Objectives: Prior studies have demonstrated that ambulation after major amputation is associated with improved survival. Although there are many factors associated with ambulation, a major modifiable target for improving ambulation is the time to initial consultation with a prosthetist. Unfortunately, less than 50% of patients who undergo a major amputation in the United States are fitted for a prosthesis. In January 2023, our institution partnered with an independent prosthesis care program (PCP) to more seamlessly integrate prosthesis care within our practice. The objective of this study was to measure the impact of this partnership on receipt of a prosthesis and ambulation.
Methods: All patients undergoing transfemoral (AKA) or transtibial (BKA) amputation from 2020-2024 at a single institution were included. The cohort was stratified based on whether the patients were included in the PCP or not (non-PCP). The outcomes of interest were prosthesis attainment and ambulation.
Results: A total of 98 patients were included (58 PCP and 40 non-PCP), of which 78 (79.6%) underwent BKA, 18 (18.4%) had a prior contralateral major amputation, 76 (77.6%) were ambulatory preoperatively, and 26 (26.5%) required a staged operation with a guillotine amputation. The non-PCP group had a higher rate of end-stage renal disease (27.5% vs 5.2%, p=0.008), but otherwise the groups were statistically similar. At one year postoperatively, the PCP group had significantly higher rates of prosthesis receipt (58.6% vs 25.0%, adjusted OR [95% CI] = 3.32 [1.30-9.97]) and ambulation (46.6% vs 12.5%, adjusted OR [95% CI] = 7.76 [2.59-29.96]) than the non-PCP group (table I and II). Additionally, the PCP group received a prosthesis (median 110 days vs 223 days, p< 0.001) and ambulated (median 111 vs 258 days, p=0.004) sooner than the non-PCP group. Among the 24 (41.1%) PCP patients that did not receive a prosthesis within 1 year, 1 (4.2%) subsequently received a prosthesis after 1 year, 4 (16.7%) died prior to prosthesis receipt, 2 (8.3%) have been unable to obtain a prosthesis yet due to poorly healing wounds, 4 (16.7%) declined prosthesis services, and 6 (25.0%) were deemed not to be a candidate for prosthesis due to medical comorbidities or poor ambulatory potential. The remaining 7 (29.2%) were lost to follow-up or selected an alternate prosthesis care provider.
Conclusions: Partnering with a dedicated prosthesis care program significantly improved rates of prosthesis receipt and ambulation after major amputation in this at-risk population.
