IMPROVING WALKING AFTER BELOW KNEE AMPUTATION THROUGH BETTER SURGERY lukebrewst@aol.com

353-01

IMPROVING WALKING AFTER BELOW KNEE AMPUTATION THROUGH BETTER SURGERY

6

United States

Oral or Poster

Ambulation after BKA can be disappointing, often limited to flat surfaces and short distances (K2 function). To address this problem, a nuanced BKA (Ewing Amputation-EA) was implemented as a pilot study. EA reconstructs agonist/antagonist tendons to the tibia (greater limb control) and encases nerves with remnant muscle (neuroma prevention) and was developed for advanced prosthetic-use in active persons. We hypothesized that EA would improve ambulation in vascular patients.

This was a prospective single arm pilot study of consecutive BKA patients at a single institution. Patients were excluded if they could not participate in rehabilitation or had end-stage renal disease. Patients were consented for the operation and underwent protocol testing for 12 months post-operatively. Operations were performed jointly with plastic surgery.

13 patients underwent EA. 3 of these were 2 stage operations whereby the EA followed an infection-control operation. 4/13 patients required operative revisions (3 for infection). 1 patient was revised to a standard BKA and used as a comparison to EA ambulation metrics. EA patients averaged 34172270 steps/day (BKA:155 steps/day), average peak cadence of 3317 steps/minute (BKA:179 steps/minute), and achieved K4 status (BKA:K1), which is the highest level of functional mobility with a prosthetic. EA patients reported (VR36) improvements in physical function and general health (P<.05), in amputation single-item mobility measure (AMPSIMM) and prosthesis satisfaction (P<.05) compared to the 4 patients who underwent revisions.

EA improves ambulation, self-assessment of physical/general health, and prosthesis satisfaction. Integrated vascular and plastic surgery teamwork minimized operative time, blood loss, and maximized followup data collection.