who had transtibial osseointegration." The research team reviewed 147 OI procedures—83 femur-level and 64 tibia-level—and found that both groups saw notable improvements in mobility and satisfaction, with no significant difference in adverse events. Dr. Reif stated, "Contrary to widespread assumptions, our research found that tibia osseointegration patients have as much to gain from the surgery as femur OI patients," adding, "Therefore, any individual with a lower-limb amputation who is dissatisfied with their current socket prosthesis should be evaluated for osseointegration if they would like to pursue that option." Co-author Dr. Hoellwarth noted that previous beliefs held that only those with femur-level amputations would benefit significantly from OI; this study challenges that view.
The second study looked at whether it was better for patients to receive osseointegration at the time of amputation or after living with an existing amputation. Researchers followed 139 procedures involving both approaches and found similar gains in mobility and quality of life across both groups. There was also no significant difference in adverse events between them. Dr. Reif commented, "Our research challenges the current paradigm that individuals with amputations should first try conventional socket prosthetics and only consider osseointegration if they are dissatisfied with their prosthesis," continuing, "It would be reasonable to offer simultaneous amputation and osseointegration to select, well-informed patients who prefer to bypass the trial of a socket prosthesis."
A third study focused on custom-made 3D-printed implants for osseointegration using electron beam melting technology. These custom implants can provide a better fit for certain patients whose residual bone shape does not match standard implant designs. Nineteen patient records were reviewed; these included above-the-knee, below-the-knee, and above-the-elbow cases between May 2024 and March 2025. Patients reported significant improvements after surgery, especially those who previously used socket prostheses more often before switching to OI. According to Dr. Reif: "We found that short-term functional outcomes were similar to standard osseointegration implants," noting also that custom implants avoided certain intraoperative complications seen with standard devices. He added: "Further studies are warranted to assess the long-term outcomes and durability of custom implants."
The three studies suggest expanding consideration of OI beyond traditional candidates may benefit more individuals with limb loss.
