Journal of orthopaedic trauma · 2026
Do Amputation Characteristics Predict Outcomes Measures and Infections After Osseointegration Surgery?
СтатьяНазвание и аннотация: Перевод в очереди
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Rivera Julio A, Bozzay Ashley B, Souza Jason M, Potter Benjamin K, Forsberg Jonathan A
Аннотация
OBJECTIVE: To determine which patient characteristics are associated with patient-reported outcomes (PROs) and infection outcomes after transfemoral Osseointegration (OI) surgery.
DESIGN: Single-center retrospective study.
SETTING: Walter Reed National Military Medical Center, Bethesda, MD.
PATIENT SELECTION CRITERIA: Patients who underwent unilateral or bilateral transfemoral OI surgery and completed 2-year follow-up.
OUTCOME MEASURES AND COMPARISONS: Baseline patient characteristics (age at primary amputation, time living with limb loss, residual femur length, age at OI surgery, and limb-loss-adjusted body mass index [BMI]) were evaluated as predictors of change in PROs from baseline to 2-year follow-up (Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) domains, patient-reported outcomes measurement information system (PROMIS) domains, and patient-reported prosthesis use) and of infection outcomes (any infection and number of infections), using generalized linear models with Akaike information criteria-guided backward elimination and adjustment for amputation laterality (unilateral vs. bilateral).
RESULTS: There were 54 patients included (37 unilateral and 17 bilateral) who completed 2-year follow-up. The unilateral cohort had a mean age of 41.1 years (range, 24-72 years) and was predominantly male (33 men and 4 women), whereas the bilateral cohort had a mean age of 33.6 years (range, 26-41 years) and consisted entirely of male patients. Adjusted BMI best predicted changes in Q-TFA Global (R 2 = 0.06, F(1,48) = 3.8, P = 0.05) and problem scores (R 2 = 0.07, F(1,48) = 4.7, P = 0.03), as well as PROMIS Pain Interference (R 2 = 0.25, F(1,50) = 17.8, P < 0.001) and Pain Behavior scores (R 2 = 0.26, F(1,50) = 18.7, P < 0.001) between baseline and 2-year follow-up. Adjusted BMI also best predicted changes in Q-TFA Prosthetic Use, PROMIS Physical Function, and prosthesis use time. Adjusted BMI was the strongest predictor of the number of infections.
CONCLUSION: Among unilateral and bilateral transfemoral amputees undergoing OI surgery with 2-year follow-up, lower adjusted BMI was associated with improved PROs and fewer infection events. Differences between unilateral and bilateral amputees suggest that amputation laterality may modify postoperative outcomes.
LEVEL OF EVIDENCE: Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Single-center retrospective study.
SETTING: Walter Reed National Military Medical Center, Bethesda, MD.
PATIENT SELECTION CRITERIA: Patients who underwent unilateral or bilateral transfemoral OI surgery and completed 2-year follow-up.
OUTCOME MEASURES AND COMPARISONS: Baseline patient characteristics (age at primary amputation, time living with limb loss, residual femur length, age at OI surgery, and limb-loss-adjusted body mass index [BMI]) were evaluated as predictors of change in PROs from baseline to 2-year follow-up (Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) domains, patient-reported outcomes measurement information system (PROMIS) domains, and patient-reported prosthesis use) and of infection outcomes (any infection and number of infections), using generalized linear models with Akaike information criteria-guided backward elimination and adjustment for amputation laterality (unilateral vs. bilateral).
RESULTS: There were 54 patients included (37 unilateral and 17 bilateral) who completed 2-year follow-up. The unilateral cohort had a mean age of 41.1 years (range, 24-72 years) and was predominantly male (33 men and 4 women), whereas the bilateral cohort had a mean age of 33.6 years (range, 26-41 years) and consisted entirely of male patients. Adjusted BMI best predicted changes in Q-TFA Global (R 2 = 0.06, F(1,48) = 3.8, P = 0.05) and problem scores (R 2 = 0.07, F(1,48) = 4.7, P = 0.03), as well as PROMIS Pain Interference (R 2 = 0.25, F(1,50) = 17.8, P < 0.001) and Pain Behavior scores (R 2 = 0.26, F(1,50) = 18.7, P < 0.001) between baseline and 2-year follow-up. Adjusted BMI also best predicted changes in Q-TFA Prosthetic Use, PROMIS Physical Function, and prosthesis use time. Adjusted BMI was the strongest predictor of the number of infections.
CONCLUSION: Among unilateral and bilateral transfemoral amputees undergoing OI surgery with 2-year follow-up, lower adjusted BMI was associated with improved PROs and fewer infection events. Differences between unilateral and bilateral amputees suggest that amputation laterality may modify postoperative outcomes.
LEVEL OF EVIDENCE: Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.