Amputation Etiology Research Articles

Postamputation Residual Limb Pain Severity and Prevalence: A Systematic Review and Meta-Analysis.

Background: Individuals with an extremity amputation are predisposed to persistent pain that reduces their quality of life. Residual limb pain is defined as pain that is felt in the limb after amputation. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of 5 databases from inception to June 2020 was performed and is registered under the PROSPERO ID: CRD42020199297. Included studies were clinical trials with residual limb pain assessed at a minimum follow-up of 1 week. Meta-analyses of residual limb pain prevalence and severity were performed with subgroups of extremity and amputation etiology. Results: Twenty clinical trials met criteria and reported on a total of 1347 patients. Mean patient ages ranged from 38 to 77. Residual limb pain prevalence at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively, was 50%, 11%, 23%, 27%, 22%, and 24%. Mean residual limb pain severity at the 6 months or longer follow-up was 4.19 out of 10 for cancer amputations, 2.70 for traumatic amputations, 0.47 for vasculopathy amputations, 1.01 for lower extremity amputations, and 3.56 for upper extremity amputations. Conclusions: Residual limb pain severity varies according to the etiology of amputation and is more common after upper extremity amputation than lower extremity amputations. The most severe pain is reported by patients undergoing amputations due to cancer, followed by traumatic amputations, while vascular amputation patients report lower pain severity. Promising methods of reducing long-term pain are preoperative pain control, nerve or epidural blocks, use of memantine, calcitonin-containing blocks, and prophylactic nerve coaptations.

Etiology of Amputation among Patients Presented At Helping Hand Institute of Rehabilitation Sciences Mansehra

Etiology of Amputation among Patients Presented At Helping Hand Institute of Rehabilitation Sciences Mansehra

Humeral amputation following total elbow arthroplasty.

Total elbow arthroplasty (TEA) is associated with a relatively high complication rate, and exceptionally catastrophic complications might lead to amputation. The purpose of this study was to determine the incidence and aetiology of amputation performed at our institution in upper extremity limbs with a prior TEA. Between 1973 and 2018, 1906 consecutive TEAs were performed at our institution. Upper extremity amputation was performed in seven (0.36%) elbows with five transhumeral amputations and two shoulder disarticulations. The group consisted of five females and two males with a mean age of 64years (range, 37-80). The index TEA had been performed for rheumatoid arthritis (n = 2), rheumatoid arthritis with acute fracture (n = 2), radiation associated nonunion (n = 2), and metastatic cancer (n = 1). Mean follow-up after amputation was three years (range, 3months-5years). Mean time between amputation and TEA was 5years (range, 2months-13years). The indications for amputation included uncontrolled deep infection in six (86%) elbows and tumor recurrence in one (14%) elbow. Only one elbow (14%) was fitted with a prosthesis. Six (86%) patients died at a mean of three years (range, 3months-5years) after amputation. The results of this study highlight a low incidence of amputation after TEA. Most amputations were the direct result of TEA complications, with infection being the most common cause of amputation. Outcomes after amputation are concerning, with poor overall survival and few patients being fit for a prosthesis.

