eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Amputations of the Lower Extremity: Follow-up

Author: Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital
Coauthor(s): William Ertl, MD, Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma; James W Pritchett, MD, Director of Orthopedic Surgery, Swedish Orthopedic Institute, Seattle
Contributor Information and Disclosures

Updated: Mar 7, 2008

Outcome and Prognosis

The success of amputation surgery is multifactorial in terms of functional and emotional satisfaction. The goal is to achieve a useful residual limb in an individual who is active with a positive attitude, who accepts the amputation, and who continues to be a productive member of society.

Most amputations in the United States are performed in elderly persons for PVD. The associated mortality rate is 20% within the first year and 40% within 5 years. This high mortality rate creates a difficulty with follow-up and documentation of functional outcome, and studies are minimal and mostly incomplete.

In a review to assist in patient management, Matsen et al attempted to identify factors that correlate with the perceived amputation result.4 Residual limb length made no difference to patients' perceptions. Factors that appeared to influence patients' perceptions included the condition of the contralateral limb; comfort of the residual limb; comfort, function, and appearance of the prosthesis; social factors; and the ability to participate in recreational activities. Additional emotional and physical impairment issues are posttraumatic stress disorder, sexual dysfunction, and depression. For the 25-35% of patients who experience depression, appropriate consultation should be obtained.

Future and Controversies

Osteointegration has been performed in Sweden. This technique was initially applied in dental surgery for tooth loss, and the procedure involves a metal post, treated similarly to a total joint ingrowth prosthesis, secured to bone. Success has been achieved with replacement for thumb amputations. Case series with transfemoral amputations have been completed; however, long-term results are unavailable. The potential for postoperative infection and osteomyelitis is high.

 


More on Amputations of the Lower Extremity

Overview: Amputations of the Lower Extremity
Workup: Amputations of the Lower Extremity
Treatment: Amputations of the Lower Extremity
Follow-up: Amputations of the Lower Extremity
Multimedia: Amputations of the Lower Extremity
References
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References

  1. Murdoch G, Wilson AB Jr, eds. Amputation: Surgical Practice and Patient Management. St Louis, Mo: Butterworth-Heinemann Medical; 1996.

  2. Tooms RE. Amputations. In: Crenshaw AH, ed. Campbell's Operative Orthopedics. Vol 1. 7th ed. St. Louis, Mo: Mosby-Year Book; 1987:597-637.

  3. Waters RL, Perry J, Antonelli D, Hislop H. Energy cost of walking of amputees: the influence of level of amputation. J Bone Joint Surg Am. Jan 1976;58(1):42-6. [Medline]. [Full Text].

  4. Matsen SL, Malchow D, Matsen FA 3rd. Correlations with patients' perspectives of the result of lower-extremity amputation. J Bone Joint Surg Am. Aug 2000;82-A(8):1089-95. [Medline].

  5. Pandian G, Kowalske K. Daily functioning of patients with an amputated lower extremity. Clin Orthop Relat Res. Apr 1999;361:91-7. [Medline].

  6. Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. Mar 2008;89(3):422-9. [Medline].

  7. Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. Oct 1 2004;39(7):885-910. [Medline]. [Full Text].

  8. Sheehan P, Edmonds M, Januzzi JL Jr, et al, for the Consensus Panel of the American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. Dec 2003;26(12):3333-41. [Medline]. [Full Text].

  9. Carter SA, Tate RB. The value of toe pulse waves in determination of risks for limb amputation and death in patients with peripheral arterial disease and skin ulcers or gangrene. J Vasc Surg. Apr 2001;33(4):708-14. [Medline].

  10. Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputation in diabetes. In: Harris MI, Cowie CC, Stern MP, et al, eds. Diabetes in America. 2nd ed. Bethesda, Md: National Diabetes Data Group, National Institute of Diabetes and Digestive and Kidney Diseases; 1995:409-28. [Full Text].

  11. Burgess EM, Matsen FA 3rd, Wyss CR, Simmons CW. Segmental transcutaneous measurements of PO2 in patients requiring below-the-knee amputation for peripheral vascular insufficiency. J Bone Joint Surg Am. Mar 1982;64(3):378-82. [Medline]. [Full Text].

  12. Wyss CR, Harrington RM, Burgess EM, Matsen FA 3rd. Transcutaneous oxygen tension as a predictor of success after an amputation. J Bone Joint Surg Am. Feb 1988;70(2):203-7. [Medline]. [Full Text].

  13. Misuri A, Lucertini G, Nanni A, Viacava A, Belardi P. Predictive value of transcutaneous oximetry for selection of the amputation level. J Cardiovasc Surg (Torino). Feb 2000;41(1):83-7. [Medline].

  14. Tseng CH, Chong CK, Tseng CP, et al. Mortality, causes of death and associated risk factors in a cohort of diabetic patients after lower-extremity amputation: a 6.5-year follow-up study in Taiwan. Atherosclerosis. Mar 2008;197(1):111-7. [Medline].

  15. Abularrage CJ, Weiswasser JM, Dezee KJ, et al. Predictors of lower extremity arterial injury after total knee or total hip arthroplasty. J Vasc Surg. Feb 21 2008;epub ahead of print. [Medline].

  16. Bevilacqua NJ, Rogers LC, DellaCorte MP, Armstrong DG. The narrowed forefoot at 1 year: an advanced approach for wound closure after central ray amputations. Clin Podiatr Med Surg. Jan 2008;25(1):127-33. [Medline].

  17. Bosse MJ, MacKenzie EJ, Kellam JF, et al. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am. Jan 2001;83-A(1):3-14. [Medline].

  18. Dormandy J, Heeck L, Vig S. The fate of patients with critical leg ischemia. Semin Vasc Surg. Jun 1999;12(2):142-7. [Medline].

  19. Joels CS, York JW, Kalbaugh CA, et al. Surgical implications of early failed endovascular intervention of the superficial femoral artery. J Vasc Surg. Mar 2008;47(3):562-5. [Medline].

  20. MacKenzie EJ, Jones AS, Bosse MJ, et al. Health-care costs associated with amputation or reconstruction of a limb-threatening injury. J Bone Joint Surg Am. Aug 2007;89(8):1685-92. [Medline].

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Further Reading

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Keywords

hemipelvectomy, hip disarticulation, above-knee amputation, AKA, below-knee amputation, BKA, knee disarticulation, Symes amputation, hindfoot amputation, Boyd amputation, Chopart amputation, Lisfranc amputation, transmetatarsal amputation, toe disarticulation, toe amputation, peripheral vascular disease

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Contributor Information and Disclosures

Author

Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

William Ertl, MD, Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma
Disclosure: Nothing to disclose.

James W Pritchett, MD, Director of Orthopedic Surgery, Swedish Orthopedic Institute, Seattle
James W Pritchett, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and Washington State Medical Association
Disclosure: Nothing to disclose.

Medical Editor

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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