Original article
Walking Ability and Quality of Life in Subjects With Transfemoral Amputation: A Comparison of Osseointegration With Socket Prostheses

https://doi.org/10.1016/j.apmr.2013.05.020Get rights and content

Abstract

Objective

To investigate walking ability and quality of life of osseointegrated leg prostheses compared with socket prostheses.

Design

Prospective case-control study.

Setting

University medical center.

Participants

Subjects (N=22) with transfemoral amputation (1 bilateral) referred to our center because of socket-related skin and residual limb problems resulting in limited prosthesis use. Their mean age was 46.5 years (range, 23–67y) and mean time since amputation was 16.4 years (range, 2–45y). Causes of amputation were trauma (n=20) and tumor (n=2).

Intervention

Implantation of an osseointegration prosthesis (OIP).

Main Outcome Measures

Global score of the Questionnaire for Persons With a Transfemoral Amputation (Q-TFA), prosthesis use, 6-minute walk test (6MWT), Timed Up & Go (TUG) test, and oxygen consumption during treadmill walking.

Results

With the socket prosthesis, the mean ± SD Q-TFA global score, prosthesis use, 6MWT, TUG, and oxygen consumption were 39±4.7 points, 56±7.9h/wk, 321±28m, 15.1±2.1 seconds, and 1330±310mL/min, respectively, and significantly improved with OIP to 63±5.3 points, 101±2.4h/wk, 423±21m, 8.1±0.7 seconds, and 1093±361mL/min, respectively.

Conclusions

Osseointegration is a suitable intervention for persons whose prosthesis use is reduced because of socket-related problems. Subjects with OIP significantly increased their walking ability and prosthesis-related quality of life.

Section snippets

Methods

Subjects with transfemoral amputation recruited for this study were referred to the outpatient clinic from the university medical center. All subjects were referred because socket-related skin and residual limb problems were contributing to limited prosthesis use. An inclusion criteria instrument for OIP was developed based on the following items: prosthesis use, prosthetic mobility, problems, and global score of a Dutch translation of the Questionnaire for Persons With a Transfemoral

Results

Between May 2009 and May 2011, 22 subjects who had undergone transfemoral amputation because of trauma (n=20) or a tumor (n=2) participated in this study. Twenty-one participants had unilateral transfemoral amputation, and 1 participant had bilateral transfemoral amputations. The mean age ± SD of the study group was 46.5±10.7 years (range, 23–67y) and included 18 men and 4 women. At the time of inclusion, the participants were at an average ± SD of 16.4±14.8 years after amputation (range,

Discussion

In this prospective case-control study, we report that OIP improved walking ability and quality of life in subjects with transfemoral amputation who initially presented with socket prosthesis–related skin and residual limb problems. In summary, subjects with OIP were capable of walking further faster while using 18% less energy. In addition, they had significantly better prosthesis-related quality of life compared with their previous situation with the socket prosthesis. Participants with OIP

Conclusions

Osseointegration is a suitable intervention for individuals with transfemoral amputation performed because of trauma or tumor, who have reduced prosthesis use as a result of socket-related residual limb/skin problems. In 1-year follow-up, subjects with OIP significantly increased walking ability and prosthesis-related quality of life.

Suppliers

  • a.

    Orthodynamics Ltd, Industrial Park, Bourton on the Water, Gloucestershire, GL54 United Kingdom.

  • b.

    Integrum AB, Krokslätts Fabriken 50, 43137, Mölndal, Sweden.

  • c.

    Cosmed Srl, Via del Piani di Monte Savello 27, 00041 Pavona di Albano, Rome, Italy.

  • d.

    OTN bv, De Weertjes 1120, 6605 RD Wychen, The Netherlands.

  • e.

    IBM Corp, 1 New Orchard Rd, Armonk, NY 10504-1722.

Acknowledgments

We thank Tjarda Tromp for her excellent assistance in follow-up assessments, planning, and data collection; and Bregina Kersten for performing all the oxygen consumption measurements.

References (27)

  • C.C. Lyon et al.

    Skin disorders in amputees

    J Am Acad Dermatol

    (2000)
  • H.E. Meulenbelt et al.

    Determinants of skin problems of the stump in lower-limb amputees

    Arch Phys Med Rehabil

    (2009)
  • L.E. Pezzin et al.

    Use and satisfaction with prosthetic limb devices and related services

    Arch Phys Med Rehabil

    (2004)
  • L.E. Pezzin et al.

    Rehabilitation and the long-term outcomes of persons with trauma-related amputations

    Arch Phys Med Rehabil

    (2000)
  • K. Hagberg et al.

    Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems

    Prosthet Orthot Int

    (2001)
  • K. Demet et al.

    Health related quality of life and related factors in 539 persons with amputation of upper and lower limb

    Disabil Rehabil

    (2003)
  • P.I. Brånemark et al.

    Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period

    Scand J Plast Reconstr Surg Suppl

    (1977)
  • R. Adell et al.

    Long-term follow up study of osseointegrated implants in the treatment of totally edentulous jaws

    Int J Oral Maxillofac Implants

    (1990)
  • R. Brånemark et al.

    Osseointegration in skeletal reconstruction and rehabilitation: a review

    J Rehabil Res Dev

    (2001)
  • H.H. Aschoff et al.

    [The endo-exo femur prosthesis–a new concept of bone-guided, prosthetic rehabilitation following above-knee amputation] [German]

    Z Orthop Unfall

    (2009)
  • H.H. Aschoff et al.

    Transcutaneous, distal femoral, intramedullary attachment for above-the-knee prostheses: an endo-exo device

    J Bone Joint Surg Am

    (2010)
  • H.H. Aschoff et al.

    [Evaluation of 10 years experience with endo-exo femur prostheses—background, data and results] [German]

    Z Orthop Unfall

    (2012)
  • K. Hagberg et al.

    Osseointegrated trans-femoral amputation prostheses: prospective results of general and condition-specific quality of life in 18 patients at 2-year follow up

    Prosthet Orthot Int

    (2008)
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    No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

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