Epidemiology of International Patients with Lower-Limb Deficiencies Treated at a United States–Based Pediatric Prosthesis Clinic

Abstract

ABSTRACT Introduction Limited epidemiological or clinical research exists describing pediatric lower-limb deficiency (LLD) patients born outside the United States (US). Objectives The purpose of this study was to characterize a cohort of international patients treated at a single tertiary care orthopedic hospital. We set out to quantify the prevalence of international patients within a broader cohort of pediatric limb deficiency patients. In addition, we evaluated similarities and differences between adopted and nonadopted internationally born patients as well as their US-born counterparts. Study Design Retrospective chart review was performed on patients born outside the US between 1995 and 2020. Methods Patients were divided into groups based on place of birth, country of residence, and adoption status. Statistical analysis was performed using χ2 and t-test. Results A total of 111/579 (19.2%) patients seen in our limb difference clinic were born outside the US, with 39.6% adopted. Geographically, patients represented 32 countries, and 96.4% were born in low- or middle-income countries (LMICs). The most common causes of LLD were congenital malformations (72.1%), trauma (17.1%), and tumor (5.4%). Syme was the most common amputation level (26.6%), followed by knee disarticulation (23.7%) and transtibial (18.7%). Congenital diagnoses were more frequent in adoptees (93.1% vs. 58.2%), whereas nonadoptees often had trauma (25.4%) or tumor (8.9%) diagnoses leading to amputation (P = 0.0003). A total of 23/60 (38.3%) international patients with preexisting lower-limb amputations had never worn a prosthesis at the time of initial presentation. Conclusions Many pediatric patients with prosthetic needs presenting for care in the US were born in LMIC. Adopted and nonadopted internationally born patients had significant differences in clinical etiologies of their LLD. Clinical Relevance Statement Internationally born patients may constitute a substantial percentage of US-based specialty clinics treating children with lower-limb differences, particularly from low- or middle-income countries where access to orthopedic and prosthetic care may be limited. This study highlights the importance of multidisciplinary health care providers addressing these children’s distinct clinical needs for improved patient-centered care.