Türkiye’de ampütasyonların endikasyonları, komplikasyonları ve revizyonları

Aim: The objective of this study is to determine the incidence of indications for amputations, major amputation related complications and revision numbers in Level I trauma center; which consists burn care unit, hyperbaric oxygen unit and hand surgery department in Turkey.
 Materials and Methods: Amputation procedures were retrospectively reviewed and evaluated according to the amputation levels, etiology, and demographic data. Major complications that require surgical intervention, type of surgical intervention for these complications and interval between index surgery and first complication related surgery were recorded. Re-amputations were evaluated according to interval between index and revision surgery, revision indication, and revised level.
 Results: A total of 558 amputations were performed for 476 patients (367 male, 109 female) in five-year period. The most common indication of amputation was diabetic complications, 250 amputations for 215 diabetic patients (44.8%) were performed. Peripheral arterial disease and trauma were the second and third common indications. The most common indication for upper extremity amputation was trauma. The most common amputation levels were hand amputations in the upper extremity, and below-knee amputation in the lower extremity. Fifty-seven of the surgical procedures were re-amputations and the interval between index surgery and revision amputation was 5.0±15.8 months. The most common indication for revision amputation was diabetic complications. Complications that required surgical intervention were infection in 46 patients, local soft tissue necrosis in 28 patients, and wound dehiscence in 2 patients.
 Conclusions: This is the first study investigating amputation etiology from high capacity hospital in capital city of Turkey that can demonstrate the whole country. The most common indications in this study were diabetic foot, PAD, and trauma as it is in developed countries. The results of this study can be the first step of multicenter epidemiological studies about amputations.

Frequency and Severity of Phantom Limb Pain in Veterans with Major Upper Limb Amputation: Results of a National Survey.

To describe the frequency and severity of phantom limb pain (PLP) in veterans with major upper limb amputation and determine the association between PLP and person, amputation, and prosthesis characteristics. Cross-sectional design. National survey of veterans living in the community. U.S. military veterans (N = 776) with major upper limb amputations. Frequency and intensity of PLP, person characteristics such as age and gender, amputation characteristics such as level and etiology, and prosthesis characteristics such as type and intensity of prosthesis use. Respondents were 97% male with a mean age of 63 years and a mean time since amputation of 31 years. The most common amputation level was transradial (36%) and 62% reported accident as the amputation etiology. 73% of amputees reported PLP with a mean intensity score of 4.2 (standard deviation 3.4). PLP frequency in the daily to always category was reported in 42% of amputees. Weekly and more frequent residual limb pain was associated with having any PLP. Amputation at the shoulder (odds ratio [OR] 3.78 [1.93, 7.39]), amputation at the transhumeral level (OR 1.76 [1.10,2.81]), and amputation due to cancer (OR 5.33 [1.15, 24.81]) were also associated with any PLP. Moderate (β = 1.34, P = < .001) and severe (β = 3.31, P < .001) residual limb pain intensity was associated with higher PLP intensity among those with pain. Amputation at the shoulder level was associated with a 1.5 points higher average pain intensity score (P < .001) compared to the transradial level. Multivariable models failed to show an association between PLP prevalence and amputation of the dominant limb (P = .08) and PLP was not associated with intensity of daily prosthesis use in bivariate analyses. This study of a large cohort of veterans with major upper limb amputation highlights the long-term persistence of moderate frequency and intensity PLP.

Factors affecting activities of daily living, physical balance, and prosthesis adjustment in non-traumatic lower limb amputees.

Objectives This study aims to identify the factors affecting the activities of daily living, balance, and prosthesis satisfaction in patients with non-traumatic lower limb amputation (LLA). Patients and methods This cross-sectional study included a total of 195 patients (120 males, 75 females; mean age 65.9±11.6 years; range, 40 to 90 years) who underwent LLA between January 2009 and April 2017. All patients were evaluated in terms of age, sex, amputation etiology, side, level, comorbidity, length of hospital stay, prosthesis adjustment, ambulation level, functional outcome, and complications. Prosthesis adjustment, physical balance ability, and daily living activities were assessed using the Turkish versions of the Trinity Amputation and Prosthesis Experience Scales (TAPES), Berg Balance Scale (BBS), and Nottingham Extended Activities of Daily Living Scale (NEADLS), respectively. Results There was no significant difference between male and female patients in terms of prosthesis and amputation adaptation, physical balance, and activities of daily living. The BBS, TAPES, and NEADLS scores were lower in the patients aged over 65 years (p<0.001, p<0.001, and p<0.001, respectively). Prosthesis and amputation adaptation, physical balance, and daily living activities were also worse in this age group. Transfemoral amputees had lower BBS, TAPES, and NEADLS scores than the transtibial amputees (p=0.009, p=0.020, and p=0.004, respectively). Prosthesis and amputation adaptation, physical balance, and daily living activities were worse in the transfemoral amputees. Conclusion Age and amputation level affect physical balance, prosthesis satisfaction, and daily living activities after non-traumatic LLA. Therefore, orthopedic surgeons and physical therapists should conduct a multidisciplinary evaluation, particularly in patients aged over 65 years and in transfemoral amputees to improve outcomes.

