1. Transfemoral/Transtibial patient prognosis predictors
Hannah Chaney ~ Sara Patterson

2. Stats 54% amputations due to vascular disease 45% due to trauma
<2% due to cancer
Odds of death are 2.3X higher with hx of cerebrovascular disease within a year
Nearly half of amputations with vascular disease will die within 5 years
Odds of death are 3.5x higher with renal disease within a year
Of people with LE amputation up to 55% will require an additional amputation of the second leg within 2-3 years

3. Transfemoral Amputation (AKA)
Average 29,607 performed annually
⅕ people with limb loss have AKA
Less metabolically efficient than BKA
Due to trauma, cardiovascular/resp disease,malignancies, diabetes
Good prognosis for people <65 y/o and without Cardiovascular disease
Patient: it was 10X more difficult with AKA than BKA
Smith, D. Amputee Coalition, 2004

4. In a 16 y/o pt with bone cancer, does a transfemoral amputation provide a better quality of life than a limb salvage procedure? (if possible)
Long term survivorship & osteosarcoma:
12-24 years later filled out functional assessment, quality of life assessment, body image assessment,self esteem assessment & social support assessment
Better leg function was significantly related to better emotional functioning
Rotationplasty had higher function, less pain, and more involvement in hobbies, work, social settings
Robert, R. Pediatric Blood and Cancer, 2010

5. Complex limb salvage or Early Amputation for Severe Lower-limb injury: A Meta- analysis of observational studies
Was based off of Injury not malignancy
9 observational studies
Length of hospital stay, pain & return to work time is similar
Limb salvage procedure:
slightly lengthier rehab, more costly, more surgeries, increased re-hospitalizations
At time of injury pt prefer limb salvage, however pt who had failed salvage say they would have opted for an amputation instead
Busse, J., Journal of Orthopaedic Trauma, 2007

6. TransTibial Amputation (BKA)
Lower Limb amputation, cm below tibial tuberosity
Due to trauma or disease (Peripheral Vascular Disease, Diabetes, Infection, Foot Ulcer, Tumor)
Historically increased in amount of this type of amputation
Doppler blood-flow detection equipment
Studies showing more successful rehab
LE Prosthetics In Class Slides
Moving Forward, 2013

7. Biomechanical adaptations of transtibial amputee sprinting in athletes using dedicated prostheses
People with a BKA have ran over 100m in little over 11 s
Many athletes train as much as their able-bodied counterparts
Benefit of training and sprint performance are affected by the design of the prosthesis
Flex-Foot Modular III - up on toes gait for sprinting lead to prosthetic limb kinematics
Major compensatory mechanisms=increased stance phase hip work on the prosthetic limb, increased hip and knee work on the intact limb during swing
Buckley, J. G. Clinical Biomechanics, 2000.

8. Goals of the Study
Determine the biomechanical adaptations in two transtibial amputee sprinters by determining the joint movements, muscle powers and the work done by the musculature at the ankle, knee and hip of the prosthetic and sound limbs
To examine the effect of dedicated prosthetic design upon these adaptations by comparing prosthetic limb kinetics when subjects used a Sprint Flex and Cheetah prosthesis
Buckley, J. G. Clinical Biomechanics, 2000.

9. Methods
Two subjects - both had competed at all levels including World and Paralympic Games
Sprint Flex Modular III (Sprint Flex) vs. Sprint Flex Modular IV (Cheetah)
Two trials - one for each prosthetic; subjects repeated maximal sprint trials
Calculations: Moments, muscle powers and the mechanical work done at the joints of the prosthetic and sound limbs
Buckley, J. G. Clinical Biomechanics, 2000.

10. Results Joint kinetics from single ground contact while sprinting
Differences in joint kinetics of each subject leads to differences of favored prostheses
From the two subjects, the study suggests that there is increased hip work on the prosthetic limb
However, there is also additional compensation found with increased work at the residual knee.
Provided insight into the biomechanical adaptations needed to obtain speed during full speed sprinting and the mechanical behavior of the prostheses used
Buckley, J. G. Clinical Biomechanics, 2000.

11. What Can Physical therapists DO?
Prior to Surgery
Exercises for conditioning, improvement in strength and flexibility
Educate the patients on how to walk with a walker or crutches, rolling in bed, sitting and transfers for after surgery
Educate on what to expect after the procedure
After Surgery
Stretching, ROM Exercises
Educate how to roll in bed, transfers
Educate how to position surgical limb to prevent contractures
Educate about using a wheelchair, stand and walk with a AD
Educate about swelling and compression
Pain Management
Moving Forward, 2013

12. References
Buckley, J. G. (2000). Biomechanical adaptations of transtibial amputee sprinting in athletes using dedicated prostheses. Clinical Biomechanics,15(5),
Busse J, Jacobs C, Swiontkowski M, Bosse M, Bhandari M. Complex Limb Salvage or Early Amputation for Severe Lower-Limb Injury: A Meta-Analysis of Observational Studies. Journal of Orthopaedic Trauma. 2007;21(1): doi: /bot.0b013e31802cbc43.
Moving Forward. Physical Therapy Brings Motion to Life. American Physical Therapy Association. December, 2013.
LE Prosthetics, In Class Slides, July 2016.
Robert R, Ottaviani G, Huh W, Palla S, Jaffe N. Psychosocial and functional outcomes in long-term survivors of osteosarcoma: A comparison of limb-salvage surgery and amputation. Pediatr Blood Cancer. 2010:n/a-n/a. doi: /pbc
Smith D. The Transfemoral Amputation Level, Part 1 | Amputee Coalition. Amputee-coalitionorg Available at: Accessed July 11, 2016.

13. Any Questions?