Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use

Abstract

Abstract-Musculoskeletal imbalances or pathologies often develop into secondary physical conditions or complications that may affect the mobility and quality of life of people with lowerlimb amputation. Using one or more prostheses causes people with amputation to alter the biomechanics of their movement. For example, people with lower-limb amputation often favor and stress their intact lower limb more during everyday activities. This can lead to degenerative changes such as osteoarthritis of the knee and/or hip joints of the intact limb. Since people with amputation spend less time on their residual limb, osteopenia and subsequent osteoporosis often occur secondary to insufficient loading through the long bones of the lower limb. A proper prosthetic fit increases the probability of equal force distribution across the intact and prosthetic limbs during ambulation, thus decreasing the risk of osteoarthritis. People with limb loss commonly complain of back pain, which is linked to poor prosthetic fit and alignment, postural changes, leg-length discrepancy, amputation level, and general deconditioning. We review the literature on secondary complications among people with lowerlimb loss who are long-term prosthesis wearers.

Effect of Free Swing Gait Training on Back Pain in a Patient with Bilateral Lower Extremity Amputations: A Case Report

“…Back pain is a common occurrence in persons with a lower extremity amputation and can cause a chronic disability if not addressed [4]. According to Edhe et al, 52% of the transfemoral amputee participants in their study experienced persistent low back pain [5].…”

“…These impairments may include decreases in strength, proprioception, and balance; as well as gait deviations and pain [4][5][6][7]. These patients are often referred to physical therapy in order to address their physical impairments and to obtain independence with prosthetic use during ambulation.…”

“…In the older amputee population, this unstable gait pattern can also lead to feelings of insecurity and fear, causing a reduced gait speed [10]. Additionally, amputees with an adaptive gait pattern spend more time on the intact limb due to increased proprioception and balance when compared to the residual limb, leading to pain in other joints [4].…”

Radiographic parameters improve lower extremity prosthetic alignment

“…Common reasons for patients requiring adjustments include improper fit, shortening, dysfunction resulting from wear, and related skin problems [4]. Additionally, it has been demonstrated in the literature that minor compensations for improper fit can increase the stress on the intact limb and expose the long-term prosthetic wearer to secondary physical conditions [7,11]. Given that many patients live in remote regions and face a financial burden due to frequent prosthetic adjustment visits, it is essential to attain a satisfactory fit when the patient initially receives their prosthesis.…”

CORR Insights®: How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

“…Likewise, the long-term secondary health effects of amputation, ranging from degenerative joint disease and lower back pain to cardiovascular disease and obesity, have been well documented [2]. Similar data are not readily available following rotationplasty or pediatric limb salvage, but one could anticipate that these patients are also probably not ''normal.''…”