Mobility one year after unilateral lower limb amputation: a modern, UK institutional report

Abstract

The aim of this current retrospective study was to assess postoperative mobility one year after above knee (AKA) or below knee amputation (BKA) in a district general hospital. Data on patient demographics, diabetic status, risks for peripheral vascular disease, mortality and mobility at one year were recorded from the vascular database. Seventy-five patients underwent lower limb amputation over a 70-month period (AKA n=31, BKA n=44). Operative mortality was 10% and mortality at one year 13.7%. Fourteen out of the 31 patients (45.1%) who underwent AKA were mobile independently or with a walking stick compared to 54.5% (24/44) in the BKA group (P=0.44). Fifteen patients (48.3%) were diabetic in the AKA group compared to 26 patients (59.1%) in the BKA group (P=0.49). In the under 60 years group and over 60 years group there was no significant difference in type of amputation (P=0.64) or mobility (P=0.69). In this current series, there was no significant rehabilitation benefits in patients undergoing BKA compared to AKA. With an ageing population who inherently have increasing significant medical problems, the perceived benefit in preserving the knee joint may not be as significant as previously reported.

Factors influencing short‐ and long‐term mortality after lower limb amputation

“…In this study we confirmed that major lower limb amputation is a high-risk procedure, with an overall 30-day mortality of 12.4%, which is consistent with recent UK data [2,10]. Thirty-day mortality was associated with worse physical status (ASA grade ≥ 4) and older age; long-term mortality was associated with increased age, ASA grade, severe renal disease and undergoing surgery outside of normal working hours.…”

Perioperative care for lower limb amputation in vascular disease

“…A recent UK series showed a BKA:AKA ratio of just greater than 1:1. 1 Patients presenting for LLA due to vascular disease are predominantly elderly and have a high prevalence of co-morbid pathology including coronary artery disease, hypertension, cerebrovascular disease, diabetes mellitus, chronic kidney disease, and smoking-related lung disease [e.g. chronic obstructive pulmonary disease (COPD)].…”

Functional outcomes of people with lower limb amputation following inpatient rehabilitation

“…The loss of a limb has been shown to negatively affect quality of life (Basu, 2008) and is associated with a deterioration of functional ability and residential status (Frykberg, 1998).…”

“…Amputation has severe consequences for the individual and health care system. Losing a limb, in particular a lower limb, has been shown to negatively affect physical ability (van Velzen, 2006), quality of life (Basu, 2008) and is associated with a deterioration of functional ability affecting residential status (Frykberg, 1998), with a significant number of amputees requiring long term care (Lavery, 1997). However, there is limited evidence as to whether the aetiology of amputation influences outcomes following subacute inpatient rehabilitation.…”

“…The loss of a lower limb has been shown to negatively impact a person's quality of life (Basu, 2008) and is associated with a deterioration in function and residential status (Frykberg, 1998). In addition to the personal consequences of lower limb amputation, a significant social and financial burden is placed on the person, community and healthcare system (Payne, 2000).…”