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Comparison of post-operative recovery of amputees that undergo two different lower extremity amputation procedures: Traditional vs. osteomyoplasty

Emmons, Kelsi
Objective: The purpose of this project was to compare the post-operative recovery of patients undergoing lower extremity amputation following either a traditional or osteomyoplasty procedure.
Methods: Peer reviewed articles were extracted from six data bases and websites published from 1967 to 2017. Search terms included: "lower-extremity amputations," "complications," "length of hospital stay," "surgical technique," "osteomyoplasty," "traumatic," "non-traumatic," "prosthesis," and "ambulation." A series of questions was also developed for interviews with health care professionals working with amputees who have undergone the traditional or osteomyoplasty surgical amputations.
Results: The average length of hospital stay for the traditional technique was 12.8 days for the studies reviewed, but no studies reported for length of hospital stay following osteomyoplasty. Time to prosthesis and ambulation for the traditional procedure was 54 days (range of 24.8 to 126 days) and the osteomyoplasty procedure was 69.2 days (range of 32.2 to 156.8 days). For the traditional procedure, infection rates were 18% (range 1.9% to 34%) compared to 15% (range 0 to 35.1%) for the osteomyoplasty procedure. Stump revision rate for the traditional procedure had an un-weighted average of 25% (range 3.2 to 50%) compared to 14% (range 0 to 37.9%) for the osteomyoplasty. Following the traditional procedure, the ambulation rate was 65% (range 38.3% to 87.8%) compared to 97% (range 87.5 to 100%) for the osteomyoplasty procedure. Employment rate for the traditional procedure was 43% (range 10 to 96.7%) compared to 70% (range 21.6 to 100%) for the osteomyoplasty. Results of the interview revealed that health care professionals who work with amputees who have undergone the traditional vs. osteomyoplasty procedure believe there are advantages for the patient long-term with the osteomyoplasty technique.
Conclusions: Based on this research, the osteomyoplasty provides better functional outcomes than the traditional procedure for patients who are good candidates. More research is needed directly comparing the two surgical techniques and training of more surgeons in the osteomyoplasty procedure before it is likely to become more widely used.