The Contemporary "Ertl": A Functional Below-Knee Amputation for Nontraumatic Comorbid Populations

Area of Science:

• Orthopedic Surgery
• Amputation Techniques
• Reconstructive Surgery

Background:

• The Ertl osteomyoplastic approach is an alternative to the Burgess technique for below-knee amputation (BKA).
• This study evaluates the functional outcomes and perioperative considerations of the Ertl technique in a patient population with multiple comorbidities.

Purpose of the Study:

• To compare the functional outcomes of the Ertl technique versus non-Ertl techniques for below-knee amputation.
• To assess perioperative considerations and complication rates in a highly comorbid patient group undergoing BKA.

Main Methods:

• Retrospective review of medical records for BKAs performed by a single surgeon (January 2017 - October 2021).
• Comparison between Ertl (n=51) and non-Ertl (n=243) amputation groups.
• Analysis of patient demographics, comorbidities, targeted muscle reinnervation rates, complication rates, reoperation rates, time to ambulation, prosthesis use, ambulatory status, pain, and mortality.

Main Results:

• Ertl patients were younger with fewer comorbidities. Higher rates of targeted muscle reinnervation were observed in the Ertl group.
• No significant differences in short-term complications or reoperation rates were found between groups.
• Ertl conferred shorter times to ambulation and prosthesis use, with a greater percentage of Ertl patients ambulatory at follow-up. Mortality was significantly lower in the Ertl group.

Conclusions:

• The Ertl technique demonstrates functional advantages in carefully selected patients, including improved ambulation and reduced mortality.
• The findings support the utility of the Ertl approach for nontraumatic lower extremity amputations in multimorbid patients.
• This study reinforces existing literature on the benefits of the Ertl technique for below-knee amputation.