The road to recovery: functional outcomes after major lower limb amputation

BACKGROUND: Most patients undergoing major lower limb amputation (MLLA) hope to regain functional independence with prosthetic limb use. We studied mortality rates and factors that may be related to whether the patient had achieved prosthetic limb use. METHODS: Retrospective study of patients who underwent MLLA due to non-reconstructible critical limb ischemia and or non-salvageable diabetic foot infection between March 2019 and February 2022. Patients were followed up. Physiotherapy and rehabilitation were recorded. RESULTS: At hospital discharge time, 40.8% went to rehabilitation, 48.1% home and 11.1% died during index admission. Six months after MLLA, 50.6% became a limb user (LU). Multivariate analysis showed that patients over 70 years were more likely to attend rehabilitation and dialysis patients were more likely to fail to attend and achieve rehabilitation. The level of amputation did not affect discharge to rehabilitation. Multivariate analysis showed that NLU patients were less likely to receive outpatient prosthetic rehabilitation and there was a higher incidence of NLU in those on dialysis (P=0.006). Patients with through knee and above knee amputations had significantly higher odds ratio of being a NLU 9.4 and 5.6, respectively (P=0.006) compared to below knee amputation. Receiving hemodialysis, NLU and failing to attend rehabilitation were found to be associated with a higher 6-month mortality rate. CONCLUSIONS: MLLA patients receiving hemodialysis, those who failed to attend rehabilitation or had a higher amputation level were less likely to become LU. Both being a NLU and receiving hemodialysis were associated with higher mortality rates. (Cite this article as: Bates KM, Alexander M, Jaques A, Metcalfe M, Elmallah A. The road to recovery: functional outcomes after major lower limb