New Data Highlight Earlier Referral Opportunities for Osseointegration, With Taylor J. Reif, MD

Patients who receive osseointegration (OI) as their first prosthetic interface may adapt to prosthetic use more efficiently than those transitioning from a conventional socket, according to a new study.¹

In a recent Hospital for Special Surgery (HSS) cohort, daily prosthetic wear time increased from 8.9 hours preoperatively to 13.7 hours postoperatively, a clinically meaningful gain reflecting both improved comfort and accelerating functional adaptation.^2,3,4

“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,” said Taylor J. Reif, MD, an orthopedic surgeon in the Osseointegration Limb Replacement Center at HSS, who presented the study. “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.”

Among the study's most striking findings was the complete elimination of intraoperative distal chip fractures with custom-fit implants, a complication occurred in 21.2% of cases using off-the-shelf devices (P = .032). Conventional implants are manufactured in standardized geometries may not conform to patient-specific cortical architecture, generating focal stress concentrations at the distal implant interface during insertion.

Custom implants, designed via 3-dimensional imaging and manufactured through electron beam melting (EBM), are engineered to match each patient's intramedullary canal geometry, distributing load more evenly across the cortical surface and eliminating the mechanical stress drives fracture at the implant tip. Notably, 61.9% of patients in this cohort also underwent simultaneous nerve surgery and demonstrated significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity scores alongside gains in wear time.

Long-term durability data for custom implants remain an open and critical research question. Osseointegration stability, revision rates, and the maintenance of patient-reported outcomes at the 5- and 10-year marks have not yet been established for EBM-manufactured devices. These milestones will be essential to fully characterize the risk-benefit profile of custom versus conventional implants and to support broader clinical adoption.

For primary care physicians (PCPs), the expanding candidate profile for OI, now including transtibial amputees and those considering primary amputation, creates a meaningful opportunity for earlier intervention. PCPs who identify patients struggling with socket fit, skin integrity, or prosthetic wear tolerance are well-positioned to initiate the OI conversation and refer to specialized surgical teams before functional decline becomes entrenched.

Patient Care Online sat down with Reif to discuss these findings. The above video is the second part of that interview.

You can view the first part of the interview here https://www.patientcareonline.com/view/osseointegration-benefits-transtibial-transfemoral-amputees-taylor-j-reif-md

Reif has no relevant disclosures to report.

References:

1. Rozbruch SR, Elghazy MA, Glassband Z, Reif TJ, Hoellwarth JS. Primary amputation with osseointegration versus osseointegration for existing amputation. Hospital for Special Surgery. 2026.
2. Glassband Z, Reif TJ, Rozbruch SR, Hoellwarth JS. Femur and tibia press-fit osseointegration - a comparison of safety and outcomes. Hospital for Special Surgery. 2026.
3. Rozbruch SR, Glassband Z, Hoellwarth JS, Reif TJ. Safety and early experience of osseointegration limb replacement with custom-fit implants. Hospital for Special Surgery. 2026.
4. The future of prosthetics: advancements in osseointegration surgery. Hospital for Special Surgery. March 2026.