Association between phantom limb complex and the level of amputation in lower limb amputee

Abstract

ObjectiveThe aim of this study was to evaluate the natural course of phantom limb complex without any treatment after lower limb amputation.MethodsThe study design was consisted of a combination of retrospective review and cross-sectional interview. 101 patients with lower limb amputation were included into the study. Patients were divided into three groups according to the amputation level: i) from hip disarticulation to knee disarticulation (including knee disarticulation) (25 patients, mean age: 55.9, 19 males, 6 females) ii) transtibial amputation (below knee to ankle including ankle disarticulation) (41 patients, mean age: 58.6, 33 males, 8 females) iii) below ankle to toe amputation (35 patients, mean age: 58.7, 26 males, 9 females). The patients were evaluated on both early postoperative period (EPP) and sixth months after the surgery (ASM). The data related amputation including amputation date, level, cause, stump pain (SP), phantom limb pain (PLP), components of PLP, phantom sensation (PS) were recorded based on the information obtained from patients' and hospital files.ResultsStatistically significant differences were found for pain intensity (VAS) between groups for SP and PLP at EPP (p < 0.001, p = 0.036; respectively). The mean VAS score in Group I for SP and PLP was higher than other groups. This differences for SP and PLP did not continue at ASM assessment (p = 0.242, p = 0.580; respectively).ConclusionVAS scores for SP in above knee amputations and VAS scores for PLP in above knee amputations and below ankle amputations were higher at EPP. But these high scores had disappeared over time. Management strategies have to be considered particularly in the early postoperative period in patients who had undergone above knee amputation.Level of EvidenceLevel III Prognostic study.

Brain and spinal stimulation therapies for phantom limb pain: a systematic review

“…102,104,105 One study did not report on amputation causes 103 and in another the majority had been either caused by trauma or diabetes mellitus. 101 When reported, the overall mean time since amputation at the most recent follow-up ranged from 6 months to 2.4 years. In three of the studies, 99,100,104 all participants used a prosthesis, whereas the remainder did not report this information.…”

“…Of the 21 epidemiology studies of amputees included in the review, eight had a longitudinal design [98][99][100][101][102][103][104][105] and 13 had a cross-sectional design. 9,10,[106][107][108][109][110][111][112][113][114][115][116] Longitudinal studies Table 21 shows the characteristics of the populations in the longitudinal studies.…”

“…Six studies had a prospective design 98,100,102-105 and two were retrospective. 99,101 In the prospective studies, patients were mostly recruited via hospitals and prosthetic fitting centres. Other than one retrospective mailed survey, 99 all studies involved interviews, sometimes combined with measurement or review of medical records.…”

“…Three of the studies took place in the UK, 99,103,105 two in the rest of Europe 102,104 and one each in Canada, 100 the USA 98 and Turkey. 101 The number of participants varied from 11 in one study 100 to 176 in the mailed survey, 99 although most studies included > 50 participants. The proportion of amputees who had PLP varied between studies (and across time points) and ranged from 45% to 92%.…”

“…In three of the studies, 99,100,104 all participants used a prosthesis, whereas the remainder did not report this information. Five studies 98,[100][101][102]105 reported the proportion of participants with stump pain, ranging from 19% to 91%.…”