Sex-specific Differences in Multisite Pain Presentation among Adults with Lower-Limb Loss.

Multisite pain remains significantly understudied following lower-limb loss (LLL), especially among females. This study aimed to explore sex-specific differences in the presentation of multisite pain post LLL. Hypotheses were multisite pain would be more prevalent among females post LLL as compared with males, and female sex would be significantly associated with multisite pain prevalence. In this cross-sectional study, participants answered standardized questions regarding the presence of amputation-specific (ie, phantom-limb, residual-limb) and secondary (ie, contralateral-limb, low-back) pain. Multisite pain was defined as pain in ≥2 locations. Sex-specific differences in pain prevalence were evaluated using chi-square tests (P≤0.050). Using logistic regression, the association between sex and multisite pain was examined after controlling for covariates (age, body mass index, time since amputation, amputation etiology and level). The sample included 303 adults (33% females) ≥1 year post unilateral LLL. More females than males reported pain in the residual limb (53.0% vs. 38.4%), low back (56.0% vs. 39.9%), contralateral knee (37.0% vs. 24.1%), and contralateral hip (25.0% vs. 12.3%; P<0.050). More females than males were classified as having multisite pain (72.0% vs. 54.7%; P=0.004). While patterns of multisite pain were similar (ie, pain affected both amputation-specific and secondary sites) between sexes, being female was independently associated with higher odds of having multisite pain (odds ratio: 2.40, 95% confidence interval: 1.40 to 4.12). Female sex appears to be associated with multisite pain ≥1 year after LLL. Future work is needed to identify mechanisms underlying sex-specific differences in pain presentation and evaluate the impact of sex on pain-related outcomes post amputation.

Effects of different anesthetic techniques on the incidence of phantom limb pain after limb amputation: a population-based retrospective cohort study.

BackgroundGeneral anesthesia (GA) has been considered the anesthetic technique which most frequent leads to phantom limb pain (PLP) after a limb amputation. However, these prior reports were limited by small sample sizes. The aims of this study were to evaluate the incidence of PLP according to the various anesthetic techniques used for limb amputation and also to compare the occurrence of PLP according to amputation etiology using the Korean Health Insurance Review and Assessment Service for large-scale demographic information.MethodsThe claims of patients who underwent limb amputation were reviewed by analyzing the codes used to classify standardized medical behaviors. The patients were categorized into three groups—GA, neuraxial anesthesia (NA), and peripheral nerve block (PNB)—in accordance with the anesthetic technique. The recorded diagnosis was confirmed using the diagnostic codes for PLP registered within one year after the limb amputation.ResultsFinally, 7,613 individuals were analyzed. According to the recorded diagnoses, 362 patients (4.8%) developed PLP after amputation. Among the 2,992 patients exposed to GA, 191 (6.4%) were diagnosed with PLP, whereas 121 (4.3%) of the 2,840 patients anesthetized with NA, and 50 (2.8%) of the 1,781 patients anesthetized under PNB developed PLP. The relative risks were 0.67 (95% confidence interval [CI], 0.53–0.84; P < 0.001) for NA and 0.43 (95% CI, 0.32–0.59; P < 0.001) for PNB.ConclusionsIn this retrospective cohort study, using large-scale population-based databases, the incidence rates of PLP after limb amputations were, in the order of frequency, GA, NA, and PNB.

Validity of the Comprehensive High-Level Activity Mobility Predictor in a heterogeneous population with lower extremity amputations.

