Investigating the Feasibility and Safety of Osseointegration With Neural Interfaces for Advanced Prosthetic Control.

Osseointegrated neural interfaces (ONI), particularly in conjunction with peripheral nerve interfaces (PNIs), have emerged as a promising advancement for intuitive neuroprosthetics. PNIs can decode neural signals and allow precise prosthetic movement control and bidirectional communication for haptic feedback, while osseointegration can address limitations of traditional socket-based prosthetics, such as poor stability, limited dexterity, and lack of sensory feedback.  This review explores advancements in ONIs, including screw-fit and press-fit systems and their integration with PNIs for bidirectional communication. ONIs integrated with PNIs (OIPNIs) have shown improvements in signal fidelity, motor control, and sensory feedback compared to popular surface electromyography (sEMG) systems. Additionally, emerging technologies such as hybrid electrode designs (e.g., cuff and sieve electrode (CASE)) and regenerative peripheral nerve interfaces (RPNIs) show potential for enhancing selectivity and reducing complications such as micromotion and scarring. Despite these advances, challenges remain, including infection risk, electrode degradation, and variability in long-term signal stability.  Osseointegration combined with advanced neural interfaces represents a transformative approach to prosthetic control, offering more natural and intuitive movement with sensory feedback. Further research is needed to address long-term biocompatibility, reduce surgical invasiveness, and explore emerging technologies such as machine learning for personalized ONI designs. The findings of this review underscore the potential of ONIs to enhance embodiment and quality of life for amputees and highlight current pitfalls and possible areas of improvement and future research.