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Immediate post-operative prosthesis following trans-tibial amputation: Comparative analysis of a contemporary series
Mujtaba M. Ali, MD1, Lorraine Loretz, NP, DPM1, Art Shea, BA, CPO2, Eli Poorvu, BS1, Andres Schanzer, MD1, Louis M. Messina, MD1, Donald T. Baril, MD1.
1University of Massachusetts Medical School, Worcester, MA, USA, 2New England Orthotic and Prosthetic Systems, Worcester, MA, USA.

OBJECTIVE:
Post-operative management of trans-tibial amputations is traditionally done with soft compressive dressings over the stump to allow for complete healing and reduction in edema prior to fitting of the initial prosthesis. A prolonged period of limited mobility is necessary with this technique, placing patients at risk for muscle weakness, body de-conditioning, joint stiffness, or fall injury to the stump. The use of an immediate post-operative prosthesis (IPOP) allows patients to begin ambulation and rehabilitation on post-operative day one which can be of great psychological benefit. The purpose of this study is to compare outcomes of a series of patients undergoing IPOP to a historical control group of patients undergoing traditional trans-tibial amputations.
METHODS:
Records of all patients undergoing trans-tibial amputations performed in traditional manner who were IPOP candidates (35 patients in 2006-2007) along with patients undergoing IPOP (37 patients in 2007-2010) were retrospectively reviewed. Patients considered for IPOP were ambulatory pre-operatively and had expected compliance to the post-operative protocol. Patient co-morbidities and preoperative ambulation status were compared. Preoperatively non-ambulatory patients were excluded from the control group. The data was analyzed using student’s t-test (two tail analysis, assuming unequal variance). Significance was set at p-value of 0.05.
RESULTS:
Preoperative patient characteristics of the two groups were similar, although the IPOP group was younger (TABLE 1).
Preoperative characteristicNon-IPOPIPOPp-value
Age (years)69.061.50.010
Gender (% male)68.6%83.8%0.135
Hypertension85.7%70.3%0.116
Diabetes mellitus74.3%89.2%0.067
Hypercholesterolemia71.4%81.1%0.344
Chronic Renal Failure34.3%43.2%0.442
Hemodialysis20.0%18.9%0.909
Coronary artery disease60.0%56.8%0.784
Tobacco use71.4%81.1%0.574
Ambulatory without assistance100%97.3%0.324

Immediate peri-operative complication rates were not significantly different (non-IPOP 31.4% vs. IPOP 29.7%,p=0.878). Post-operative complication rates were as follows: wound infection (non-IPOP 25.0% vs. IPOP 18.9%,p=0.568), wound dehiscence (non-IPOP 25.0% vs. IPOP 29.7%,p=0.677), skin breakdown separate from incision (non-IPOP 3.6% vs. IPOP 18.9%,p=0.044), and fall (non-IPOP 21.4% vs. IPOP 10.8%,p=0.266). The need for revision was significantly greater in the non-IPOP group (non-IPOP 27.6% vs. IPOP 5.4%,p=0.021). The time from surgery to placement of the definitive leg was 51 days in the IPOP group.
CONCLUSION:
Patients undergoing IPOP had similar complication rates as those undergoing the traditional method but were less likely to require surgical revision. The use of IPOP is of great psychological benefit to the patient and allows for early ambulation and rehabilitation. It should be considered for all appropriate candidates undergoing trans-tibial amputation.


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