The first instance of an NHS-funded elective osseointegrated prosthetic took place in November 2022 on a lower limb amputation patient. This option for amputees, whereby a titanium implant is inserted directly into the bone and extending out of the residual limb to allow direct anchoring of the prosthesis to the stump, has been available for decades, but now for the first time is being offered outside of the private sector in the UK.

This follows the advocation in a paper from October 2022 of its greater use by centrally funded resources, for those patients who have poor mobility with conventional socket prostheses, citing quality of life and cost effectiveness as the key benefits. Those will be welcome advantages to claimants and insurers alike engaged in injury claims. There is generally a higher instance of socket problems for above knee amputees, making those patients the prime candidates for osseointegration.

As we previously discussed with Professor Grimer in our vlog, osseointegration is a popular choice with patients when it works. A key benefit is the greater proprioception afforded to the user, as they can feel their prosthetic limb touch the ground when walking, providing a more intimate experience. It is best for those who have problems with socket attachment, for example due to a short stump, problems with skin breakdown, or for double amputees.  

But there are a number of risks, such as frequent infection requiring long-term antibiotics, loosening or fracture of the titanium rod and ultimately removal of the implant, which may require further shortening of the residual limb. Current data on long-term outcomes is sparse and there is a significant instance of failure.

The present indications are that there will be more widespread use for those with lower limb loss. However, longer-term the greatest benefits are likely to be seen for upper limbs, particularly mid-humerus amputees, and, further into the future, with advancements in targeted muscle reinnervation and bionics, enabling a usable hand.

Osseointegration remains problematic and will not be suitable or successful for all claimants in injury claims but is an option that now has greater opportunity for exploration and for an insurer in the right case could bring savings on indemnity spend. The advent of provision on the NHS is a welcome event for patients, and the first step towards a promising future for this technology.


David Thompson is a member of Clyde & Co's Amputation Subject Matter Group