Lower extremity amputee outcome measures assess basic mobility. The Comprehensive High-Level Activity Mobility Predictor was developed to assess high-level mobility. Validity evidence was collected in military men with traumatic lower extremity amputations. This study examines its validity in a broader population. Cross-sectional. Forty-five lower extremity amputees (Medicare Functional Classification Level K3 or K4) completed the 2-min walk test, Amputee Mobility Predictor with Prosthesis, and Comprehensive High-Level Activity Mobility Predictor. The Comprehensive High-Level Activity Mobility Predictor correlated with the Amputee Mobility Predictor with Prosthesis (r = 0.77, p < 0.01) and the 2-min walk test (r = 0.65, p < 0.01). The Comprehensive High-Level Activity Mobility Predictor differentiated between K-levels, age groups, etiology of amputation, and amputation level (p < 0.005). No ceiling effect was observed (range: 2.5-29/40). This study provides convergent and discriminative validity evidence for Comprehensive High-Level Activity Mobility Predictor use in a more heterogeneous population than previously published, suggesting that clinicians should feel confident to use it as an outcome measure for individuals with amputations who are capable of more than level-ground walking. Clinically, the Comprehensive High-Level Activity Mobility Predictor has validity evidence for use in a more heterogeneous population than originally demonstrated, including civilians, women, people over age 40 years, and non-traumatic etiologies. The Comprehensive High-Level Activity Mobility Predictor may be more useful than standard outcome measures for high-level mobility.

Outcomes and special techniques for treatment of penile amputation injury

IntroductionManagement of severe penile trauma presents great challenges for reconstructive urologists since these injuries vary from abrasions to total emasculation. A review of our case experience with penile amputation is presented, emphasizing techniques used to salvage or reconstruct the most difficult of penile injury cases. Materials and methodsA total of 13 patients with penile amputation injury referred to us between 2007 and 2016 were analyzed. Mean age at surgery was 16 years (ranged from 4 to 29 years). Etiology of penile amputation (partial or total) combined with management and outcomes were evaluated. Management included different surgical procedures with the aim to achieve good functional and esthetical outcomes. Postoperative questionnaire was used for assessment of patient's overall satisfaction. ResultsFollow-up ranged from 13 to 182 months (mean 53). Causes of penile injury were iatrogenic trauma (8), self-amputation (2), electrocution (1), intentional sexual assault (1) and mother's hair strangulation (1). Outcome criteria including aesthetic appearance, urinary function and ability to engage in satisfactory coitus, were noted in 11 cases (85%). Two cases with ensuing complications relating to the total phalloplasty required additional treatment due to urethral fistula. ConclusionsSevere penile injuries should be treated on a case by case basis utilizing the most propitious techniques. We respectfully propose that the needs of such patients are best served by referral centers with extensive experience.

Evaluation of Neurotized Hypothenar Free Perforator Flaps Used for Fingertip Reconstruction

In reconstruction of digital amputations of the upper extremity, composite tissue alternatives with similar features are limited for finger tip reconstruction. Among these alternatives, free perforator flaps elevated from the hypothenar region (HFPFs) are defined, but reluctancy goes on for utilization of these flaps.In this study, we aimed to highlight the sensory results of HFPFs when a neural repair is incorporated to the flap and also to justify their usage by presenting functional and aesthetic outcomes of the reconstructions performed with HFPFs. This clinical study was conducted from June 2015 to June 2017. Twelve patients with acute finger tip amputations were examined. Distal amputation levels were subgrouped according to Ishikawa classification. Patient demographics and amputation etiology were listed. All fingertip defects were reconstructed with a neurotized HFPF. All perforator anastomoses were performed in an end-to-end fashion. During follow-up, 2-point discrimination and dynamometric test were conducted. In addition, the Michigan Hand Outcomes Questionnaire was carried out. Evaluation of the results from a cosmetic standpoint was also conducted, with 4 blinded, independent surgeons using the visual analog scale. Of 12 digital amputations reconstructed with neurotized HFPFs, 10 were totally viable during follow-up, whereas partial loss was observed in 2 flaps. The mean age was 38.8 ± 11.8 years. Most of the amputations were classified as Ishikawa subgroup 2 (50%). The mean dynamic 2-point discrimination was 3.2 ± 0.11 mm and slightly greater compared with contralateral digit (P = 0.003). Also minor decreases were measured in forced grip and pulp-to-pulp grip strengths (P = 0.003). Overall satisfaction was 92.7% in Michigan Hand Outcomes Questionnaire. Average visual analog scale score was 7.25 out of 10. Hypothenar free perforator flaps, with incorporation of neural repair, give promising results for reconstruction of the fingertip. In addition to superior sensorial outcomes, HFPFs yield satisfying results from aesthetic and functional perspectives.

