Skip to main content

Advertisement

SpringerLink
Log in

The effect of amputation level and age on outcome: an analysis of 135 amputees

  • Original Article • GENARAL ORTHOPAEDICS - LOWER LIMB
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

In this retrospective study, the impact of age, amputation level and the cause of amputation were examined using the Hospital Anxiety and Depression Scale (HADS) and Medicare K scores of amputees with unilateral lower-limb amputation.

Materials and methods

In total, 135 patients with unilateral transfemoral (TF) or (TT) transtibial amputations were examined. All data were collected using questionnaires that were either self-administered or administered during an interview. The HADS was developed as a self-reporting questionnaire to detect adverse anxiety and depressive status. K code is used to describe the functional abilities of amputees.

Results

The mean age at the time of surgery was 52.79 ± 13.08 years. The mean time since amputation was 59.20 ± 24.41 months for TT, and 60.89 ± 22.09 months for TF amputation. The HADS-A scores of the transfemoral amputation group were determined as significantly high compared to those of the transtibial group (p < 0.05). The K index of the group aged 35 years and below was significantly higher than that of the other groups (p 0.002, p 0.001, p < 0.01).

Conclusion

The data show higher HADS-A scores with traumatic transfemoral amputation. Therefore, adequate psychiatric evaluation and rehabilitation should be applied to all amputees, especially in cases of young, traumatic, transfemoral amputations.

Level of Evidence

Level 3, retrospective comparative cohort study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    Article  PubMed  CAS  Google Scholar 

  2. Beekman C, Axtell L (1987) Prosthetic use in elderly patients with dysvascular above-knee and through-knee amputations. Phys Ther 67:1510–1516

    PubMed  CAS  Google Scholar 

  3. Bradway JK, Malone JM, Racy J, Leal JM, Poole J (1984) Psychological adaptation to amputation: an overview. Orthop Prosthet 38:46–50

    Google Scholar 

  4. Cansever A, Uzun O, Yildiz C, Ates A, Atesalp AS (2003) Depression in men with traumatic lower part amputation: a comparison to men with surgical lower part amputation. Mil Med 168:106–109

    PubMed  Google Scholar 

  5. Cavanagh SR, Shin LM, Karamouz N, Rauch SL (2006) Psychiatric and emotional sequelae of surgical amputation. Psychosomatics 47:459–464

    Article  PubMed  Google Scholar 

  6. Dillingham TR, Pezzin LE, MacKenzie EJ (2002) Limb amputation and limb deficiency: epidemiology and recent trends in the United States. South Med J 95:875–883

    PubMed  Google Scholar 

  7. Doğan A, Sungur İ, Bilgiç S, Uslu M, Atik B, Tan O et al (2008) Amputations in eastern Turkey(Van): a multicenter epidemiological study. Acta Orthop Traumatol Turc 42:53–58

    Article  PubMed  Google Scholar 

  8. Fisher K, Hanspal RS (1998) Phantom pain, anxiety, depression, and their relation in consecutive patients with amputated limbs: case reports. BMJ 316:903–904

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  9. Gailey RS, Roach KE, Applegate EB, Cho B, Cunniffe B, Licht S, Maguire M, Nash MS (2002) The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee’s ability to ambulate. Arch Phys Med Rehabil 83:613–627

    Article  PubMed  Google Scholar 

  10. Hawamdeh ZM, Othman YS, Ibrahim AI (2008) Assessment of anxiety and depression after lower limb amputation in Jordanian patients. Neuropsychiatr Dis Treat 4:627–633

    Article  PubMed  PubMed Central  Google Scholar 

  11. Johnson V, Kondziela S, Gottschalk F (1995) Pre and post-amputation mobility of trans-tibial amputees: correlation to medical problems, age and mortality. Prosthet Orthot Int 19:159–164

    PubMed  CAS  Google Scholar 

  12. Keagy B, Schwartz J, KotbM Burnham S, Johnson G (1986) Lower extremity amputation: the control series. J Vasc Surg 4:321–326

