Long-term cost comparison of major limb salvage using the Ilizarov method versus amputation

Hospital costs and professional fees of Ilizarov limb reconstruction patients were compared with hospital costs, professional fees, and prosthetic costs of lower-extremity amputation patients. Ten patients with tibial nonunions, osteomyelitis, infected nonunions, and/or bone defects underwent Ilizarov limb reconstruction while six patients with similar traumatic injuries underwent amputation (three acute and three delayed). The average age was 41 years for the Ilizarov group and 40 years for the amputation group. Both the Ilizarov and the amputation groups required an average of four surgical procedures. The average hospital length of stay was 16 days for the Ilizarov group and 25 days for the amputation group. The total average treatment time was 322 days for the Ilizarov group and 175 days for the amputation group. The total cost of the Ilizarov limb reconstruction averaged $59,213.71. The hospital costs and professional fees for the amputation group averaged $30,148.02 without prosthetic costs, but with the projected lifetime prosthetic costs included, averaged $403,199.18. This study suggests that Ilizarov limb reconstruction is cost-effective when compared with amputation when prosthetic costs are also considered.