Technical Report

Abstract

Introduction:With advances in surgical approach like osteomyoplastic amputation, it is unknown whether outcomes of walking at different speeds or carrying performance by men with an osteomyoplastic transfemoral limb (OTFL) are comparable with those of intact controls. Materials and Methods: Otherwise healthy men with unilateral OTFL and intact controls consented to participate. All were independent walkers without history of diabetes or other dysvascular condition. All underwent 2-minute walk tests (2MWTs) at self-paced and brisk-paced speeds and 25-ft carry-to-capacity testing as part of a multiyear work performance study. For the current report, investigators compared walking and carrying baseline outcomes between OTFL and control groups. Results: Sixmen with OTFL (mean age, 33.7 ± 14.8 years) and 20 controls (mean age, 31.7 ±11.1 years) completed the study. No initial differences between groups were found in age, height, weight, heart rate, blood oxygen saturation, hemoglobin A1c, overall reported pain, or report of perceived exertion scores. However, the OTFL group walked shorter mean distances at self-paced (137.2 ±18.1 m) and brisk-paced (167.8 ± 20.3 m) 2MWTs than the controls did (self-paced, 155.7 ± 19.9 m, P = 0.015; brisk paced, 211.7 ± 3.0 m, P < 0.0001) and demonstrated less 25 ft-carry capacity (18.1 ± 9.7 kg) than the controls did (26.8 ± 3.1 kg; P = 0.001). Reported pain by the OTFL group was greater only during carry testing (P < 0.046). Conclusions: Despite receiving similar, well-fitted prosthetic limbs and standard rehabilitation after osteomyoplastic amputation, the OTFL group demonstrated lower walking and carrying capacities than a comparable control group. Results may reflect that the OTFL group may still be at risk of injury, demonstrating the need for further investigation of gait and other work performance outcomes by work-eligible men with OTFL and standard rehabilitation approaches. (J Prosthet Orthot. 2021;00:00–00) KEY INDEXING TERMS: osteomyoplastic transfemoral limb loss, work performance Approximately 185,000 lower-limb amputation surgeries are performed in the United States each year, and 27% of them are performed proximal to the knee joint, that is, knee disarticulation or transfemoral amputation. Fifty percent of those with transfemoral amputation are of the working age (21–65 years), whose percentage will increase by 27% over the next 10 years because of survival from combat or pathologic conditions that lead to amputation. However, despite advances in technology, medicine, prosthetics, and rehabilitation, the US Department of Labor estimates that 64.1% of those with lower-limb amputation who are employable and could return to a productive life after amputation are not part of the workforce. For those in the working-age group with transfemoral limb loss (TFL), it is imperative that surgery, prosthetics, and rehabilitation strategically focus on returning these individuals to the workforce and remain otherwise healthy and work-eligible. However, the working-age adults with TFL still struggle with job reentry and retention. According to the US Department of Labor, the unemployment rate for working-age adults with any limb loss inMarch 2009 was 13.1%, compared with considerably lower rates for those without limb loss. And, many with amputation fail to enter or reenter the workforce. In short, many otherwise employable people with TFL are not actively at work. The osteomyoplastic technique, still considered a novel surgical approach to transfemoral amputation, was originally described by Janos Ertl, MD, in the early 1900s. The premise of the technique was to use osteoperiosteal flaps to close the medullary canal, reestablish soft tissue balancing, create a cylindrical limb that can accept a prosthesis, prevent severe abduction of the residual limb, and provide adequate distal soft tissue coverage. The surgical approach to osteomyoplastic transtibial amputation as well as the respective rehabilitation has been CAROL P. DIONNE, DPT, PhD, JONATHAND. DAY,MA, CPO, KIMBERLY P. VEIRS, MPT, PhD, and WILLIAM J.J. ERTL, MD, are affiliated with the University of Oklahoma Health Sciences Center. JAMES L. REGENS, PhD, ANDREW H. FAGG, PhD, and DOUGLAS J. BRYANT, PhD, are affiliated with the University of Oklahoma. Disclosure: The authors declare no conflict of interest. Funded by Oklahoma Center for the Advancement of Sciences and Technology Health Grant HR15-017. Copyright © 2021 American Academy of Orthotists and Prosthetists. Correspondence to: Carol P. Dionne, DPT, PhD, University of Oklahoma Health Sciences Center, Department of Rehabilitation Sciences, 1200 North Stonewall Ave, Oklahoma City, OK 73117; email: [email protected] Volume 00 • Number 00 • 2021 1 Copyright © 2021 by the American Academy of Orthotists and Prosthetists. Unauthorized reproduction of this article is prohibited. documented in the literature. However, there is a paucity regarding work performance outcomes related to osteomyoplastic transfemoral limb (OTFL) with current, standard rehabilitation approaches. The walking performance of adults with transfemoral amputation in general has been previously examined. For example, Boonstra and colleagues compared self-paced and brisk walking performed by 24 men and women with transfemoral limb loss (transfemoral and knee disarticulation) and 15 healthy intact controls. The investigators determined that the mean self-selected gait speed and brisk-paced gait speeds were significantly slower in the groups of individuals with amputations than controls. However, comparability between working-age men, specifically with OTFL, and controls performed at different speeds or burden (carry capacity) has yet to be examined. The following report is from the initial segment of a completed multiyear work performance study. The purpose of the current study was to compare performance outcomes from the 2-minute walk test (2MWT) at selfand brisk-paced walking speeds and 25-ft carrying test between otherwise healthymen with unilateral OTFL and intact controls.