NEW ORLEANS — Obesity could severely reduce the chance for prosthetic rehabilitation in lower limb amputees, according to a speaker here at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium.
With such large amounts of soft tissue surrounding the residual limb, it is difficult to capture bone needed to properly control a prosthesis, Heikki Uustal, MD, medical director of the Prosthetic and Orthotic Team at JFK-Johnson Rehab Institute, said.
Most suspension designs hold soft tissue, so ischial capture may be nearly impossible in a transfemoral socket, he said. This could result in lateral shift and femur abduction.
Establishing a functional level for componentry is also a challenge. Shrinkers, gel liners and socks are often not manufactured to fit large residual limbs. Patients often experience decreased mobility and endurance as well as higher costs of energy. Skin breakdown and early onset of osteoarthritis in weight-bearing joints could occur, leading to increased pain, less involvement in daily activities and reduced in quality of life.
“Almost 70% of the general adult population is overweight or obese,” Uustal said. “So that means a good part of the prosthetic population is overweight or obese. We need to be more aware. We need to be addressing this.”
Treatment options such as diet, behavioral therapy, medication and surgery could reduce obesity in certain patients, Uustal said, but rebound weight gain is a common setback.
He added that while obesity is not always a predictor of functional outcomes in prostheses, physicians should continue to monitor and educate at-risk patients.
“Let’s calculate BMI, let’s warn our patients when they slip into the overweight category. It is not an opinion, it is an objective measure…and it could have a profound impact on the fit of a device.” – by Shawn M. Carter
Uustal. OS9. Presented at: American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium; Feb. 18-21, 2015; New Orleans.
Disclosure: Uustal is a salaried physician at the JFK-Johnson Rehab Institute. He is on the board of governors for AAPMR; the board of directors for the New Jersey Orthotic and Prosthetic licensing board; is a scientific reviewer for SAR/Department of Defense and the Orthotic/Prosthetic Research Outcome Panel.