ISPO UK ASM 2023 - Free Paper Abstracts

Review of mobility outcomes for Transfemoral amputees at West Midlands Rehabilitation Centre

 

Presenter:  Umer Saeed, Secialty Trainee Registrar, NH - West Midlands Rehabilitation Centre, Birmingham, UK

E-mail:  umer.saeed1@nhs.net

Other authors:  Elizabeth Wood, Geoffrey Yu, Muhammad Chughtai, Poornashree Ramaurthy, Thuya Win

 

Aim: 

Due to multiple factors associated with above knee amputations (level of energy expenditure, balance issues and co-morbidities), the prospects of walking with a prosthesis after transfemoral amputation (TFA) are limited and rehabilitation takes longer compared with the amputations at lower levels. We wanted to know the status of functional walking with prosthetic leg in long term for patients who have had TFA.

Methods:

This was a retrospective study. Data was collected for 95 patients referred to West Midlands Rehabilitation Centre. Variables included age, gender, health condition leading to amputation (e.g., Diabetes mellitus, Peripheral vascular disease, traumatic etc) and if patients had further revision surgeries or amputations of contralateral lower limb. We also investigated the reasons why patients stopped walking with prosthesis.

Inclusion Criteria:

1)  Patients who had TFA from 1st of January 2017 to 31st of December 2017.

2)  Patients who received delivery of TFA prosthesis.

Outcome measures:

Main outcome measures were SIGAM grades at 2 and 5 years.

Results:

Amongst the 95 patients 60 were males and 35 were females. 12 patients progressed to receive prosthesis. At the end of two years 1 patient was graded SIGAM-B, 5 patients SIGAM-C, 5 patients SIGAM-D, and 1 patient SIGAM-E. At five years 4 patients were SIGAM-A, 4 patients SIGAM-C, 2 patient’s SIGAM-D, 1 patient SIGAM-E and 1 patient SIGAM-F. One patient had osteointegration at 5 years. Over 5 years SIGAM Grade deteriorated in 6 patients, stayed stable in 3 patients, and improved in 3 patients. One patient had osteointegration at 5 years.

Prosthetic mobility outcomes were better in non-vascular patients compared to vascular. All the patients who achieved SIGAM-D were non-vascular.

Mortality at 6 years post amputation was 48.42 % (46 patients) and 43.15 % (41 patients) at 5 years.

In 29 patients’ Peripheral vascular disease (PVD) with Diabetes mellitus (DM) was identified as the main health condition leading to amputation and mortality amongst these patients at 6 years was 68.96 % (20 patients). 37 patients had PVD without DM and mortality at 6 years was 51.35 % (19 patients). Other conditions leading to amputation included acute vascular, infections (bone and soft tissue), trauma/mechanical, malignant primary tumours and neurological disorder. Mortality in non-vascular patients at 6 years was 26.92 % (7 patients died out of 26).

Age was a significant factor. Mortality at 6 years for patients 60 years of age and below was 22.22% (6 patients died amongst 27) and for patients 61 years of age and above was 58.82% (40 patients died amongst 68).

Conclusions:

Our study shows that only a limited number of patients with TFA are able to achieve functional walking using prothesis and even in such small subgroup there is likelihood of further decline in mobility over the following years. The study also shows that mortality and prosthetic mobility outcomes are better in non-vascular patients compared to dysvascular patients.