Gait Analysis in Individuals with Transtibial Amputation Walking on Sand: Comparing Everyday Prosthesis with a Water-Activity Prosthesis

ABSTRACT Introduction This exploratory descriptive case-control study examined gait characteristics during sand walking in people with unilateral transtibial amputation, comparing patterns between everyday prosthesis with shoe, everyday prosthesis without shoe (EPWS), and a water-activity prosthesis (WAP), and evaluated how users experience the use of the WAP. Materials and Methods Three-dimensional gait analysis, using an eight-camera Vicon motion capture system, was completed for 16 participants (mean age, 51.4 ± 5.5; 75% male, amputation etiology 63% trauma) when walking independently over level ground (baseline) and sand (gait adaptation response). Outcome variables were spatiotemporal data and kinematic data for the hip, knee, and ankle, and additionally, a purposefully designed Water Activity Prosthesis Survey was completed. Results The results demonstrated cautious gait with reduced walking speed (P &lt; 0.05) and decreased ankle range of motion (&lt;0.05) in the prosthetic limb when walking with the EPWS and WAP. Using the WAP resulted in most prominent kinematic adaptational changes on sand. When comparing differences between the EPWS and WAP, significantly less hip extension (−2.92°; 95% confidence interval, −5.56 to −0.28; P = 0.02) and significantly less movement at the ankle (P &lt; 0.05) occurred in the prosthetic limb in walking trials with the WAP. Nevertheless, more than 80% of the participants used the WAP at least twice a week for shower, pool, and beach activities. Conclusions This study suggests that, although important for participation in ADL and leisure activities and supporting higher quality of life, the use of the WAP leads to unfavorable biomechanical gait alterations. Therefore, when prescribing the WAP, this trade-off should be taken into consideration.

Low Back Pain in Adults With Transfemoral Amputation: A Retrospective Population-Based Study.

Low back pain (LBP) is common among individuals with transfemoral amputation (TFA) and has a negative impact on quality of life. Little is known about health care utilization for LBP in this population and whether utilization varies by amputation etiology. To determine if individuals with TFA have an increased likelihood of seeking care or reporting symptoms of acute or chronic LBP during physician visits after amputation compared with matched individuals without amputation. Retrospective cohort. Olmsted County, Minnesota (2010 population: 144 248). All individuals with incident TFA (N = 96), knee disarticulation, and transfemoral amputation residing in Olmsted County between 1987 and 2014. Each was matched (1:10 ratio) with non-TFA adults on age, sex, and duration of residency. Individuals were divided by etiology of amputation: dysvascular and trauma/cancer. Not applicable. Death and presentation for evaluation of LBP (LBP event) while residing in Olmsted County. LBP events were identified using validated International Classification of Diseases, Ninth Revision (ICD-9) codes and corresponding Berkson, Hospital International Classification of Diseases Adapted (HICDA), and ICD-10 diagnostic codes. Hurdle and competing-risk Cox proportional hazard models were used. Having a TFA of either etiology did appear to correlate with increased frequency of LBP events, although this association was only statistically significant within the dysvascular TFA cohort (dysvascular TFA cohort: relative risk [RR] 1.80, 95% confidence interval [CI] 1.07-3.03, median follow-up 0.78 years; trauma/cancer TFA cohort: RR 1.14, 95% CI 0.58-2.22, median follow-up 7.95 years). In time to event analysis, dysvascular TFA had an increased risk of death and event. Obesity did not significantly correlate with increased frequency of LBP events or time to event for either cohort. At any given point in time, individuals with TFA of either etiology who had phantom limb pain were 90% more likely to have an LBP event (hazard ratio [HR] 1.91, 95% CI 1.11-3.31). Conditional on not dying and no LBP event within the first 2.5 years, individuals with prosthesis had a decreased risk of LBP events in subsequent years. Risk of LBP events appears to vary by TFA etiology. Obesity did not correlate significantly with increased frequency of LBP event or time to event. Phantom limb pain correlated with decreased time to LBP event after amputation. The association between prosthesis receipt and LBP events is ambiguous. III.

