Transtibial amputation. Prosthetic use and functional outcome.

Annually, roughly 80,000 to 100,000 amputations are performed with a total cost of greater than $50,000 per patient. Amputations in general and TTAs in particular are worthy of investigation to provide a cost-effective functional outcome that provides high patient satisfaction. The process of prosthetic selection, functional outcome, and avoidance of common complications begins with preoperative education of the patient and communication with the rehabilitation team. Determining an individual patient's perceptions of the process and his or her desired functional needs can help establish a baseline for prosthetic prescription and patient education. With the apparent difficulty in predicting who will be functional with a prosthesis, it seems prudent to initiate prosthetic training and fitting with all patients who have a moderate potential for use. Because many patients undergoing this operation have significant illness, as judged by the high mortality rate at follow-up, it is important to begin this process early to promote the highest recovery of functional independence. With the continual improvement in prosthetic components and postoperative management, it seems possible for the ill, elderly patient to regain near preoperative functional independence with the use of a prosthesis.