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Transcutaneous Osseointegration for Upper Extremity: A Systematic Review of the Literature
Introduction: Interest has grown in transcutaneous osseointegrated (TOI) upper extremity prosthetics as an alternative to traditional socket prosthetics. As of 2023, no upper extremity TOI prosthetic have received FDA approval in the United States. This study examines demographics and postoperative outcomes in patients who have received upper extremity TOI prosthetics globally. Methods: The PubMed, EMBASE, and Cochrane databases were queried for cases of upper limb TOI prosthetics with variations in terms for osseointegration, prosthetics, and upper extremity anatomy. Studies were included if demographic and outcome data on patients with at least one amputation and TOI prosthetic at any site of the upper limb were present. Studies that pertained only to endoprostheses or lower extremity TOI, had incomplete information on multiple patients, exclusively reported biomechanical or material data, or were in non-English languages were excluded. Site and etiology of limb loss, age, sex, history of infection at TOI site, and subsequent surgery on the site were recorded. Descriptive statistics were calculated. Results: The search returned 1,314 articles, of which 907 were screened after duplicate exclusion. Ultimately, 27 studies with 95 patients were analyzed. Patients were predominantly male (N=70, 73.6%) and age at prosthetic placement ranged from 10 to 68 years. The most common prosthetic sites were the thumb (N=33, 35.7%) and humerus (N=21, 22.1%). Eleven patients required secondary surgery; 10 were for hardware problems (e.g., loosening, breakage) and one was a soft tissue revision. Infections between surgery and first follow-up were reported in 11.5% of patients. Only 46.3% of studies explicitly discussed infection outcomes following TOI. Conclusion: TOI prosthetics have been used with some success internationally, but clinical data is limited and reports are inconsistent. Lack of approval in the U.S. has made analysis of outcomes difficult. While infection is a valid concern, implant hardware is a frequently reported cause of subsequent surgeries at TOI prosthetic sites.