Distance et vitesse de marche chez les amputés en transfémoral équipés d’une prothèse à appui distal

IntroductionPreservation of femoral condyles in patients with knee disarticulation amputation (KDA) facilitates distal support inside the socket, compared to transfemoral amputation (TFA), and allows the direct transfer of weight-bearing loads toward residual limbs. HypothesisThe hypothesis was that the gait distance and speed of TFA patients after a surgical femoral implant that allowed the distal support of the residuum would improve. Material and methodsIn total, 23 TFA patients received a titanium implant that allowed the distal weight bearing of the residuum inside the socket. The post-intervention follow-up period lasted 14 months. Gait distance and speed were assessed with the 2-minute walk test (2MWT). ResultsThe amputation etiology was trauma in 11 patients (48%), peripheral vascular disease in nine (39%) and oncologic disease in three (13%). The mean 2MWT distance was 103.6±34.7m prior to femoral implant and 128±38.9m at 14 months, which implies an improvement of 24% (p<0.001). The mean gait speed was 0.86±0.29m/s prior to femoral implant and 1.06±0.32m/s at 14 months (p<0.001). DiscussionAfter implant placement, distance covered increased by 24%. This value is higher than those described by other groups, such as Rau (12.6%) and Darter (19.2%), who assessed improvement in distance covered with the 2MWT in a younger population and after completing different physiotherapy programs. Our results showed improved distance walked and gait speed as well as in the physical functioning score in TFA patients 14 months after receiving a femoral implant that permitted distal residuum loading. Type of studyAn experimental prospective study. Level of proofIII, case-control study.

Prosthetic Foot Selection for Individuals with Lower-Limb Amputation: A Clinical Practice Guideline.

ABSTRACTIntroductionThis guideline was developed to present current evidence and to provide associated clinical recommendations on prosthetic foot selection for individuals with lower-limb amputation.MaterialsNAMethodsThe guideline is based upon the best available evidence as it relates prosthetic foot selection during the provision of definitive lower-limb prostheses. Where possible, recommendations are drawn from Cochrane Review, meta-analysis, systematic and narrative literature reviews, and published evidence-based guidelines. Where this standard is unavailable, alternate academic literature has been used to support individual recommendations.ResultsRecommendation 1: For patients ambulating at a single speed who require greater stability during weight acceptance because of weak knee extensors or poor balance, a single-axis foot should be considered. Recommendation 2: Patients at elevated risks for overuse injury (i.e., osteoarthritis) to the sound-side lower limb and lower back are indicated for an energy-storage-and-return (ESAR) foot to reduce the magnitude of the cyclical vertical impacts experienced during weight acceptance. Recommendation 3: Neither patient age nor amputation etiology should be viewed as primary considerations in prosthetic foot type. Recommendation 4: Patients capable of variable speed and/or community ambulation are indicated for ESAR feet.ConclusionsThese clinical practice guidelines summarize the available evidence related to prosthetic foot selection for individuals with lower limb amputation. The noted clinical practice guidelines are meant to serve only as “guides.” They may not apply to all patients and clinical situations.

