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Peripheral Vascular Disease And Its Impact On Gait Function In Patients With Below Knee Amputation With Targeted Muscle Reinnervation
Luke J. Llaurado, B.A., Wynne Zheng, M.A., Jie Jung Shih, MS, Roumina Adab, BS, Ahmed H. Abdelfatah, MS, Rachel N. Rohrich, BS, Cameron M. Akbari, MD, Jayson N. Atves, DPM, Karen K. Evans, MD, John S. Steinberg, DPM, Richard C. Youn, MD, Chris E. Attinger, MD.
Georgetown University, Georgetown, DC, USA.
Background:Peripheral vascular disease (PVD) is frequently associated with peripheral neuropathy and is often compounded by comorbidities such as diabetes.1 PVD significantly increases the risk of lower extremity amputation, particularly below-knee amputation (BKA), which severely impairs patients' mobility.2 Although recent surgical advances, such as targeted muscle reinnervation (TMR), have been developed to improve outcomes, patients with PVD who undergo BKA continue to face considerable functional ambulatory challenges. This study investigates and quantifies the impact of PVD on lower extremity gait function in patients having undergone BKA with TMR.
Methods:A single-center study was conducted from June 2021 to July 2024. Adult patients who could safely ambulate and did not have open wounds or lower extremity surgery within the past 90 days were included. PVD status and BKA with TMR history were documented through a retrospective chart review. Participants completed a 120-second walk test and a 30-second Romberg sway test with wearable sensors. Gait data were collected through Motility lab software, speed (m/s), elevation mid-swing (cm), step duration (s), cadence (steps/min), single limb support (%), double limb support (%), stride length (m) were collected for both lower extremities and averaged. Root-mean-square (RMS) sway (m/s2) indicative of sway area posture stability was also extrapolated.
Results: Eighteen patients with unilateral BKA with TMR were identified; ten (55.6%) had PVD. Patient characteristics including age, BMI, and CCI were comparable between PVD and Non-PVD groups. Average gait speed (0.89 ± 0.08 vs 0.58 ± 0.28, p=0.009), single limb support (35.91 ± 1.50 vs 31.68 ± 3.37, p=0.005), double limb support (28.13 ± 2.99 vs 36.71 ± 6.99, p=0.005), and stride length (0.85 ± 0.08 vs 0.71 ± 0.11, p=0.008) were significantly different between Non-PVD and PVD groups, respectively. There were no differences in elevation mid-swing, step duration, cadence, or RMS sway (Table 1).
Conclusion: Patients with PVD undergoing BKA with TMR experience significantly impaired gait function compared to non-PVD patients. These findings highlight the need for tailored rehabilitation strategies to address this population's mobility challenges.
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