The patient with unilateral trans-tibial amputation for vascular disease : functional assessments, prognostic factors and cost of prostheses

Abstract: The patient with unilateral trans-tribal amputation for vascular disease. Functional assessments, prognostic factors and cost of prostheses. The aims of the study were to focus on the functional ability of the dysvascular patient with unilateral trans-tibial amputation and the early rehabilitation period, defined here as the period between the amputation and the prosthetic fitting. Results revealed the standing balance and the gait performance of the dysvascular amputees to be significantly inferior to that of the trauma amputees and healthy controls. The mortality rate six months after the amputation was 33 % and after eight years 92 %. Six months after the amputation half of the patients were fitted and half of these were prosthetic walkers. Within one year 63 % of the patients had been fitted with a prosthesis. Half of the dysvascular amputees were 80 years or older and half of these were fitted, compared to three quarters of those younger. Within six months after the amputation 62 % of the patients were able to return to their own homes. Each patient received a median of one prosthesis and one additional socket. The median cost for prostheses, additional sockets and maintenance was USD 1,582 per patient. The costs of prostheses on average corresponded to 6 % of the costs of hospitalisation and surgery. No significant difference in the costs between patients with poor or good prosthetic function was revealed. It appeared to be an advantage to be amputated on the left leg if the patient had been able to walk alone outdoors before the amputation and was not using a wheelchair. Three times as many men as women were found in the group that had good function with the prosthesis. The prognostic factor was ability to walk alone outdoors before the amputation. The majority of the patients were dependent on another person one week after the amputation, at discharge from the hospital and six months after the amputation. The Katz Index of ADL on days 5-7 after the amputation may be useful in identifying those patients who will probably survive the first month post-operatively and who will be discharged to their own homes.The translated and slightly modified version of the FRSA-scale seemed to be an appropriate instrument for assessing functional ability in dysvascular amputees, with or without a prosthesis at discharge from hospital, and throughout their lives. Training of balance and gait performance in the dysvascular patient after the amputation seems to be important for prosthetic rehabilitation and choice of future residence for the patient. Further studies will elucidate whether training before the amputation, especially in women, will result in increased independence with or without prosthesis.