The risk of major cardiovascular events for adults with transfemoral amputation

BackgroundIt is well-known that the risk of cardiac disease is increased for those with lower-limb amputations, likely as a result of the etiology of the amputation. Using a longitudinal population-based dataset, we examined the association between transfemoral amputation (TFA) status and the risk of experiencing a major cardiac event for those undergoing either dysvascular or traumatic amputations. The association of receiving a prosthesis with the risk of experiencing a major cardiac event was also examined.MethodsStudy Population: All individuals with TFA (N 162), i.e. knee disarticulation and transfemoral amputation, residing in Olmsted County, MN, between 1987 and 2014. Each was matched (1:10 ratio) with non-TFA adults on age, sex, and duration of residency.Data Analysis: A competing risk Cox proportional hazard model was used to estimate the relative likelihood of an individual with a TFA experiencing a major cardiac event in a given time period as compared to the matched controls. The cohort was divided by amputation etiology: dysvascular vs trauma/cancer. Additional analysis was performed by combining all individuals with a TFA to look at the relationship between prosthesis receipt and major cardiac events.ResultsIndividuals with a dysvascular TFA had an approximately four-fold increased risk of a cardiac event after undergoing an amputation (HR 3.78, 95%CI: 3.07–4.49). These individuals also had an increased risk for non-cardiac mortality (HR 6.27, 95%CI: 6.11–6.58). The risk of a cardiac event was no higher for those with a trauma/cancer TFA relative to the able-bodied controls (HR 1.30, 95%CI: 0.30–5.85). Finally, there was no difference in risk of experiencing a cardiac event for those with or without prosthesis (HR 1.20, 95%CI: 0.55–2.62).ConclusionThe high risk of initial mortality stemming from an amputation event may preclude many amputees from cardiovascular disease progression. Amputation etiology is also an important factor: cardiac events appear to be more likely among patients with a dysvascular TFA. Providing a prosthesis does not appear to be associated with a reduced risk of a major cardiac event following amputation.

Prosthesis satisfaction in lower limb amputees: A systematic review of associated factors and questionnaires.

Background:Factors influencing patient satisfaction with a transtibial prosthesis have been studied fragmentarily. The aims of this systematic review were to review the literature regarding factors of influence on patient satisfaction with a transtibial prosthesis, to report satisfaction scores, to present an overview of questionnaires used to assess satisfaction and examine how these questionnaires operationalize satisfaction.Methods:A literature search was performed in PubMed, Embase, PsycInfo, CINAHL, Cochrane, and Web of Knowledge databases up to February 2018 to identify relevant studies.Results:Twelve of 1832 studies met the inclusion criteria. Sample sizes ranged from 14 to 581 participants, mean age ranged from 18 to 70 years, and time since amputation ranged from 3 to 39 years. Seven questionnaires assessed different aspects of satisfaction. Patient satisfaction was influenced by appearance, properties, fit, and use of the prosthesis, as well as aspects of the residual limb. These influencing factors were not relevant for all amputee patients and were related to gender, etiology, liner use, and level of amputation. No single factor was found to significantly influence satisfaction or dissatisfaction. Significant associations were found between satisfaction and gender, etiology, liner use, and level of amputation.Conclusion:Relevance of certain factors for satisfaction was related to specific amputee patient groups. Questionnaires assessing satisfaction use different operationalizations, making comparisons between studies difficult.

The relationship between lumbar lordosis angle and low back pain in individuals with transfemoral amputation.

