Three recent studies from the Hospital for Special Surgery (HSS) have examined the use and benefits of osseointegration (OI) for people with amputations, challenging some existing views on which patients might benefit most. Osseointegration is a surgical procedure that attaches a prosthetic limb directly to the bone, removing the need for a traditional socket prosthesis.
The research was presented at the 2026 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans. HSS has performed more OI surgeries than any other hospital in the United States, treating over 300 patients since 2017.
“Osseointegration represents a significant advancement in the field of prosthetics for patients who have had a limb amputation, and interest is building rapidly,” said Jason Hoellwarth, MD, director of research in the Limb Lengthening and Complex Reconstruction Service and the Osseointegration Limb Replacement Center. “At HSS, we have performed more OI surgeries than any other hospital in the United States, treating more than 300 patients since 2017. We have found that osseointegration provides improved mobility, comfort and quality of life for patients when compared to a standard socket prosthesis.”
The first study compared safety and outcomes between femur-level (above-the-knee) and tibia-level (below-the-knee) osseointegration procedures. Taylor J. Reif, MD, an orthopedic surgeon at HSS who presented this research, 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 study reviewed 147 procedures—83 femur-level and 64 tibia-level—and found both groups showed substantial improvements in mobility and satisfaction without significant differences in adverse events.
Dr. Hoellwarth explained that it was previously believed only femur-level amputees would benefit significantly from OI because they generally had poorer outcomes with socket prostheses compared to those with tibia-level amputations. “It was widely believed that patients with a below-the-knee amputation did well enough with their socket prosthesis and therefore would not derive significant benefit from osseointegration. Our study directly challenged that perspective.”
Dr. Reif added: “Contrary to widespread assumptions, our research found that tibia osseointegration patients have as much to gain from the surgery as femur OI patients. 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.”
The second study assessed outcomes for patients receiving OI at the time of amputation versus those who had it after living with an existing amputation. The researchers included 139 procedures—81 femur-level and 58 tibia-level—with both simultaneous amputation/OI cases and established amputees receiving OI later.
Results indicated comparable gains in mobility and quality of life between both groups; there were no significant differences in adverse events. Dr. Reif stated: “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. 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 OI using electron beam melting technology for better fit based on preoperative CT scans. Nineteen patient records were reviewed—including above-the-knee, below-the-knee, and above-the-elbow procedures—from May 2024 through March 2025.
“Some designs of press-fit osseointegration implants have standard curvatures and contours with patient-specific length, leading to difficulty fitting the shape of the residual bone in some cases,” Dr. Hoellwarth said.
Dr. Reif noted: “We found that short-term functional outcomes were similar to standard osseointegration implants,” adding there were statistically significant improvements reported by patients after surgery as well as increased use among those previously using sockets. He also highlighted reduced risk of intraoperative fractures when using custom EBM implants but emphasized further studies are needed on long-term results.
HSS is recognized for its contributions to community health through specialized orthopedic care and musculoskeletal research. The institution consistently ranks highly nationally in orthopedics and holds multiple Magnet designations for nursing excellence while expanding its services through partnerships including regions such as Southwest Florida to enhance access. HSS continues advancing patient care aimed at improving mobility and quality of life while supporting innovation within orthopedic surgery.
