Benefits of Early Prosthetic Management of Transtibial Amputees: A Prospective Clinical Study of a Prefabricated Prosthesis

Abstract

To evaluate the use of an immediate postoperative prosthesis (IPOP) for transtibial amputees, we compared patient outcomes from a prospective clinical study of 19 patients managed with an IPOP with those of a retrospective review of a matched historic control group of 23 patients managed with standard soft dressings. Data were analyzed with the Student's t-test, and significance was set at P = 0.05. The IPOP patients had no surgical revisions, whereas the patients with standard soft dressings had 11. This was a significant difference. IPOP patients also had significantly fewer postoperative complications and shorter times to custom prosthesis than did controls.

A Contemporary Comparative Analysis of Immediate Postoperative Prosthesis Placement Following Below-Knee Amputation

“…This lower rate of surgical revision in the IPOP group is similar to that reported in Schon et al's study, 8 which reported no surgical revisions in their IPOP group and a 47.8% revision rate in their non-IPOP group. This lower rate of surgical revision is likely multifactorial in etiology.…”

“…In our review, the incidence of falls in the case control group was twice as high as that in the IPOP group, although this difference did not reach statistical significance (P ¼ 0.266). Schon et al 8 showed similar results in a review of the use of IPOP using an air cast rather than a rigid plaster cast IPOP.…”

“…This length is similar to the mean of 50.1 ± 27.3 days for time of fitting of first prosthesis in the IPOP group shown by Van Velzen et al 11 In their study, the conventional group had a mean fitting time of 110.4 ± 73.0 days. Schon et al 8 found that the mean time to first custom prosthetic fitting was 3.4 ± 0.3 months and 5.1 ± 1.0 months in the IPOP and non-IPOP groups, respectively. Although direct comparisons of the outcomes of those from our case control group to those of the non-IPOP groups of these other studies cannot be made, the mean time until first prosthesis fitting for the IPOP group in our study is consistent with a significantly shorter time until fitting for conventional non-IPOP groups in these previous studies.…”

“…8e11 The theoretical advantages of IPOP include early mobilization, decreased stump edema, pain reduction, improved balance and safety during transfers, protection of the wound from trauma, prevention of joint contracture and loss of muscle strength, faster gait training, and psychological benefits of early ambulation. 8,12 In these earlier studies, the main advantages have been lower rates of stump revision, a lower rate of postoperative complications, and shorter durations of time until final custom prosthesis fitting. 8e11 Despite these encouraging superior results of IPOP after BKA, the use of IPOP after a BKA has not gained widespread use; in fact, <5% of BKAs are being performed with an IPOP.…”

Barriers to rehabilitation of patients with extremity sarcomas

“…Possible medical complications immediately following amputation that could delay the onset of rehabilitation services or interfere with progression through rehabilitation include shock, hematoma formation, infection, ischemic necrosis, residual or phantom limb pain, deep venous thrombosis, and excessive edema formation [4]. Depending on the level of amputation, an immediate postoperative prosthesis (IPOP), applied in the operating room can reduce the amount of residual or phantom limb pain, reduce time to definitive prosthesis, and lessen the psychological distress of limb loss (NCCN Category 2B) [20,21]. This requires coordination between the surgeon, physiatrist, and prosthetist.…”