Low back pain is a common secondary disabling condition in the transfemoral amputee population. Transfemoral amputees are at risk of excessive lumbar lordosis; it has been suggested that increased lumbar lordosis may be associated with low back pain. However, the relationship between lumbar lordosis angle and low back pain has not yet been studied in this population. To determine whether the extent of lumbar lordosis is associated with low back pain in transfemoral amputees. Case-control observational study. Participants included eight transfemoral amputees without low back pain and nine transfemoral amputees with low back pain. Etiology of amputation was primarily trauma. All participants underwent lateral view radiographs of the lumbar spine, from which lumbar lordosis angle and sacral inclination angle were measured. Lumbar lordosis angle mean ± standard deviation was 46.1° ± 12.4° in participants with low back pain and 51.0° ± 12.6° in those without. Sacral inclination angle mean ± standard deviation was 38.3° ± 8.7° in participants with low back pain and 39.1° ± 7.5° in those without. There was no significant difference in lumbar lordosis angle or sacral inclination angle between participants with and without low back pain. This study suggests that increased lumbar lordosis angle and sacral inclination angle are not significantly associated with low back pain in transfemoral amputees of a primarily traumatic etiology. Low back pain (LBP) is a common, disabling condition in transfemoral amputees. In the clinical setting, increased lumbar lordosis is implicated in LBP. This study does not support an association between increased lumbar lordosis and LBP; further study is needed to understand the increased prevalence of LBP in this population.

Distance and speed of walking in individuals with trans-femoral amputation fitted with a distal weight-bearing implant.

Preservation of femoral condyles in patients with knee disarticulation amputation (KDA) facilitates distal support inside the socket, compared to trans-femoral amputation (TFA), and allows the direct transfer of weight-bearing loads toward residual limbs. The hypothesis was that the gait distance and speed of TFA patients after a surgical femoral implant that allowed the distal support of the residuum would improve. Twenty-three TFA patients received a titanium implant that allowed the distal weight bearing of the residuum inside the socket. The post-intervention follow-up period lasted 14 months. Gait distance and speed were assessed with the 2-minute walk test (2MWT). The amputation etiology was trauma in 11 patients (48%), peripheral vascular disease in nine (39%) and oncologic disease in three (13%). The mean 2MWT distance was 103.6±34.7m prior to femoral implant and 128±38.9m at 14 months, which implies an improvement of 24% (p<0.001). The mean gait speed was 0.86±0.29m/s prior to femoral implant and 1.06±0.32m/s at 14 months (p<0.001). After implant placement, distance covered increased by 24%. This value is higher than those described by other groups, such as Rau (12.6%) and Darter (19.2%), who assessed improvement in distance covered with the 2MWT in a younger population and after completing different physiotherapy programs. Our results showed improved distance walked and gait speed as well as in the physical functioning score in TFA patients 14 months after receiving a femoral implant that permitted distal residuum loading. An experimental prospective study. III, case-control study.

Botulinum toxin therapy in amputee pain management

Background: Post-amputation pain is common, occurring in up to 85% of patients. The pain can be related to the etiology of amputation, post-surgical healing, or prosthetic use. Pain syndromes may arise from a variety of tissue pathologies and can be broadly categorized into residual limb pain (RLP) or phantom limb pain (PLP). Botulinum toxin (BTX) has been found to be effective in treating a variety of neuropathic pain conditions. This scoping review summarizes the use of BTX in RLP and PLP management of patients with a major extremity amputation.&#x0D; Methods: A literature search was conducted using PubMed, Web of Science, Cochrane Library, Scopus, and Google Scholar. Sixteen studies were included. Most studies excluded did not address BTX use in amputee pain management. Extracted data were categorized by either RLP or PLP.&#x0D; Results: Two randomized controlled trials (RCTs), 10 case series, and 4 case reports were included (total 68 patients, 82 amputations). Seven studies addressed BTX use in both RLP and PLP, 5 studies address RLP exclusively, and 5 additional studies exclusively addressed PLP. Toxin types, injection techniques, and dosages varied between the studies. Negative results were reported in 2 RCTs and 2 case series showing 30% of patients with RLP and 50% patients with PLP did not benefit from BTX.&#x0D; Conclusion: Literature for BTX in PLP and RLP is broad but lacking rigour for definitive conclusions to guide usage. There were more positive results for BTX use in RLP than in PLP. Case reports and patient series show promising results for both PLP and RLP, indicating future research should be directed at adequately-powered prospective trials.