학술논문
Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?: A Secondary Analysis of the OUTLET Study
Document Type
Academic Journal
Author
Fram, Brianna R.; Bosse, Michael J.; Odum, Susan M.; Reider, Lisa; Gary, Joshua L.; Gordon, Wade T.; Teague, David; Alkhoury, Dana; MacKenzie, Ellen J.; Seymour, Rachel B.; Karunakar, Madhav A.; Fox, W. Everett; Hsu, Joseph R.; Kempton, Laurence; Robinson, Katherine Sample; Sims, Stephen H.; Churchill, Christine; Teasdall, Robert D.; Carroll, Eben A.; Scott, Aaron T.; Halvorson, Jason J.; Pilson, Holly; Goodman, James Brett; Holden, Martha B.; McAndrew, Christopher M.; Gardner, Michael J.; Miller, Anna N.; Hughes, Amanda Spraggs; Stinner, Daniel J.; Rivera, Jessica C.; Osborn, Patrick M.; Nadeau, Jason T.; Howes, Cameron; Schenker, Mara L.; Mir, Hassan; Taylor, Benjamin C.; Schmidt, Andrew H.; Mullis, Brian H.; Shively, Karl D.; Sorkin, Anthony T.; Virkus, Walter; Konda, Sanjit R.; Choo, Andrew; Munz, John W.; Boutte, Sterling; Breslin, Mary A.; Toledano, James E.; Langford, Joshua Robert; Horne, Andrea; O’Toole, Robert V.; Boulton, Christina; Manson, Theodore; Nascone, Jason; Pollak, Andrew N.; Sciadini, Marcus F.; Degani, Yasmin; Howe, Andrea L.; Zych, Gregory A.; Cannada, Lisa K.; Dawson, Sarah A.; Jones, Clifford B.; Sietsema, Debra L.; Miclau, Theodore; Morshed, Saam; Wilken, Jason M.; Bergin, Patrick F.; Graves, Matt L.; Spitler, Clay A.; Jones, LaRita C.; Ertl, William; Moloney, Gele B.; Evans, Andrew R.; Weiss, David B.; Yarboro, Seth R.; Lester-Ballard, Veronica; McVey, Eric D.; Firoozabadi, Reza; Agel, Julie; Obremskey, William; Archer, Kristin R.; Burgos, Eduardo J.; Gajari, Vamshi; Rodriguez-Buitrago, Andres; Tummuru, Rajesh R.; Trochez, Karen M.; D’Alleyrand, Jean-Claude G.; Castillo, Renan C.; Allen, Lauren E.; Carlini, Anthony R.
Source
The Journal of Bone and Joint Surgery. Mar 21, 2024
Subject
Language
English
ISSN
0021-9355
Abstract
BACKGROUND:: The purpose of this study was to compare 18-month clinical and patient-reported outcomes between patients with severe lower-limb injuries treated with a transtibial amputation or a hind- or midfoot amputation. Despite the theoretical benefits of hind- and midfoot-level amputation, we hypothesized that patients with transtibial amputations would report better function and have fewer complications. METHODS:: The study included patients 18 to 60 years of age who were treated with a transtibial amputation (n = 77) or a distal amputation (n = 17) and who were enrolled in the prospective, multicenter Outcomes Following Severe Distal Tibial, Ankle, and/or Foot Trauma (OUTLET) study. The primary outcome was the difference in Short Musculoskeletal Function Assessment (SMFA) scores, and secondary outcomes included pain, complications, amputation revision, and amputation healing. RESULTS:: There were no significant differences between patients with distal versus transtibial amputation in any of the domains of the SMFA: dysfunction index [distal versus transtibial], 31.2 versus 22.3 (p = 0.13); daily activities, 37.3 versus 26.0 (p = 0.17); emotional status, 41.4 versus 29.3 (p = 0.07); mobility, 36.5 versus 27.8 (p = 0.20); and bother index, 34.4 versus 23.6 (p = 0.14). Rates of complications requiring revision were higher for distal amputations but not significantly so (23.5% versus 13.3%; p = 0.28). One distal and no transtibial amputees required revision to a higher level (p = 0.18). A higher proportion of patients with distal compared with transtibial amputation required local surgical revision (17.7% versus 13.3%; p = 0.69). There was no significant difference between the distal and transtibial groups in scores on the Brief Pain Index at 18 months post-injury. CONCLUSIONS:: Surgical complication rates did not differ significantly between patients who underwent transtibial versus hind- or midfoot amputation for severe lower-extremity injury. The average SMFA scores were higher (worse), although not significantly different, for patients undergoing distal compared with transtibial amputation, and more patients with distal amputation had a complication requiring surgical revision. Of note, more patients with distal amputation required closure with an atypical flap, which likely contributed to less favorable outcomes. LEVEL OF EVIDENCE:: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.