Comparison of Prosthetic Costs and Service Between Osseointegrated and Conventional Suspended Transfemoral Prostheses

Background: Nowadays, a transfemoral amputation prosthesis can be fitted to the skeleton using an osseointegrated implant, that is, without a socket. Treated patients have reported improvements in quality of life.

Objectives: To investigate differences in prosthetic costs and service of osseointegrated prostheses compared to socket-suspended prostheses.

Study Design: Retrospective cost analysis and survey.

Methods: Costs and noted visits during in mean ~10 years were taken from one prosthetic workshop and included 50 patients with unilateral transfemoral amputation (36 socket-suspended prostheses, 20 osseointegrated prostheses, 6 patients used both kinds of prostheses). A survey comprised 71 patients (69% males; mean age = 52.3 year; cause: 66% trauma, 23% tumour, 11% other).

Results: Statistically significant fewer workshop visits were shown with osseointegrated prostheses compared to socket-suspended prostheses (cost analysis: 3.1 vs. 7.2 visits/year, survey: 3.4 vs. 9.2 visits/year). The mean total annual cost of new prostheses, services, repairs and adjustments was 14% lower for osseointegrated prostheses than socket-suspended prostheses (€3149 and €3672 respectively, p = 0.632). A subgroup analysis of recent produced prostheses revealed cost of material to account for 92.5% for osseointegrated prostheses and 70% for socket-suspended prostheses.

Conclusion: Despite significantly fewer visits for prosthetic service the annual mean costs for osseointegrated prostheses were comparable with socket-suspended prostheses. This study suggests it is due to more advanced prosthetic components being used with osseointegrated prostheses. Clinical relevance Patients with osseointegrated transfemoral prostheses require fewer visits for prosthetic service than patients with socket-suspended prostheses. The total prosthetic cost does not seem to differ between the two kinds of prostheses. However, more sophisticated prosthetic knees were more frequently used with osseointegrated prostheses, which could explain the lack of differences.