Ambulatory Status following Major Lower Extremity Amputation
Katherine P. MacCallum, MD, Patricia Yau, MD, Karan Garg, MD
Montefiore Medical Center, Bronx, NY
Objectives The ability to ambulate following major lower extremity amputation, either below (BKA) or above knee (AKA), is a major concern for all prospective patients. This study analyzed ambulatory rates and risk factors for non-ambulation in patients undergoing a major amputation. Methods A retrospective review of 811 patients who underwent BKA or AKA at our institution between January 2009 and December 2014 was conducted. Demographic information and comorbid conditions, including the patients’ functional status prior to surgery, at 6 months, and at latest follow up was recorded. Following exclusion criteria, 538 charts were reviewed. Patients who were either independent or used an assistive device were considered ambulatory, those who were completely wheelchair-dependent or bed-bound were considered non-ambulatory. Results Preoperatively, 368 of 443 of BKA patients were ambulatory (83.1%), significantly more so than those undergoing AKA (79/175 or 44.9%, p<0.0001). At six-month follow-up these percentages fell to 60.0% and 25.2%, respectively. At latest follow up (average 2.74 years) there was a trend toward improvement with 64.3% of BKA and 29.1% of AKA patients ambulating. Various factors were identified leading to higher odds of an ambulatory patient being non-ambulatory at least 1 year after surgery: male sex (OR 1.486, 95% CI 1.049-2.105), admission from a nursing facility (1.671, 1.015-2.750), and osteomyelitis as reason for amputation (1.807, 1.188-2.751). Risk factors for dependent status in all patients, regardless of pre-operative functional capacity, included age > 70 (OR 4.520, 95% CI 2.912-7.014), non-ambulatory status prior to amputation (12.077, 6.519-22.371), and admission from a nursing facility (3.949, 2.382-6.547). None of the comorbid conditions recorded (diabetes, renal insufficiency, end stage renal disease, peripheral vascular disease, or body mass index > 30) was found to have a statistically significant correlation with post-operative ambulation. Conclusions The majority of patients were able to ambulate with assistance following BKA at six-month follow up. For ambulatory patients, male sex, admission from a nursing home, and osteomyelitis were all independent factors leading to higher odds of becoming non-ambulatory following surgery. These findings will assist in the pre-operative counseling of patients prior to major lower extremity amputation.
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