Current challenges and future prospects of osseointegration limb reconstruction for amputees

Although osseointegration has proven successful at improving the physical deficits that traditional prostheses leave unfulfilled, future innovation should be systematically guided rather than randomly explored. Therefore, this article attempts to summarise, in a systematic manner, the challenges and prospects of osseointegration limb reconstruction for amputees from an implant design and manufacturing point of view, to provide a template for the development of the next generation of osseointegration implants. A scoping literature review was conducted, and key papers were identified and summarised. To combat osseointegration-related infection, advances such as smart implant coatings, mechanical inactivation of bacteria, biofilm eradication, implant monitoring technologies and nanotechnology were evaluated. Regarding production and biomaterials, the potential of 3D printing to balance supply and demand to achieve cost-effectiveness and sustainability were investigated. Considering the evolution of designs and the goal to provide a sensate limb, the prospects of smart implants, biofeedback and myoelectric pattern recognition were also explored. Osseointegration appears to follow a trajectory like that of total joint arthroplasty, which gained widespread clinical acceptance and adoption over the last 50 years. In our opinion, the future of amputee rehabilitation is bright, and we are optimistic osseointegration will continue to progress and advance as new technologies emerge.