Artificial limbs that move and feel like real ones

How far are prosthetic limbs that are controlled by the nervous system, attached to bone and give touch feedback from routine care?

A bone-anchored prosthesis is authorised in the US for some above-knee amputees. A five-year follow-up of 51 patients reported 92% cumulative fixture survival, though 11 patients had 14 deep infections. Nerve and muscle interfaces that give some control and sensory feedback have been tested in one to seven people at a time, and the 2024 leg study was not randomised. None of these is in routine care, and the sources reviewed give no cost or wider access figures.

AI illustration · Illustrative scene, not a photograph of the specific device or experiment.
WHERE WE AREPilots

Close. Early pilots are running in the real world.

Bone-anchored prostheses are authorised in the US for a defined group of transfemoral (above-knee) amputees and have been used in small numbers of patients. Limbs controlled through nerves and muscles, with sensory feedback, have been shown only in small studies, mostly non-randomised, and the sources reviewed do not show clinical benefit over years of use. That is beyond proof of principle but short of routine care, so the stage is pilot.

The tech tree

Everything recorded on Vrulum that this future needs, oldest foundations at the top and the goal at the bottom. Lines show what each step requires.

What it takes: Artificial limbs that move and feel like real ones Unlocked Being researched Locked
  1. 2007Bionic limbs with nerve and bone connectionPilot and early commercial Unlocked.
  1. 2007Targeted muscle reinnervation in one patient with an arm amputationDone Unlocked.
  2. 2014Two-year results for a bone-anchored cohortDone Unlocked.
  3. 2014Nerve-controlled grip with sensory feedback in one amputeeDone Unlocked.
  4. 2014Sensory feedback through an implanted bone-anchored interfaceDone Unlocked.
  5. 2018Five-year results for the same bone-anchored cohortDone Unlocked.
  6. 2020Bone-anchored prosthesis authorised in the US for transfemoral amputeesDone Unlocked.
  7. 2024Agonist-antagonist interface compared with standard leg amputationDone Unlocked.
  8. Date not recordedPost-approval study for the bone-anchored systemIn progress Being researched.
  9. Date not recordedRandomised or blinded comparison with standard prosthesesNot started Locked.
  10. Date not recordedNerve and muscle interfaces for arm amputeesNot started Locked.
  1. GoalArtificial limbs that move and feel like real onesGoalRequires: Bionic limbs with nerve and bone connection, Bone-anchored prosthesis authorised in the US for transfemoral amputees, Two-year results for a bone-anchored cohort, Five-year results for the same bone-anchored cohort, Sensory feedback through an implanted bone-anchored interface, Nerve-controlled grip with sensory feedback in one amputee, Targeted muscle reinnervation in one patient with an arm amputation, Agonist-antagonist interface compared with standard leg amputation, Post-approval study for the bone-anchored system, Randomised or blinded comparison with standard prostheses, Nerve and muscle interfaces for arm amputees. Locked.

The road so far

7 of 10 steps done, 1 in progress.

  1. Done · 18 Dec 2020Bone-anchored prosthesis authorised in the US for transfemoral amputees

    The FDA granted premarket approval (PMA P190009) for the OPRA Implant System, for skeletally mature people with transfemoral amputation from trauma or cancer who have, or are expected to have, rehabilitation problems with a conventional socket prosthesis, or who cannot use one. The FDA record does not state specific conditions of approval. [1]

  2. Done · Jan 2014Two-year results for a bone-anchored cohort

    In a single-centre, non-randomised study of 51 patients with 55 transfemoral amputations, enrolled between 1999 and 2007, cumulative survival was 92% at two years. Superficial infection was the most frequent complication, with 41 episodes in 28 patients. [2]

  3. Done · 2018Five-year results for the same bone-anchored cohort

    Of 51 patients, 40 were followed for five years. Cumulative fixture survival at five years was 92%. Eleven patients had 14 deep infections over the period, and four fixtures were removed, one for deep infection and three for loosening. The authors described increases in deep infections and mechanical complications as a concern. The study was small, non-randomised and single-centre, with mid-term follow-up only. [3]

  4. Done · Oct 2014Sensory feedback through an implanted bone-anchored interface

    In one amputee followed for more than a year, the authors reported more precise control than surface electrodes gave, and stable myoelectric pattern recognition and sensory feedback delivered through neurostimulation. Results from one person show that this is feasible, not how common the result would be. [4]

  5. Done · Feb 2014Nerve-controlled grip with sensory feedback in one amputee

    Stimulating median and ulnar nerve fascicles with sensor data from a hand prosthesis gave one amputee near-natural sensory feedback during real-time control. The participant modulated grip force across three levels without visual or auditory cues. The study had one participant. [5]

