SAN ANTONIO — Patients who received an immediate postoperative prosthesis had equivalent outcomes compared to patients who underwent a traditional below knee amputation and compressive dressings, according to data presented here.
Art Shea, CPO, presented the results of the study which compared outcomes for patients with transtibial amputation who did and did not receive an immediate postoperative prosthesis (IPOP) during the Thranhardt Lecture Series at the American Orthotic and Prosthetic Association National Assembly, here.
Art Shea
A previous study had found IPOP is not widely used due to “unacceptable rates of wound complications,” Shea said.
Shea and colleagues conducted a retrospective study of 37 patients who underwent IPOP and 35 patients who underwent traditional soft compressive dressing placement and were IPOP candidates but did not receive an IPOP. They compared outcomes, including perioperative system complications, wound complications, need for surgical revision and the time until placement of a definitive prosthesis.
Perioperative complication rates were not significantly different between the two groups, although one perioperative mortality occurred in the case control group. There was no difference in overall wound infection rates, but the researchers noted a slight trend toward higher rates in non-IPOP patients. The results also did indicate a significant difference in wound dehiscence between the groups.
The control group was twice as likely to fall as the IPOP group (21% vs. 11%). The IPOP group also was able to receive earlier placement of the initial prosthesis. Ambulation was achieved more quickly in the IPOP group at a statistically significant level. The need for surgical revision also was significantly lower for the IPOP group than for the control group.
Shea said IPOP is an acceptable alternative to traditional transtibial amputation with traditional soft compressive dressing placement, but a successful outcome depends on the partnership between the prosthetist and surgeon.
“Close cooperation with doctors in their offices is essential to set up the protocol for the IPOP,” Shea said. “Include instructions for the OR; the doctor’s orders to be written at that time for the [physical therapy] in-hospital the next day; and for the rehab facility when they go.”
The cast should be applied immediately postsurgery to prevent infection and cast changes can be determined postsurgery, he said.
Careful selection of patients who will succeed with an IPOP is also important: patients with poor rehabilitation potential or who are noncompliant are not good candidates. But for carefully selected patients, the procedure can offer physiological and psychological benefits.
“The IPOP application should be considered for all appropriate candidates requiring below knee amputation if they meet the criteria,” Shea said. – by Amanda Alexander
Reference: Shea A. Immediate postoperative prosthesis: A comparative analysis. Presented at: American Orthotic and Prosthetic Association National Assembly; Oct. 7-10, 2015; San Antonio.
Disclosure: Shea reports no relevant financial disclosures.
