Background: A recent study demonstrated that patients treated with
amputation and those treated with reconstruction had comparable functional
outcomes at two years following limb-threatening trauma. The present study was
designed to determine whether those outcomes improved after two years, and
whether differences according to the type of treatment emerged.
Methods: Three hundred and ninety-seven patients who had undergone
amputation or reconstruction of the lower extremity were interviewed by
telephone at an average of eighty-four months after the injury. Functional
outcomes were assessed with use of the physical and psychosocial subscores of
the Sickness Impact Profile (SIP) and were compared with similar scores
obtained at twenty-four months.
Results: On the average, physical and psychosocial functioning
deteriorated between twenty-four and eighty-four months after the injury. At
eighty-four months, one-half of the patients had a physical SIP subscore of
=10 points, which is indicative of substantial disability, and only 34.5%
had a score typical of a general population of similar age and gender. There
were few significant differences in the outcomes according to the type of
treatment, with two exceptions. Compared with patients treated with
reconstruction for a tibial shaft fracture, those with only a severe
soft-tissue injury of the leg were 3.1 times more likely to have a physical
SIP subscore of 5 points (p < 0.05) and those treated with a
through-the-knee amputation were 11.5 times more likely to have a physical
subscore of 5 points (p < 0.05). There were no significant differences in
the psychosocial outcomes according to treatment group. Patient
characteristics that were significantly associated with poorer outcomes
included older age, female gender, nonwhite race, lower education level,
living in a poor household, current or previous smoking, low self-efficacy,
poor self-reported health status before the injury, and involvement with the
legal system in an effort to obtain disability payments. Except for age,
predictors of poor outcome were similar at twenty-four and eighty-four months
after the injury.
Conclusions: The results confirm previous conclusions that
reconstruction for the treatment of injuries below the distal part of the
femur typically results in functional outcomes equivalent to those of
amputation. Regardless of the treatment option, however, long-term functional
outcomes are poor. Priority should be given to efforts to improve
post-acute-care services that address secondary conditions that compromise
optimal recovery.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.