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Analysis of selected factors determining quality of life in patients after lower limb amputation- a review article

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Grzebień A., Chabowski M., Malinowski M., Uchmanowicz I., Milan M., Janczak D.
Polish Journal of Surgery
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2017
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vol. 89(2)
57-61
EN
The amputation of the lower limb is a crippling procedure, which impairs both physical and mental aspect of the patient’s life and therefore, it is important to provide these patients with comprehensive health care. Patients and their families must change their lives and reorganize them, which is undoubtedly associated with a decrease in the quality of life. The aim of this study was to analyze various determinants of quality of life in patients after lower limb amputation and their impact on the physical, mental and social aspect of life. Based on the available literature, this paper discusses certain factors determining quality of life, including the presence of phantom pain and stump pain, the way patients move, independence in daily activity, occupational activity, and access to rehabilitation. Analysis of the impact of particular factors on quality of life in people after lower limb amputation may contribute to the improvement and introduction of new paradigms regarding care provided for amputees.
2
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Treadmill gait analysis of rehabilitated and independent lower-limb amputees

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Tonon Da Luz S. C., Vargas Ávila A. O., De Andrade M. C., Conceição Silva Alves Rodrigues B.
Human Movement
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2012
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vol. 13
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issue 3
204-210
EN
Purpose. A description of gait analysis during overground locmotion has been the subject of various studies, in relation to describing both the kinetic and spatial-temporal characteristics of walking. Measuring the gait of amputees using treadmills is a useful test to quantify locomotive ability, and a tool that helps to control gait parameters during rehabilitation. The aim of this study is to describe the kinetic and spatial-temporal characteristics of gait of rehabilitated amputees, measured with an instrumented treadmill. Methods. Twenty-four participants aged between 20 and 40 years were chosen, who had all suffered unilateral traumatic amputation either above or below the knee, and were classified as well-rehabilitated. Following a paperbased assessment form, the participants were subjected to gait analysis on an instrumented treadmill fitted with two force platforms. Results. The first peak vertical force of intact and amputated limbs presented higher values and was significantly (p 0.05) larger than the second peak vertical force for the amputated limb, indicating less propulsion during walking. A significant difference was observed in the load rate in intact and amputated limbs, indicating more overload in the intact limb. The spatial-temporal variables, cadence, step and stride length were significantly greater (p 0.05) in the below-knee than in the above-knee amputees. Conclusions. The kinetic and spatial-temporal characteristics of gait, measured with an instrumented treadmill, which were observed in all lower limb amputees involved in this study, were similar to the ones commonly reported in numerous studies on overground walking. Thus, treadmill gait training and control of the progress of rehabilitation with amputees is recommended.
3
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Risk factors for impaired wound healing and prolonged hospitalization in patients after amputation of the lower limb above the knee joint

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Orłowski M., Pluta P., Kowalczyk A., Kasprzak-Szczepańska K., Pająk M., Dziki A.
Polish Journal of Surgery
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2019
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vol. 91(5)
27-33
EN
ntroduction: Lower limb amputation is a surgery performed as a last resort, when all other therapeutic options have been exhausted. The duration of treatment lasts from a few to several months and depends on the extent of amputation, the patient's overall health and the course of the stump healing process. Materials and methods: A retrospective analysis was performed using the database of the General and Vascular Surgery Ward of the Nikolay Pirogov Regional Specialist Hospital in Łódź. Patients who underwent lower limb amputation at the transfemoral level in 2017 were analyzed. 92 patients undergoing surgery were qualified for the study. Patients were divided into two groups: those with no healing complications and those with stump healing complications. Medical records of both groups were analyzed for risk factors for impaired healing. The obtained data were subjected to statistical analysis. Results: Patients with impaired stump healing most often had minimal bleeding and higher ASA scores compared to patients without healing complications. No differences between the two groups were found for the remaining parameters. Patients with complications needed an average of 28 days to heal the wound and spent an average of 40 days in hospital, compared to 14 and 21 days, respectively, for patients without complications. The percentage of deaths in the group of patients with complications was also significantly higher (35%) than in the group of patients without complications (5%). Conclusions: Statistically significant factors increasing the risk of impaired stump healing include high ASA scale and minimal muscle bleeding during surgery. Patients who experienced this complication are at greater risk of prolonged hospitalization and death in the postoperative period. This study showed statistically significant risk factors for impaired stump healing following amputation and confirmed the negative impact of this complication on the length of hospitalization and risk of death.
4
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The negative impact of local recurrence on overall survival in adult patients with extremity localized osteosarcoma

63%
Goryń T., Szostakowski B., Pieńkowski A., Rutkowski P.
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vol. 87
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issue 1
8-12
PL
Kostniakomięsak jest najczęstszym pierwotnym nowotworem złośliwym kości u dorosłych i najczęściej lokalizuje się się w kościach długich. Standardowe leczenie obejmuje chemioterapię okołooperacyjną i radykalną resekcję chirurgiczną. W przypadku lokalizacji kończynowej złotym standardem jest operacja oszczędzająca kończynę z wykorzystaniem różnych technik rekonstrukcyjnych. W naszej pracy przeanalizowano 175 dorosłych pacjentów w stadium I-III wg MSTS leczonych w naszej placówce w latach 2000-2017 z powodu kostniakomięsaka w lokalizacji kończynowej. Mediana obserwacji wyniosła 41 miesięcy (3-225 miesięcy). 111 pacjentów poddano operacji oszczędzającej kończynę, 80 pacjentów poddano resekcji guza, a następnie rekonstrukcji z wykorzystaniem endoprotezoplastyki poresekcyjnej, 31 pacjentów poddano resekcji miejscowej bez rekonstrukcji, a 64 pacjentów poddano amputacji. Wskaźniki 5-letniego przeżycia całkowitego (OS) i przeżycia wolnego od choroby (DFS) w grupie badanej wynosiły odpowiednio 62% i 52%, a oczekiwana długość życia 136 miesięcy. Wznowa miejscowa wystąpiła u 34 (19%) pacjentów w całej grupie, w tym 16 (17%) po rekonstrukcji, 11 (35%) po resekcji miejscowej i 7 (10%) po amputacji. W grupie pacjentów z nawrotem miejscowym wskaźnik 5-letniego przeżycia całkowitego (OS) wyniósł 30%, i był istotnie statystycznie gorszy niż pacjentów bez wznowy (5-letnie OS 70%).
EN
Osteosarcoma is the most common primary malignant bone tumour in adults and is usually located in long bones. Standard treatment consists of perioperative chemo-therapy and radical surgical resection. In the case of the extremity location, the gold standard is limb-sparing surgery using various reconstructive techniques. Our study analyzed 175 adult patients in MSTS I-III stage treated for extremity os-teosarcoma at our institution between 2000 and 2017. The median observation was 41 months (3-225 months). 111 patients were treated with limb-sparing surgery, 80 patients had tumour resection followed by endoprosthetic reconstruction, 31 patients had local resection without reconstruction and 64 patients underwent amputation. 5-year OS (overall survival) and DFS (disease-free survival) rates in the study group were 62% and 52%, respectively, and life expectancy was 136 months. Local recurrence occurred in 34 (19%) patients in the whole group, including 16 (17%) patients after reconstruction, 11 (35%) patients after local resection and 7 (10%) patients who had an amputation. In the group of patients with local recurrence, 5-year OS rate was 30%, statistically significantly worse than patients without recurrence (5-year OS 70%).
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