Researchers conducted a study to compare transfemoral amputation (TFA) to knee disarticulation (KD) as a reamputation level after failed transtibial amputation in patients with peripheral vascular disease and/or diabetes.
The study included 152 patients undergoing reamputation after a failed transtibial amputation; 86 had a TFA and 66 patients had a KD. The primary outcome was reamputation and reoperation, and secondary outcomes were prosthetic fitting and mortality. Logistic regression analyses were performed to identify factors associated with the outcome.
The reamputation rate was 36 percent after KD and 15 percent after TFA. The multivariable analysis showed that TFA was associated with a significantly reduced risk of reamputation. The overall reoperation rate was 38 percent after KD and 22 percent after TFA.
Prosthetic limb fitting was possible in 30 percent after KD and 19 percent after TFA. Previous amputation in the contralateral leg was the only factor associated with reduced ability for prosthetic fitting in the multivariable analysis. Mortality at 30 days was 17 percent and 53 percent at one year. No independent factors affected 30-day mortality in the multivariable analysis, according to the study.
As a result, the researchers concluded there was a significantly lower risk of reamputation after TFA compared with KD and considered TFA to be the reamputation level of choice, especially when there is a need of reducing risk of further reamputations.
The study “Knee disarticulation vs. transfemoral amputation after failed transtibial amputation: Surgical outcome and prosthetic fitting in patients with peripheral vascular disease,” was published in Prosthetics and Orthotics International.
