The prosthetic rate, preoperative clinical characteristics & ambulatory functional outcome of below knee amputations : a retrospective descriptive analysis of all BKA patients having had surgery in CWMH from January 1, 2016 to January 1, 2017

Introduction: Anecdotally our prosthetic rate is low. Despite being a major determinant of functional independence, ambulation after major limb amputation has not been well studied. The purpose, therefore, of this study was to investigate the relationship between a variety of preoperative clinical characteristics and postoperative use of a prosthetic limb.
Aim: To describe the prosthetic outcomes for those having had a BKA at CWMH between January 1, 2016 and January 1, 2017. To determine associations between preoperative clinical characteristics and post amputation prosthetic usage, as well post prosthetic fitting ambulatory function.
Objectives:
To determine the prosthetic rate of below knee amputations in CWMH
• To determine association between preoperative clinical characteristics and the use of a prosthetic limb
• To determine ambulatory function in patients who have had a prosthesis after a BKA
Method(s): This is a retrospective descriptive study. From January 1, 2016 to January 1, 2017, 144 BKA were done at CWMH. Of these, data was available for 124 cases.The mean agae at presentation was 58 yrs, the ratio of males to females was 1.3 and 70% of amputations were of iTaukei ethnicity. Analysis was performed using chi square testing & fisher exact testing to determine association between variuos preoperative clinical characteristics and post amputation prosthetic usage. A review of folders of those with a prosthesis was made to determine ambulation post fitting.
Results: Prosthetic rate was 40% (50 out of 124 went on to be fitted with a prosthesis). By ethnicity, the prosthetic rate amongst FOID was 56% compared with 33% amongst iTaukei. Statistically significant preoperative characteristics associated with not wearing a prosthesis include- Age>70 (p<0.001), Female (p<0.001), iTaukei (p<0.001), Previous Amputation (p<0.001), Bilateral Amputation (p<0.001), Higher Amputation (p<0.005), Multiple comorbidities (p<0.001), Cardiac condition (p<0.001), eGFR <58 (p<0.033). Paucity of information on the post-prosthetic fitting ambulatory status. 1-year mortality rates amongst those with prostheses were 2% and amongst those without was 14.9%. The overall 1-year mortality rate was 9.7%.
Conclusion: Our prosthetic rate is in keeping with the literature 45-55%, our mortality rates are lower than what is documented in literature. Amongst our group of patients without prosthesis, there are a lot of preoperative clinical characteristics of post-amputation prosthetic usage. Of significance is the higher number of amputations amongst our indigenous population and despite this a generally lower prosthetic uptake as compared to the general population. Collectively this information indicates that our prosthetic rate is lower than it should be, the need for resource and capacity building with regards to prosthetics and importantly to address behavioural and socioeconomic discrepancies in the general population with regards to non-traumatic lower limb amputations and post amputation prosthetic usage.