Rehabilitation of the Older Lower Limb Amputee: A Brief Review

Abstract

Age alone should not determine prosthetic rehabilitation. Comorbidities and general health are important determinants. The more proximal the amputation, the more energy is demanded from the cardiovascular and pulmonary systems for prosthetic gait. Changes in surgical technique and revascularization procedures have allowed preservation of the knee, which decreases energy demands and allows more older patients a chance to undergo rehabilitation for ambulation. Although the ratio of below knee (transtibial) amputations to above knee (transfemoral) amputations has increased, overall postsurgical mortality (10-30%), long term survival (40-50%@2 years, 30-40%@5 years), and risk of loss of the contralateral leg (15-20%@2 years) has not changed significantly since the 1960s. Despite the lack of improvement in survival as a result of the systemic vascular disease, the older patient can benefit from rehabilitation efforts with goals of prosthetic ambulation or simply cosmesis. The shortened longevity emphasizes the need for timely rehabilitation to enhance the quality of the remaining years. The geriatrician can add to the presurgical care and preprosthetic phase of rehabilitation by attention to the problems common to the older patient, i.e., multiple comorbidities, polypharmacy, immobility, and depression. Postoperatively, early mobilization is crucial to avoid the deleterious effects of immobility in the older person. Further investigations into the psychosocial issues and cost benefits of limb loss and prosthetic rehabilitation are needed. In addition, comparison of the various rehabilitation protocols and the impact of cardiac resting before rehabilitation are needed.

Reactions to Amputation: Recognition and Treatment

“…Most amputations in the United States are a consequence of chronic vascular disease: 82% of amputations done in this country each year are a result of DM or PVD. 1 Approximately 50,000 lower-limb amputations are done annually; roughly 300,000 persons living in the United States are survivors of 1 or more limb amputations. Unfortunately, there is only a 2-to 5-year life expectancy following amputation for chronic vascular disease for 60% of patients because of the risk of death from cardiovascular disease.…”

Knee disarticulation after total-knee replacement

“…a cane instead of a walking frame). Besides, the more distal the amputation, the less energy is required of the cardiovascular and pulmonary system for prosthetic gait (Cutson and Bongiorni, 1996;Pinzur, 1993).…”

A study of technical changes to lower limb prostheses after initial fitting

“…The shortened longevity emphasises the need for timely rehabilitation and the enhancement of quality of the remaining years. ( Cutson and Bongiorni, 1996).…”