Outcome After Trans-tibial Amputation for Vascular Disease: A Follow-Up After eight Years

Abstract

All 112 patients (55 females and 57 males) with a primary unilateral trans-tibial amputation for vascular disease performed in one year at all five hospitals in Malmöhus county, Sweden were examined at 6 months according to the prosthetic function and prospectively followed-up 8 years after the amputation for survival, and prosthetic fitting. The prosthetic function was re-examined among the survivors 8 years postoperatively. At 6 months 50% were fitted with a prosthesis and later (up to 8 years) a further 13%, in total 32 females and 39 males. The mortality at 6 months was 33%, at 2 years 47% and at 8 years 92%. Age at amputation (p = 0.015), to be amputated on the left leg (p = 0.0004), to be able to walk alone outdoors before the amputation (p = 0.007) and not using a wheelchair (p = 0.02) were all found to be statistically significant predictors for receiving a prosthesis. Predictors for good function with the prosthesis 6 months postoperatively was male sex (23 of 57 vs 8 of 55 females) (p = 0.006) and greater ability to walk alone outdoors before the amputation (p = 0.01). There was no significant age difference in this comparison. The finding that it is more favourable to be amputated on the left leg merits further study.

Predicting prosthetic prescription after major lower-limb amputation

“…Data from several retrospective studies and several cohort studies in the United States [9][10][11][12][13][14] and abroad [15][16][17][18][19][20][21][22] show that the rates of prosthetic fitting vary by amputation level, with 1 yr prescription rates ranging from 49 to 93 percent for people with transtibial (TT) amputation, 14 to 57 percent for transfemoral (TF) amputation, 38 to 67 percent for knee disarticulation, and 38 to 100 percent for below-ankle amputation. However, these studies vary in their sampling frame and inclusion and exclusion criteria, and it is not possible to generalize findings to all persons who underwent major limb amputation in the United States or in the VA system.…”

Preoperative characteristics and functional outcomes of lower limb amputees treated at Southern Älvsborg Hospital, Sweden

“…The median of total LCI-5 scores for all participants before amputation was 42 (range = 16-56). The median of LCI-5 basic score was 27 (range = [16][17][18][19][20][21][22][23][24][25][26][27][28], and the median of LCI-5 advanced score was 17 (range = 0-28).…”

Cost of prostheses in patients with unilateral transtibial amputation for vascular disease: A population-based follow-up during 8 years of 112 patients

“…We have stated in an earlier study (Hermodsson et al 1998) that two thirds of all the patients amputated were fitted with a prosthesis within 1 year, despite the high mortality rate of one third within 6 months postoperatively. Of the 71 patients accounted for in this study, half of the original 112 patients were 80 years or older and half of them had been fitted, while three fourths of those younger than 80 were fitted.…”

“…The mean age of the 112 patients was 77 (4&95) years with 47% (53/112) being 80 years or older. Further details about subjects and methods have been presented (Hermodsson et al 1998).…”

“…In a study of a 1-year cohort of lower limb amputees for vascular disease, we have earlier presented the fraction of patients fitted with a prosthesis (Hermodsson et al 1998) and the in-hospital costs (Eneroth et al 1996), where about 213 of all amputations were performed at the unilateral transtibial level. In this study we analyzed the annual number and costs of prostheses (including components, material and fitting work) in the unilateral transtibial amputees in the above-mentioned cohort during an 8-year follow-up.…”