Systematic Review Shows One-Stage Osseointegration Outperforms Two-Stage Approach

A systematic review, published in the Bone & Joint Open journal, has brought to light significant advancements in osseointegrated prosthetics. The study, conducted by a team of researchers led by Stephen R Bested and including Professor Munjed Al Muderis, highlights the safety advantages of the one-stage approach over the traditional two-stage procedure for limb amputation patients.

Osseointegration, a technique that anchors a prosthetic implant directly into the bone, has been a game-changer for individuals with limb amputations. While the traditional two-stage approach has been the standard of care, the one-stage procedure is now emerging as a more favourable option.

The one-stage approach was developed by Australian orthopaedic surgeon Professor Munjed Al Muderis over a decade ago. He was initially criticised for his pioneering approach. Today, most osseointegration centres around the world are moving to his one-stage method.

The comprehensive study encompassed 19 individual research papers and included data from both one- and two-stage osseointegration procedures. The results revealed compelling evidence in favour of the one-stage approach, with key safety benefits demonstrated as follows:

  • Reduced Incidence of Complications: The one-stage cohort exhibited a slightly lower overall complication rate compared to the two-stage group. Patients undergoing the one-stage procedure experienced fewer adverse events, highlighting the potential for improved patient outcomes.
  • Lower Risk of Osteomyelitis: Osteomyelitis, a severe bone infection, was completely absent in the one-stage group, while the two-stage cohort reported an average incidence of 10%. This critical finding suggests that the one-stage approach offers superior protection against deep infections.
  • Fewer Instances of Implant Failure: Implant failure, a significant concern for osseointegrated prosthetics, occurred significantly less frequently in the one-stage cohort compared to the two-stage group. This points to increased implant stability and long-term success with the one-stage approach.
  • Superior Soft-Tissue Management: The one-stage procedure demonstrated a notable reduction in superficial infections compared to the two-stage method. This advantage is attributed to better soft-tissue seal and improved management of the soft-tissue bone-anchored implant interface.

Professor Al Muderis emphasised the importance of this study’s findings: “Our research indicates that the one-stage approach to osseointegrated prosthetics presents tangible safety benefits for patients. Lower infection rates and reduced risk of osteomyelitis, along with improved implant stability, underscore the advantages of this innovative technique.”

The adoption of the one-stage approach can significantly reduce the time from the start of the surgery to the beginning of rehabilitation and could reduce the surgical and post-surgical complications for patients with limb amputations. As safety remains a primary concern, this study paves the way for enhanced treatment protocols and the potential establishment of the one-stage procedure as the new standard of care.

The study, titled “The Safety of One-Stage Versus Two-Stage Approach to Osseointegrated Prosthesis for Limb Amputation: A Systematic Review,” is accessible in the Bone & Joint Open journal here: