Amputee Medicine Research Articles

LIMB SALVAGE VERSUS BELOW-KNEE AMPUTATION FOR SEVERE ADULT LOWER LIMB DEFORMITY: A RETROSPECTIVE COMPARATIVE SERIES

IntroductionSevere, multiplanar, fixed, pantalar deformities present a challenge to orthopaedic surgeons. Surgical options include limb salvage or amputation. This study compares outcomes of patients with such deformities undergoing limb preservation with either pantalar fusion (PTF) or talectomy and tibiocalcaneal fusion (TCF), versus below knee amputation (BKA).MethodsFifty-one patients undergoing either PTF, TCF and BKA for failed management of severe pantalar deformity were evaluated retrospectively. Twenty-seven patients underwent PTF, 8 TCF and 16 BKA. Median age at surgery was 55.0 years (17 to 72 years) and median follow-up duration was 49.9 months (18.0 to 253.7 months). Patients with chronic regional pain syndrome, tumour, acute trauma or diabetic Charcot arthropathy were excluded. Clinical evaluation was undertaken using the MOxFQ, EQ-5D and Special Interest Group in Amputee Medicine score (SIGAM). Patients were also asked whether they were satisfied with their surgical outcome and whether they would have the same surgery again.ResultsThere was no statistically significant difference in patient reported outcomes, satisfaction, or complication profile between the groups. Twenty-two patients undergoing PTF (81.5%), 6 patients undergoing TCF (75%), and 15 patients undergoing BKA (93.8%) were satisfied overall (p=0.414). Similarly, there was no difference in the proportion of patients who would opt for the same procedure again (p=0.142): 23 in the PTF group (85.2%), 8 in the TCF group (100%), and 11 in the BKA group (68.8%). Seven patients undergoing PTF (25.9%), 2 patients undergoing TCF (25%) and 6 patients undergoing BKA (37.5%) had major complications (p=0.692).ConclusionThis study has shown that PTF, TCF and BKA can all provide an acceptable outcome in treatment of severe, degenerative deformities of the lower extremity. Therefore, surgical decisions must be based on individual patient considerations. This data may also be useful in counselling patients when considering limb salvage versus amputation for severe deformity.

Amputation vs Reconstruction in Type IV Tibial Hemimelia: Functional Outcomes and Description of a Novel Surgical Technique.

The management of tibial hemimelia can be complex and involve either amputation or reconstruction. The decision made carries significant implications on patients and their families. This is a case series in the management of Type IV tibial hemimelia with a description of a novel surgical technique in the reconstructive arm of the pathway. The study included four patients with bilateral tibial hemimelia have an amputation in one limb and reconstructive surgery on the other. The reconstruction involved a supratalar double osteotomy of the tibia and fibula, followed by a staged hindfoot osteotomy using a circular ring fixator. Functional outcomes are reported using the Special Interest Group in Amputee Medicine (SIGAM) and the short form 12 (SF-12) methods. The mean age of patients in our cohort is 14 years (3-27 years) with mean age of surgery at 3 years. One case had an amputation following initial reconstructive surgery due to psychological distress and regressive behaviour. SIGAM functional outcome scores of F were recorded in three of four cases, with one patient performing at level B. On the reconstructive side, two of three patients reported a mean physical short form 12 (SF-12) score of 56.7 and a mental SF-12 score of 55.7. One patient reported a physical SF-12 score of 28.5 and a mental SF-12 score of 30.3. A reconstructive option provides a satisfactory functional outcome, comparable to the population mean, in the majority of patients in our cohort. A staged supratalar double osteotomy followed later by a hindfoot osteotomy is effective in centralising the ankle and creates a plantigrade weight-bearing platform for ambulation in patients with Type IV tibial hemimelia. Tang CH, Addar A, Fernandes JA. Amputation vs Reconstruction in Type IV Tibial Hemimelia: Functional Outcomes and Description of a Novel Surgical Technique. Strategies Trauma Limb Reconstr 2023;18(1):32-36.

Health utility in community-dwelling adults with dysvascular lower limb loss.

Adults with dysvascular lower extremity amputation (LEA) experience a large number of secondary health conditions yet there is a gap in the literature on health utility scores for this population. A health utility score relates to a person's state of well-being, and is a single metric anchored at 0 (death) and 1 (perfect health).This study aimed to provide a descriptive account of health utility scores in community-dwelling adults with dysvascular LEA. Participants were adults with dysvascular LEA who were 3months post-amputation. Data collected included socio-demographic characteristics, the Special Interest Group in Amputee Medicine (SIGAM)grades, the dysvascular conditions scale (DCS), which is a scale developed for this study, and the Short Form-36 (SF-36). SF-6D health utility scores were derived from the SF-36 using a software algorithm. Participants were grouped into low-impact and high-impact groups based on self-reported severity of symptoms using the DCS. Health utility scores were compared between the low-impact and high-impact groups using independent t-tests. A total of 231 participants were enrolled in the study. The mean SF-6D health utility score was 0.689 (0.127). A significant association was found between health utility score and SIGAM grade (p < 0.001, η2 = .09). Health utility was positively associated with age (r = 0.137, p = 0.037) and months post-amputation (r = 0.141, p = 0.032), and negatively associated with DCS severity (r = -0.526, p < 0.001). Health utility scores were lower for participants in the DCS high-impact groups for conditions such as diabetes mellitus, phantom limb pain, musculoskeletal pain, back pain, psychological distress, depression, vision problems, and other pain. Cost-utility analyses rely on health utility estimates and our findings provide data for future economic evaluations that may assist policy makers in evidence informed allocation of healthcare resources for this population.

Self-reported health condition severity and ambulation status postmajor dysvascular limb loss.

Individuals with dysvascular lower limb amputations (LLA) secondary to complications of peripheral arterial disease (PAD) and/or diabetes have high rates of co-morbidities. To describe self-reported health condition severity and their association with sociodemographic factors and ambulations status among individuals with major dysvascular LLA. Cross sectional telephone and in person survey with adults with major dysvascular LLA living in the community setting in Ontario, Canada. Survey by phone/in person, and completion of the Dysvascular Conditions Scale and Special Interest in Amputee Medicine Mobility (SIGAM) Grade by each participant. Two hundred thirty-one individuals with major dysvascular LLAs participated in the study. Most of them were male individuals (80.5%) and had undergone a transtibial amputation (74%). On average, participants were 3.4 years postlimb loss and had five identified Dysvascular Conditions Scale health conditions. The top five reported health conditions were diabetes, hypertension, phantom limb pain, musculoskeletal pain, and back pain. With the exclusion of hypertension, these conditions were also perceived by respondents to be quite severe for their impact. Vision impairment was also rated as being severe in nature. Lower mobility Special Interest Group in Amputee Medicine grades were associated with higher health condition severity scores. Individuals with dysvascular limb loss experience high multimorbidity with perceived negative impact on their overall wellness and function. Rehabilitation and self-management strategies to help patients with dysvascular LLAs to manage chronic health conditions may improve outcomes.

Preoperative Factors Influencing Functional Rehabilitation after Major Lower Limb Amputation and Validation of a Preoperative Scoring Tool

Introduction: The ability to walk with prosthesis is a major determinant of functional independence after major lower limb (MLL) amputation. The Blatchford Leicester Allman-Russell Tool (BLARt) score is a potentially valuable tool that can predict the functional outcome after MLL amputation. The study aimed to identify preoperative factors that influence functional rehabilitation after MLL amputation and validation of BLARt score. Methods: This retrospective study analyzed 71 patients referred for rehabilitation postamputation. The level of functional outcome at 6 and 12 months were recorded using Special Interest Group in Amputee Medicine grading. Preoperative factors and BLARt score were analyzed for association with functional outcome. Results: BLARt score was found to have a significant correlation with functional outcome in 6 and 12 months. BLARt showed a fair to good predictive ability with an area under the receiver operating characteristic curve of 0.713 (SE 0.61, 95% confidence intervals 0.593–0.832) and 0.705 (SE 0.061, 95% confidence intervals 0.585–0.825) for the nonfunctional outcome at 6 and 12 months, respectively. Preoperative mobility was the only significant risk factor that was associated with functional mobility (P = 0.02). Conclusion: With the validation analysis showing a fair to good predictive ability, BLARt score does serve its proposed role in risk stratification.

Limb salvage versus below knee amputation for severe adult lower limb deformity — A retrospective, comparative series

BackgroundThis study compares outcomes of patients with severe, multiplanar, fixed, pantalar deformities undergoing limb preservation with either pantalar fusion (PTF) or talectomy and tibiocalcaneal fusion (TCF), versus below knee amputation (BKA). MethodsFifty-one patients undergoing either PTF, TCF and BKA for failed management of severe pantalar deformity were evaluated retrospectively. Twenty-seven patients underwent PTF, 8 TCF and 16 BKA. Median age at surgery was 55.0 years (17–72 years) and median follow-up duration was 49.9 months (24.0–253.7 months). Clinical evaluation was undertaken using the MOxFQ, EQ-5D and Special Interest Group in Amputee Medicine score (SIGAM). Patients were also asked whether they were satisfied with their surgery and whether they would have the same surgery again. ResultsThere was no statistically significant difference in functional outcomes, satisfaction, or complications between the groups. Twenty-two patients undergoing PTF (81.5%), 6 patients undergoing TCF (75%), and 15 patients undergoing BKA (93.8%) were satisfied overall (p = 0.414). There was no difference in the proportion of patients who would opt for the same procedure again (p = 0.142): 23 in the PTF group (85.2%), 8 in the TCF group (100%), and 11 in the BKA group (68.8%). Seven patients undergoing PTF (25.9%), 2 patients undergoing TCF (25%) and 6 patients undergoing BKA (37.5%) had major complications (p = 0.692). ConclusionThis study concludes that PTF, TCF and BKA can all provide an acceptable outcome in treatment of severe, degenerative pantalar deformities. This data may be useful in counselling patients when considering salvage versus amputation in such cases. Level of evidenceLevel 3(Original) Clinical Research Article.

751 Preoperative Factors Influencing Functional Rehabilitation After Major Lower Limb Amputation

Abstract Introduction To identify the preoperative factors that influence functional rehabilitation after Major Lower Limb (MLL) amputation. Method This retrospective study analyzed all patients referred post-amputation to an amputee rehabilitation centre over a period of 1 year. The level of functional outcome at 6 and 12 months were recorded using SIGAM (Special Interest Group in Amputee Medicine) grading. Data on various preoperative factors were collected and analyzed for association with functional outcome. Results A total of 71 cases were analyzed. The mean age was 65.18 (range 24 - 91) years and 45 were males (63.4 %). Peripheral arterial disease was the major cause of amputation (80.3%). The level of amputation was above / through knee in 60.6%. Contralateral limb problems were present in 28.2%. Functional mobility was achieved by 38% of the MLL amputees within 6 months of rehabilitation, which increased to 46.5% at 12 months. Pre amputation mobility was a significant factor for a good functional outcome (p-value 0.002). An increasing value of BLARt (Blatchford Leicester Allman-Russell Tool) score showed a significant correlation with poor functional outcome. Conclusions Pre amputation mobility and BLARt score can be used in the prediction of functional outcome and can aid in better pre-operative decision making and rehabilitation planning.

Quality of Life Associated Factors in a North African Sample of Lower Limbs Amputees.

Objective To study factors associated to the quality of life in a North African sample of lower limbs amputees.MethodsWe conducted a prospective study in the Department Physical Medicine and Rehabilitation, University Hospital of Monastit, Tunisia. A consecutive sample of patients with amputations of the lower limbs was included. The evaluated parameters were quality of life using the Short-Form quality-of-life questionnaire (SF-36), pain using a visual analog scale, function using, the perimeter of walking (PW), the Special Interest Group of the Amputee Medicine (SIGAM) and the Locomotion Capacities Index of the Prosthetic Profile of the Amputee (LCI), and psychological status thanks to the Hospital Anxiety and Depression scale. In the study, the patients were evaluated at the first consultation (T0) and again at 12 months (T1).ResultsWe included 85 patients (age, 59.3±16.7 years) with a sex ratio of 3. The patient quality of life was positively correlated to distal type of amputation, traumatic origin, better LCI (p≤0.001, r=0.349), SIGAM (p=0.046) and PW. A negative correlation was noted with age (p=0.012, r=-0.483) and higher psychological scores (p=0.002, r=-0.321).ConclusionIn our sample of North African lower limbs amputees the age and the functional status were the most important predictors of the quality of life.

Outcomes and evaluation in lower limb amputees

Assessment is part of our professional practices. Moreover, the arrival of several new microprocessor prosthetic knee and bionic prosthetic feet requires lower limb amputee assessment particularly to help rehab professionals to prescribe devices considering the amputee life project. Amputee evaluation, wearing or not a lower limb prosthesis, is organised according 3 axes: prosthesis assessment (technology), amputee assessment (deficiency, satisfaction) and the “amputee-prosthesis” couple assessment in terms of capability and disability. The aim of the study was to realize a review of the literature over the last 10 years to define the significant outcomes in lower limb amputees. Medline, Reedoc, Scopus were interviewed between January 2006 and September 2016 with the following words: lower limb amputee, lower limb amputation, survey, questionnaire, evaluation, assessment, outcome and their equivalent in French. Only studies in English and in French were selected. Self-reports and clinical tests assessing mobility and balance were included. Instrumental objective measures (biomechanics, kinematics, and energetics) realized with motion capture optoelectronic systems or with wearable systems were not retained. More than 52 different outcomes (either generic or specific) were found. These outcomes covered a wide range of assessment such as mobility, balance, satisfaction, coping strategy, quality of life or body image. Questionnaires and clinical tests were listed from the most to the less used. The clinical test AMP-Pro (amputee mobility predictor) evaluates the predicted mobility of amputee with and without a prosthesis. By differentiating Medicare Functional Classification Level, this test is already used for feet prescription in the USA. Several specific self-reports are available in French as Amputee Body Image Scale (ABIS), Trinity Amputation Prosthetics Profil Evaluation Scale (TAPES) or Special Interest Group in Amputee Medicine mobility grades (SIGAM). In lower limb amputees, many specific or generic outcomes could be used either in clinical purpose–help for rehab professionals to prescribe devices, follow-up–or in clinical research–cohort follow-up, devices evaluation by the couple “amputee-prosthesis” assessment–. Minimum detectable change for the dedicated population as well as psychometric properties like ceiling or floor effect must be considered for their “good use”. Moreover, questionnaires are increasingly available in French.

Establishing the Turkish version of the SIGAM mobility scale, and determining its validity and reliability in lower extremity amputees

Purpose: The aim of this study is to adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility scale to Turkish, and to test its validity and reliability in lower extremity amputees.Material and methods: Adaptation of the scale into Turkish was performed by following the steps in American Association of Orthopedic Surgeons (AAOS) guideline. Turkish version of the scale was tested twice on 109 patients who had lower extremity amputations, at hours 0 and 72. The reliability of the Turkish version was tested for internal consistency and test–retest reliability. Structural validity was tested using the “scale validity” method. For this purpose, the scores of the Short Form-36 (SF-36), Functional Ambulation Scale (FAS), Get Up and Go Test, and Satisfaction with the Prosthesis Questionnaire (SATPRO) were calculated, and analyzed using Spearman’s correlation test.Results: Cronbach’s alpha coefficient was 0.67 for the Turkish version of the SIGAM mobility scale. Cohen's kappa coefficients were between 0.224 and 0.999. Repeatability according to the results of the SIGAM mobility scale (grades A–F) was 0.822. We found significant and strong positive correlations of the SIGAM mobility scale results with the FAS, Get Up and Go Test, SATPRO, and all of the SF-36 subscales.Conclusion: In our study, the Turkish version of the SIGAM mobility scale was found as a reliable, valid, and easy to use scale in everyday practice for measuring mobility in lower extremity amputees.Implications for RehabilitationAmputation is the surgical removal of a severely injured and nonfunctional extremity, at a level of one or more bones proximal to the body.Loss of a lower extremity is one of the most important conditions that cause functional disability.The Special Interest Group in Amputee Medicine (SIGAM) mobility scale contains 21 questions that evaluate the mobility of lower extremity amputees.Lack of a specific Turkish scale that evaluates rehabilitation results and mobility of lower extremity amputees, and determines their needs, directed us to perform a study on this topic when we took the number of amputations performed in our country into consideration.SIGAM mobility scale is directed at rehabilitation specialists who are working in amputee medicine. Turkish version of this scale was found both reliable and valid in our study and hence it can be used in clinical practice and studies.

Trauma-related amputations in war and at a civilian major trauma centre—comparison of care, outcome and the challenges ahead

The Afghanistan conflict has resulted in a large number of service personnel sustaining amputations. Whilst obvious differences exist between military and civilian trauma-related amputations both settings result in life changing injuries. Comparisons offer the potential of advancement and protection of the knowledge gained during the last 12 years.This paper compares the military and civilian trauma-related amputee cohorts’ demographics, management and rehabilitation outcomes measures.The UK military Joint Theatre Trauma Registry and a civilian major trauma centre database of trauma-related amputees were analysed.255 military and 24 civilian amputees were identified. A significant difference (p>0.05) was seen in median age (24, range 18–43, vs. 48, range 24–87 years), mean number of amputations per casualty (1.6±SD 0.678 vs. 1±SD 0.0), mean ISS (22±SD 12.8 vs. 14.7±SD 15.7) and gender (99% males vs. 78%). Rehabilitation outcome measures recorded included the Special Interest Group in Amputee Medicine score where the military group demonstrated significantly better scores (91% Grade E+ compared to 19%).Differences in patients underlying physiology and psychology, the military trauma system and a huge sustained investment in rehabilitation are all contributing factors for these differing outcomes. However the authors also believe that the use of a consultant-led MDT and central rehabilitation have benefited the military cohort in the acute rehabilitation stage and is reflected in the good short-term outcomes.

Functional and Mental Health Status of United Kingdom Military Amputees Postrehabilitation

ObjectivesTo evaluate the functional and mental health status of severely injured traumatic amputees from the United Kingdom military at the completion of their rehabilitation pathway and to compare these data with the published normative data. DesignRetrospective independent group comparison of descriptive rehabilitation data recorded postrehabilitation. SettingA military complex trauma rehabilitation center. ParticipantsAmputees (N=65; mean age, 29±6y) were evaluated at the completion of their rehabilitation pathway; of these, 54 were operationally (combat) injured (23 unilateral, 23 bilateral, 8 triple) and 11 nonoperationally injured (all unilateral). InterventionsContinuous ∼4-week inpatient, physician-led, interdisciplinary rehabilitation followed by ∼4-weeks of patient-led, home-based rehabilitation. Main Outcome MeasuresThe New Injury Severity Score at the point of injury was used as the baseline reference. The 6-minute walk test, Amputee Mobility Predictor with Prosthesis, Special Interest Group in Amputee Medicine, Defence Medical Rehabilitation Centre mobility and activity of daily living scores as well as depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder Scale-7), mental health support, and pain scores were recorded at discharge and compared with the published normative data. ResultsThe mean New Injury Severity Score was 40±15. After 34±14 months of rehabilitation, amputees achieved a mean 6-minute walk distance of 489±117m compared with age-matched normative distances of 459 to 738m. The 2 unilateral groups walked (544m) significantly further (P>.05) than did the bilateral amputee (445±104m) and triple amputee (387±99m) groups. All groups demonstrated mean functional mobility scores consistent with scores of either active adults or community ambulators with limb loss. In total, 85% could walk/run independently and 95% could walk and perform activities of daily living independently with an aid/adaptation. No significant difference in mental health outcome was reported between the groups (P>.05). At discharge, 98% of patients were able to control their pain. ConclusionsSeverely injured military amputees who completed intensive interdisciplinary rehabilitation achieved levels of physical function comparable with those in age-matched healthy adults. Mental health outcomes were indicative of preparedness for full integration back into society.

Transcultural validation of the SIGAM mobility grades in French: The SIGAM-Fr

BackgroundThe main French language scales evaluating functioning after lower-limb amputation have not undergone exhaustive psychometric validation. ObjectiveA transcultural validation of the Special Interest Group in Amputee Medicine (SIGAM) mobility grades questionnaire, with 21 closed questions, as an administered questionnaire. MethodsThe questionnaire translation, back-translation and original-author validation was followed by a pretest with 5 patients to check comprehension. The psychometric properties of the scale were validated with 49 patients at the definitive prosthesis stage by an investigator via telephone. Criterion validity was evaluated by comparison with the Houghton Scale score and construct validity by correlation between the questionnaire scores and convergent dimensions (performing everyday activities and performing transfers on a numerical rating scale [NRS], 2-min walk test) and divergent dimensions (managing medication and stump skin care on an NRS). Internal consistency was assessed by the Kuder–Richardson Formula 20 (KR-20) coefficient and test–retest reproducibility by the Cohen kappa coefficient. ResultsThe resulting questionnaire was validated by the original author after the back-translation. It showed good psychometric properties when administered by an investigator as a self-reporting questionnaire, excellent criterion validity (r=0.89, P<0.01), excellent reproducibility (kappa coefficient 0.87) and satisfactory construct validity. The KR-20 coefficient was 0.67. ConclusionThe French version of the SIGAM mobility grades questionnaire (SIGAM-Fr) has satisfactory psychometric properties and can be administered in clinical practice.

Stepping Asymmetry Among Individuals With Unilateral Transtibial Limb Loss Might Be Functional in Terms of Gait Stability

The asymmetry in step length in prosthetic gait is often seen as a detrimental effect of the impairment; however, this asymmetry also might be a functional compensation. An advantage of a smaller step length of the nonprosthetic leg, and specifically foot forward placement (FFP), might be that it will bring the center of mass closer to the base of support of the leading foot and thus increase the backward margin of stability (BW MoS). The purpose of this study was to characterize differences in step length, FFP, and the concomitant difference in BW MoS between steps of the prosthetic and nonprosthetic legs (referred to as prosthetic and nonprosthetic steps, respectively) of people after transtibial amputation. This was an observational and cross-sectional study. Ten people after transtibial amputation walked for 4 minutes on a self-paced treadmill. Step length and FFP were calculated at initial contact. The size of the BW MoS was calculated for the moment of initial contact and at the end of the double-support phase of gait. Step length (5.4%) and FFP (7.9%) were shorter for the nonprosthetic step than for the prosthetic step. The BW MoS at initial contact was larger for the nonprosthetic step, but because of a significant leg × gait event interaction effect, BW MoS did not differ significantly at the end of the double-support phase. All participants were relatively good walkers (score of E on the Special Interest Group in Amputee Medicine [SIGAM] scale). The smaller step length and FFP of the nonprosthetic step help to create a larger BW MoS at initial contact for the nonprosthetic step compared with the prosthetic step. Hence, step length asymmetry in people after transtibial amputation might be seen as a functional compensation to preserve BW MoS during the double-support phase to cope with the limited push-off power of the prosthetic ankle.

Memory and executive function predict mobility rehabilitation outcome after lower-limb amputation

Purpose. Post-amputation rehabilitation is physically and cognitively demanding. Understanding which specific cognitive domains mediate outcome is critical to the development of interventions.Method. A cohort undergoing post-amputation rehabilitation was assessed before limb fitting and followed up at 6 months (n = 34). The average age was 60.69 years (SD = 13.98). 82.4% of the sample was male. 79.4% had amputations because of peripheral arterial disease. Memory, visuospatial function, executive function, praxis, emotion and language were assessed at Time 1 (first prosthetic clinic attendance). Time 1 data were also gathered on aetiology, level of amputation, comorbidities, pain and demographics. Six month outcomes were the locomotor capability index (LCI), the special interest group in amputee medicine (SIGAM) mobility grades and self reported hours of use.Results. The LCI at 6 months was significantly predicted in regression analyses by a measure of visual memory (figure recall) (adjusted R2 = 24.8%, df = 32, zβ = 0.52, p = 0.002. Hours of use were predicted by the verbal fluency test total (adjusted R2 = 17.1%, df = 26, zβ = 0.45, p = 0.017). SIGAM mobility grades were predicted by a combination of immediate verbal memory (story recall), age, level of amputation and presence of pain (adjusted R2 = 58.2, df = 30, zβ = 0.52, p = 0.000).Conclusions. Neuropsychological and clinical variables predict a large amount of 6 month outcome variance. Cognitive difficulties may be considered mediators of poor outcome.

Functional Results After Through-Knee and Above-Knee Amputations: Does More Length Mean Better Outcome?

The objective was to evaluate our results on functional outcome for both through-knee amputations and above-knee amputations. Functional outcome was measured using the Special Interest Group in Amputee Medicine score, which focuses on walking distance and use of prosthesis. From 1997 to 2006, 39 through-knee amputations (53%) and 34 above-knee amputations (47%) were performed. Eight (21%) of 39 through-knee amputations needed to be converted to above-knee amputations. Fifty patients (24 above-knee amputations, 26 through-knee amputations) were eligible for follow-up. During follow-up, 71% (of above-knee amputations) and 69% (of through-knee amputations) did not walk with a prosthesis, and 29% of above-knee amputations and 27% of through-knee amputations walked more or less than 50 m. In conclusion, only a minority of patients is able to walk with a prosthesis, and a lot of the through-knee amputations need conversion to a higher level. On the basis of this results, it would be preferable to perform a straight above-knee amputation instead of a through-knee amputation if the correct amputation level is in doubt in high-risk patients.

The SIGAM mobility grades: a new population-specific measure for lower limb amputees

Purpose : To develop a valid measure of lower limb amputee mobility suitable for routine clinical use, including monitoring change. Methods : The Special Interest Group in Amputee Medicine (SIGAM) described a single-item scale comprising six clinical grades (A-F) of amputee mobility. A self-report questionnaire was developed and algorithm designed to facilitate grade assignment. Reproducibility of the questionnaire and grades were assessed in 62 amputees. Concurrent validity and sensitivity to change were investigated using the timed walking test (TWT). The mobility construct was examined in 200 amputees, using item response theory, by co-calibration with the Rivermead Mobility Index (RMI) on the same patients. Results : Patients included 144 males and 66 females, aged 13-90. Intraclass correlation coefficients and reproducibility kappa values were satisfactory. Observers agreed 100% in using the algorithm. TWT improved as SIGAM grade increased. Examination of psychometric properties revealed the SIGAM item fitted within the RMI mobility matrix. Average measures for the six grades were ordered correctly. There was no local dependency or differential item functioning for clinically relevant patient subgroups. The SIGAM scale showed an effect size of 10.66. Conclusions : The SIGAM mobility grades represent a novel, valid, clinically useful measure of amputee mobility which is also sensitive to change.