    Article  PubMed  CAS  Google Scholar 

  13. Kerstein M, Zimmer H, Dugdale F, Lerner E (1975) What influence does age have on rehabilitation of amputees? Geriatrics 30:67–71

    PubMed  CAS  Google Scholar 

  14. Leung EC-c, Rush PJ, Devlin M (1996) Predicting prosthetic rehabilitation outcome in lower limb amputee patients with the functional independence measure. Arch Phys Med Rehabil 77:605–608

    Article  PubMed  CAS  Google Scholar 

  15. Melchiorre P, Findley T, Boda W (1996) Functional outcome and comorbidity indexes in the rehabilitation of the traumatic versus the vascular unilateral lower limbamputee. Am J Phys Med Rehabil 75:219–224

    Google Scholar 

  16. Moore T, Barron J, Hutchinson F, Golden C, Ellis C, Humphries D (1989) Prosthetic usage following major lower extremity amputation. Clin Orthop 238:219–224

    PubMed  Google Scholar 

  17. Muzaffar N, Mansoor I, Hafeez A, Margoob M (2012) Psychiatric comorbidity in amputees with average sociodemographic status and the role of theologic and family support in a conflict zone. Australas J Disaster Trauma Stud 1:31–38

    Google Scholar 

  18. Ng E, Berbrayer D, Hunter G (1996) Transtibial amputation: preoperative vascular assessment and functional outcome. J Prothet Orthot 8:123–129

    Article  Google Scholar 

  19. Pezzin LE, Dillingham TR, MacKenzie EJ (2000) Rehabilitation and the long-term outcomes of persons with trauma-related amputations. Arch Phys Med Rehabil 81:292–300

    Article  PubMed  CAS  Google Scholar 

  20. Pohjolainen T, Alaranta H, Karkkainen M (1990) Prosthetic use and functional and social outcome following major limb lower limb amputation. Prosthet Orthot Int 14:75–79

    PubMed  CAS  Google Scholar 

  21. Radloff L (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  22. Rommers GM, Vos LD, Groothoff JW, Schuiling CH, Eisma WH (1997) Epidemiology of lower limb amputees in the north of The Netherlands: aetiology, discharge destination and prosthetic use. Prosthet Orthot Int 21:92–99

    PubMed  CAS  Google Scholar 

  23. Seidel E, Lange C, Wetz HH, Heuft G (2006) Anxiety and depression after loss of a lower limb. Orthopade 35:1154–1158

    Article  Google Scholar 

  24. Settakorn J, Rangdaeng S, Arpornchayanon O, Lekawanvijit S, Bhoopat L, Attia J (2005) Why were limbs amputated? An evaluation of 216 surgical specimens from Chiang Mai University Hospital. Thail Arch Orthop Trauma Surg 125:701–705 Epub 2005 Oct 8

    Article  Google Scholar 

  25. Snaith RP, Zigmond AS (1986) The hospital anxiety and depression scale. Br Med J 292:344 (Clin Res Ed)

    Article  CAS  Google Scholar 

  26. Zidarov D, Swaine B, Gauthier-Gagnon C (2009) Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up. Arch Phys Med Rehabil 90:634–645

    Article  PubMed  Google Scholar 

  27. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Haseki Training and Research Hospital, Fatih, 34096, Istanbul, Turkey

    Murat Yilmaz, Ibrahim Kaya & Erhan Bayram

  2. Dr. Lütfi Kırdar Kartal Training and Research Hospital, Semsi Denizer Cad. E5. Yanyol Cevizli Kavsagi, Kartal, 34890, Istanbul, Turkey

    Deniz Gulabi & Gultekin Sitki Cecen

Authors
  1. Murat Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deniz Gulabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ibrahim Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erhan Bayram
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gultekin Sitki Cecen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deniz Gulabi.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yilmaz, M., Gulabi, D., Kaya, I. et al. The effect of amputation level and age on outcome: an analysis of 135 amputees. Eur J Orthop Surg Traumatol 26, 107–112 (2016). https://doi.org/10.1007/s00590-015-1709-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-015-1709-z

Keywords

Search

Navigation