  6. Done · Feb 2007Targeted muscle reinnervation in one patient with an arm amputation

    Nerves were transferred to chest muscles and skin in a woman with a shoulder-level arm amputation, creating new control signals for her prosthesis and a route for sensory feedback. Functional tests improved substantially with the new prosthesis, and she reported intuitive control. This was a single case study, and the full text was not checked for this record. [6]

  7. Done · Jul 2024Agonist-antagonist interface compared with standard leg amputation

    Seven people with below-knee amputation who had the surgery reached a maximum walking speed of 1.78 m/s, against 1.26 m/s for seven matched people with standard amputations. The study was non-randomised, and participants and the research team were not blinded to testing conditions. The authors state that future studies should show the clinical benefits of long-term use. [7]

  8. In progressPost-approval study for the bone-anchored system

    The FDA approval record refers to a post-approval study with a report schedule. The record does not give its design or results, so whether it is ongoing is not verified. [1]

  9. Not startedRandomised or blinded comparison with standard prostheses

    The sources reviewed do not describe a randomised trial of bone-anchored or nerve-controlled limbs against standard care. A 2025 review states that a direct comparison of patient-reported outcomes with standard amputation is still a future step. [9]

  10. Not startedNerve and muscle interfaces for arm amputees

    MIT reports that the surgery can also be done for people with arm amputations, but the 2024 study tested leg amputees only. The sources reviewed do not report results for arm amputees. [8][7]

Why it matters

The FDA indication for the bone-anchored system refers to people who have, or are expected to have, rehabilitation problems with a conventional socket prosthesis, or who cannot use one. If limbs that attach to bone can be controlled and felt more naturally, and if they stay safe over years, they could give some users more natural movement and touch feedback. The sources reviewed do not yet show this over the long term.

What stands in the way

  • Infection where the implant passes through the skin is a safety concern the authors flag. In the five-year cohort, 11 of 51 patients had 14 deep infections.
  • The evidence is small and mostly mid-term: a five-year cohort of 51 patients, one person with implanted sensory feedback followed for more than a year, and a comparison of seven people with seven matched controls.
  • Sensory feedback is only partial. MIT reports that the agonist-antagonist interface gives less than 20% of the feedback a person without amputation would normally receive.
  • In the 2024 leg study, the nerve-controlled ankle-foot unit ran for about two hours on one charge and weighed 2.42 kg without its battery module.
  • No randomised comparison with standard care appears in the sources reviewed, and they give no cost or access figures for these procedures.

Signals to watch

  • A randomised or blinded comparison of bone-anchored or nerve-controlled limbs with standard prostheses.
  • Infection and implant survival figures beyond five years for the approved bone-anchored system, from a registry or the post-approval study.
  • Published results for nerve and muscle interfaces in arm amputees.
  • Published cost, reimbursement or access decisions for the surgery and the prosthesis.
  • Battery life and weight of nerve-controlled prostheses improving in later studies.

Sources

  1. government report
    PMA P190009: OPRA Implant System
    US Food and Drug Administration, 18 Dec 2020.
  2. peer reviewed paper
    A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation
    R. Brånemark, O. Berlin, K. Hagberg. The Bone & Joint Journal, Jan 2014.
  3. peer reviewed paper
    Osseointegrated Percutaneous Prosthetic System for the Treatment of Patients With Transfemoral Amputation: A Prospective Five-year Follow-up of Patient-reported Outcomes and Complications
    R. P. Brånemark, K. Hagberg, K. Kulbacka-Ortiz et al.. Journal of the American Academy of Orthopaedic Surgeons, 2018.
  4. peer reviewed paper
    An osseointegrated human-machine gateway for long-term sensory feedback and motor control of artificial limbs
    M. Ortiz-Catalan, B. Håkansson, R. Brånemark. Science Translational Medicine, Oct 2014.
  5. peer reviewed paper
    Restoring natural sensory feedback in real-time bidirectional hand prostheses
    S. Raspopovic, M. Capogrosso, F. M. Petrini. Science Translational Medicine, Feb 2014.
  6. peer reviewed paper
    Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study
    T. A. Kuiken, L. A. Miller, R. D. Lipschutz. The Lancet, Feb 2007.
  7. peer reviewed paper
    Continuous neural control of a bionic limb restores biomimetic gait after amputation
    Hyungeun Song, Hugh M. Herr. Nature Medicine, Jul 2024.
  8. university press release
    A prosthesis driven by the nervous system helps people with amputation walk naturally
    MIT News, 1 Jul 2024.
  9. review article
    Agonist-antagonist myoneural interface (AMI): Innovative treatment option for lower limb amputees?
    M. N. Kalff, V. Hoursch, J. Ernst. Unfallchirurgie, 6 Mar 2025.

Last reviewed 21 Oct 2026.