Is There a Difference in Function Outcome, Satisfaction, and Adjustment to Having a Prosthesis in Primary Transtibial Amputations Versus Multiple Previous Reconstructive Procedures Prior to Amputation?

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Background: Over the years, multiple procedures have been developed with variable results in terms of achieving the correction of limb deformities and length discrepancies. This kind of treatment involves a prolonged treatment time that usually requires more than one surgical procedure due to an unaesthetic and failed functional limb; at times, the final outcome is an amputation.Objective: The objective of this study was to determine if there is a difference in the functional outcome, satisfaction, and adjustment in patients with transtibial amputation surgery without previous reconstruction procedures versus patients who had undergone multiple reconstruction procedures before amputation.Methods: We evaluated 59 patients with transtibial amputations, of which 25 were first treated with an amputation and 34 had undergone multiple reconstruction procedures before amputation. We determined the difference between both groups by means of the etiology of the amputation, the number of surgeries previous to the amputation, and the complication rate. By means of the Pediatric Outcome Data Collection Instrument (PODCI) and Trinity Amputation Prosthetic Experience Scale (TAPES), we determined the functional outcome, satisfaction, and adaptation to using a prosthesis. A Student t-test for nonpaired groups was used for the statistical analysis.Results: A statistical difference was found in patients with multiple operations before the amputation in the subscales of transfers, pain, and global function compared with patients with a primary amputation. We also found that the multiple surgeries group had significant lower values in the adjustment to limitation than those with a primary treatment.Conclusions: There is still controversy on which is the best initial treatment for patients with lower-limb deformities. Finding differences in outcomes of patients with multiple surgeries compared with patients undergoing amputation surgery alone without previous surgical procedures indicates that the initial treatment of patients with limb deformities can be more critical in terms of the consequences of a failed treatment.

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