Physical Recovery After Transfemoral Amputation Using Press-Fit Percutaneous Osseointegrated Prosthesis

Jesse C Christensen; Jacob Smith; Benjamin J Darter; Bart Gillespie; Erik K Kubiak; Jayant Agarwal; Sarina Sinclair

doi:10.1016/j.apmr.2026.02.494

Physical Recovery After Transfemoral Amputation Using Press-Fit Percutaneous Osseointegrated Prosthesis

Arch Phys Med Rehabil. 2026 Mar 26:S0003-9993(26)00574-5. doi: 10.1016/j.apmr.2026.02.494. Online ahead of print.

Authors

Jesse C Christensen¹, Jacob Smith², Benjamin J Darter³, Bart Gillespie⁴, Erik K Kubiak⁵, Jayant Agarwal⁶, Sarina Sinclair⁷

Affiliations

¹ Veterans Affairs Salt Lake City Health Care System, Department of Physical Medicine and Rehabilitation, 500 So, Foothill Dr., Salt Lake City, UT, USA, 84148. Electronic address: jesse.christensen@hsc.utah.edu.
² Veterans Affairs Salt Lake City Health Care System, Department of Physical Medicine and Rehabilitation, 500 So, Foothill Dr., Salt Lake City, UT, USA, 84148. Electronic address: jacob.smith10@va.gov.
³ Virginia Commonwealth University, Department of Physical Therapy, 900 E. Leigh Street, PO Box 980224, Richmond, VA 23298. Electronic address: bjdarter@vcu.edu.
⁴ Veterans Affairs Salt Lake City Health Care System, Department of Physical Medicine and Rehabilitation, 500 So, Foothill Dr., Salt Lake City, UT, USA, 84148. Electronic address: bart.gillespie@va.gov.
⁵ University of Nevada Las Vegas, Department of Orthopaedics, 1707 W. Charleston Blvd, Las Vegas, NV 89102. Electronic address: erik.kubiak@icloud.com.
⁶ University of Utah, Division of Plastic Surgery, 50 Medical Dr N E15, Salt Lake City, UT 84132. Electronic address: jay.agarwal@hsc.utah.edu.
⁷ Veterans Affairs Salt Lake City Health Care System, Department of Physical Medicine and Rehabilitation, 500 So, Foothill Dr., Salt Lake City, UT, USA, 84148. Electronic address: sarina.sinclair@va.gov.

PMID: 41903644
DOI: 10.1016/j.apmr.2026.02.494

Abstract

Objectives: A press-fit percutaneous osseointegrated prosthesis (POP) is an innovative bone anchored prosthesis shown to be safe and effective compared to traditional socket suspension systems for adults post-transfemoral amputation. However, research has been limited in evaluating the trajectory of physical recovery post-POP. The purpose of this study was to evaluate physical recovery based on physiological measures of gait economy, gait speed, exertional heart rate, comprehensive high-level activity mobility predictor (CHAMP) and daily step counts over the first 12 months post-POP.

Design: Prospective longitudinal cohort study.

Setting: Academic hospital.

Participants: Ten participants underwent a unilateral POP implantation from a parent prospective study.

Intervention: Surgery.

Main outcome measures: gait economy, gait speed, exertional heart rate, CHAMP and daily step counts.

Results: Significant improvement in gait economy, relative to baseline, were observed at 3-month (p=0.02), 6-month (p=0.02) and 12-month (p<0.01) post-POP. Significant increase in CHAMP scores, relative to baseline, were observed at 6-months (p=0.01) and 12-months (p<0.01) post-POP. Significant increase in exertional heart rate (p<0.01), gait speed (p=0.03) and daily step count (p=0.04), relative to baseline, was observed at 12-months post-POP. The gait economy and CHAMP scores showed earlier gains compared to exertional heart rate, gait speed and daily step count scores, with the greatest gains observed in the first 3-6 months post-POP.

Conclusion: These data will help to inform expectations for outcomes for patients and clinicians considering POP implantation and could assist in detecting outliers from the normal recovery curve who may benefit from targeted interventions post-POP.

Keywords: amputation; metabolic economy; physical activity; physical function; press-fit percutaneous osseointegrated prosthesis.