Osseointegration for the transfemoral amputee has been used in the United Kingdom since 1997. To date, 11 candidates have undergone the procedure. The rehabilitation programme for the osseointegration candidate is a long and intensive programme following two surgical operations. This paper outlines the importance of a preosseointegration assessment to explore candidates’ suitability and expectations for the procedure. The physical and prosthetic advantages of direct skeletal attachment have led to improvements in candidates’ comfort, function and quality of life. However, some aspects of this promising developmental procedure for the management of the transfemoral amputee need to be critically evaluated before it becomes a routine clinical procedure in the United Kingdom.

This study aimed to provide a description of the continuous recording of the true load regime experienced during daily living by the abutment of a trans-femoral amputee fitted with an osseointegrated fixation. The specific objectives: (i) To present an apparatus and a procedure allowing recording of the load regime, and (ii) an example of the raw data and six performance indicators of the usage of the prosthesis obtained with this method. A subject was monitored for a period of 5 hours as he went about his daily activities. The load regime was directly measured and recorded using a commercial transducer and data logger. The overall load profile presented alternative periods of variable length of inactivity (64%) and activity (36%), respectively. The maximum load applied on the mediolateral, anteroposterior and the long axes represented 21%, 21% and 120% of the body weight, respectively. The anteroposterior, mediolateral and long components of the impulse were 395 kN.s, 359 kN.s and 2,323 kN.s, respectively. The amputee generated a total of 2312 gait cycles of the prosthetic leg, giving an approximate overall cadence of 8 stride/min. Preliminary outcomes indicated that the proposed method was an improvement on the current techniques as it provided the true loading and actual usage of the prosthesis during daily living. This study is a stepping stone in the development of future affordable, on-board and user-friendly load recording systems that can be used in evidence-based practice.

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