Benjamin J. Brown1, Matthew L. Iorio1, Mitch Klement1, Michael R. Conti Mica1, Amine El-Amraoui1, Peter O'Halloran1, Richard F. Neville2, Christopher E. Attinger1
1Plastic Surgery, Georgetown University, Washington, DC; 2George Washington University, Washington DC.
OBJECTIVES: Advances in prosthetic technology have allowed below knee amputees an efficient and functional return to their pre-injury level of activity. Below knee amputation (BKA) can be a more functional option to limb salvage in select patients. Difficulty remains in patient selection. In order to improve patient selection for limb salvage vs. early BKA, we reviewed our experience with BKAs and limb salvage to determine predictive variables for treatment success and ambulation.
METHODS: We performed a retrospective, institutional review board- approved review of below knee amputations performed by the senior author between 2004 and 2011 in patients who ambulated pre-operatively.
RESULTS: 286 BKAs on 262 patients. Mean age 59.5 years. 69% were male. Mean follow-up 18.4 months. 4.9% of the BKAs were performed on patients with traumatic lower extremity injuries. 86% had diabetes. 25% were on dialysis. Ambulation rate was 77% after BKA, with 78% and 61% of unilateral and bilateral amputees ambulating, respectively. Pre-amputation variables found to be positively associated with post-amputation ambulation included female gender (p=0.002). Pre-amputation variables that approached significance for being negatively associated with post-amputation ambulation included elevated pre-operative serum creatinine level (p=0.053). Twenty-three percent (n=67) of BKA patients required at least one operative revision with most being due to falls postoperatively.
CONCLUSIONS: Following below knee amputation, regardless of etiology, most patients will go on to ambulate with a prosthesis. Additionally, our review indicated that women are even more likely to ambulate following a BKA. Given these successful outcomes following BKA, we believe BKA should be considered as a viable option for patients in whom a limb salvage effort will lead to a biomechanically compromised limb.
AUTHOR DISCLOSURES: C. E. Attinger, Nothing to disclose; B. J. Brown, Nothing to disclose; M. R. Conti Mica, Nothing to disclose; A. El-Amraoui, Nothing to disclose; M. L. Iorio, Nothing to disclose; M. Klement, Nothing to disclose; R. F. Neville, Nothing to disclose; P. O'Halloran, Nothing to disclose.
Posted April 2012