Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

Abstract

Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These individuals consisted of 14 adults reporting knee-disarticulation amputation in one limb and best-matched cases (14 reporting transfemoral amputation and 14 reporting transtibial amputation) from a larger cross-sectional sample of 472 individuals. Participants were rigorously matched based on time since amputation, reason for amputation, age, sex, diabetes diagnosis, and pain before amputation. Continuous outcome variables were analyzed by one-way analysis of variance. Categorical outcomes were analyzed by Pearson chi-square statistic. Given the relatively small sample size and power concerns, mean differences were also described by estimated effect size (Cohen’s d). Of the 42 participants, 83% were male. They ranged in age from 36 to 85 (median = 55.1, standard deviation = 11.0). Most amputations were of traumatic origin (74%), and participants were on average 12.4 years from their amputations at the time of the survey. Individuals with transtibial amputation reported significantly more prosthesis use than did individuals with knee-disarticulation amputation. Amputation levels did not significantly differ in phantom limb pain, residual limb pain, back pain, and pain-related interference with physical function. Estimates of effect size, however, indicated that participants with knee-disarticulation amputation reported less phantom limb pain, phantom limb pain-related interference with physical function, residual limb pain, residual limb pain-related interference with physical function, and back pain-related interference with physical function than did participants with transtibial or transfemoral amputations. This study demonstrated that patients with knee-disarticulation amputation used prostheses significantly less than did patients with transtibial amputation. However, no evidence was found that patients with knee-disarticulation amputation have worse outcomes in terms of pain and pain-related interference with physical function; in fact, they may have more favorable long-term outcomes.

Long-term activity in and among persons with transfemoral amputation

“…Achieving these objectives may be markedly affected by both the site (i.e., limb) and level of the amputation. Transfemoral amputation (TFA), for example, is associated with impaired strength [3][4][5], limited range of motion [6][7], diminished sensation [8][9], and pain [10][11] in the residual limb in addition to the loss of the distal limb (i.e., knee, leg, ankle, foot). Although a lower-limb prosthesis is traditionally provided to replace absent limb structures, its capability to restore function and fulfill users' needs is limited, variable, and not well defined.…”

Development of a Multiple Degree of Freedom Knee Disarticulation Prosthesis with Active Leg Length Variation

“…If d a > , however, the compensation force 2 F would have to act in the same direction as the piston movement. Since a force in that direction cannot be generated in a passive system, 2 F is set to 0 and a combination of mechanical and hydraulic absorption of lateral forces is required (7).…”

“…Knee disarticulation was the amputation through the knee joint and was performed first in 1825 in the USA [2]. Compared to above knee amputation, knee disarticulation offers many advantages.…”

“…F is loaded with 1000 N, 2 F is loaded 800 N, and 3 F is loaded with 200 N. These test signals are chosen, because they show a high difference between the lateral forces 2 F and 3 F . As a result, the three pistons move differently.…”

The Effect of Mirror Therapy on the Management of Phantom Limb Pain

“…[1][2][3][4] PLP is one of the main causes of disability and distress among amputees, [5] and incidence of this phenomenon is up to 80 percent. [4,[6][7][8][9] Individual physiological, environmental, and psychological factors are involved in the etiology of PLP. [4,[10][11][12][13][14][15] Pathophysiology of PLP is not clearly known yet.…”