Predictors of Prosthetic Eligibility after Major Lower Limb Amputation: A Retrospective Cohort Study

Peripheral arterial disease (PAD) and lower limb ischemia often require major amputation, with profound effects on patients' quality of life and substantial health care and social costs. Although prosthetic rehabilitation is complex, it can significantly improve functional autonomy and quality of life. This study aimed to identify clinical, functional, and demographic factors associated with prosthetic eligibility to optimize rehabilitation pathways and streamline prosthesis allocation.

A retrospective observational study was conducted, including 218 patients who underwent major lower limb amputation between 2020 and 2023. Demographic, clinical, and functional data were collected. Associations with prosthesis prescription or waiting status were analyzed using chi-squared and Mann-Whitney tests and confirmed by multivariable logistic regression.

Only 30.7% of patients were deemed eligible for a prosthesis, and 12.8% ultimately received the device. In multivariable analysis, preamputation autonomy (odds ratio [OR] = 0.222; P = 0.006) and participation in a rehabilitation program (OR = 34.7; P < 0.001) remained independently associated with prosthetic fitting. Younger age, male sex, and transtibial amputation level were positively associated in univariate analysis.

Preamputation functional autonomy and access to structured rehabilitation programs are critical determinants of successful prosthetic rehabilitation. Early referral and structured rehabilitation strategies may improve functional outcomes, reduce health-care costs, and enhance patients' quality of life.