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Measurements of Motor Function and Other Clinical Outcome Parameters in Ambulant Children with Duchenne Muscular Dystrophy
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Ambulation and functional outcome after major lower extremity amputation.

Atish Chopra1, Amir F Azarbal1, Enjae Jung1

  • 1Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore.

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Less than 50% of patients achieve ambulation after major lower extremity amputations (MLEAs). Obesity and frailty significantly predict nonambulatory status, highlighting the need for fitness improvement and tailored surgical considerations.

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Area of Science:

  • Orthopedics
  • Vascular Surgery
  • Rehabilitation Medicine

Background:

  • Major lower extremity amputations (MLEAs) are a significant cause of disability.
  • Contemporary trends in functional outcomes and predictability following MLEA are not well-understood, particularly in aging and obese populations.

Purpose of the Study:

  • To evaluate current trends in functional outcomes after major lower extremity amputations (MLEAs).
  • To identify factors predicting ambulatory status post-MLEA in an evolving patient demographic.

Main Methods:

  • Retrospective chart review of patients undergoing MLEA between October 2005 and November 2016.
  • Analysis of demographics, comorbidities, perioperative variables, and outcomes using descriptive statistics, t-tests, chi-squared tests, and multivariate logistic regression.
  • Survival analysis performed using the Kaplan-Meier method.

Main Results:

  • The 1-year postamputation ambulatory rate was 46.1%.
  • Nonambulatory patients exhibited higher BMI, lower hematocrit, increased modified frailty index (mFI), higher rates of chronic alcohol use, dependent preoperative functional status, and lack of family support.
  • Predictors of nonambulatory status included increased BMI (OR, 0.88) and mFI (OR, 0.23), while higher hemoglobin was protective (OR, 1.3).

Conclusions:

  • Less than 50% of patients achieve ambulation after MLEA.
  • Patient counseling should emphasize the impact of obesity on ambulatory outcomes, motivating fitness improvements.
  • Consideration for above-knee amputations (AKAs) is recommended for patients with elevated mFI, dementia, or on dialysis.