Trans-femoral amputation in elderly dysvascular patients: reliable results with a technique of myodesis

The clinical and functional results of traditional techniques for trans-femoral amputation are often poor. The ISPO consensus conference on amputation surgery in 1990 at Glasgow recommended myodesis as an important integral part of surgical procedure and should be carried out as much as possible. Muscle stabilization provides a stable functional amputation stump. This improves the prosthetic management and walking ability. A technique of myodesis for trans-femoral amputation has been developed in Dundee, especially for elderly dysvascular patients. The functional and clinical results of this technique were studied in 33 patients, who underwent the surgical procedure. Data regarding patient demographics, postoperative morbidity, mortality and functional status were obtained from a prospectively recorded pro forma. Fourteen patients out of 33, who were operated using this technique, were fitted with artificial limbs. Of these, 11 (78.5%) were still using the prosthesis at a mean follow-up of 40 months. There was 100% primary wound healing. Two patients underwent further revision surgery for delayed stump problems. Good clinical and functional results were obtained using this technique. It is particularly suited for the elderly dysvascular patients, whose stumps are shorter and bone quality poor. The low rate of stump problems and consequent revision surgery enables a more comfortable stump for non-prosthetic users.