Impact of Incision Technique and Post-operative Factors on Time to Prosthetic Fitting following Transtibial Amputation: A SwedeAmp Registry Study.

Abstract

This study aimed to evaluate the prosthetic fitting rate in lower limb amputation, with a focus on transtibial amputation (TTA) cases, using data from the SwedeAmp registry. It also explored the relationship between incision technique, post-operative treatments, socket fabrication methods, and time to prosthetic fitting in patients undergoing TTA. This register-based outcome study examined prosthetic fitting rates following 4,419 lower-limb amputations (LLAs) performed in 3,915 patients across 17 hospitals in Sweden. The cohort comprised 2,443 transtibial amputations (TTA), 373 knee disarticulations (KD), and 1,603 transfemoral amputations (TFA). Data were obtained from the SwedeAmp registry (2018-2023) and cross-referenced with the Swedish National Inpatient Register, as described in a previous study. Only hospitals with a registry coverage rate of ≥60% were included. Outcome measures included prosthetic fitting rate, age and sex distribution, and detailed post-operative outcomes for TTA cases. Among 826 patients, 859 residual limbs were fitted with prostheses. The prosthetic fitting rates were 80.3% for TTAs, compared with 3.7% for knee disarticulations and 15.9% for transfemoral amputations. A statistically significant man to women ratio of approximately 2:1 was observed. In the 450 TTA cases with complete datasets, 66.2% used the sagittal incision technique. The shortest median time to prosthetic fitting (37 days; interquartile range 26.3 days) was observed when the sagittal incision was combined with post-operative silicone liner compression therapy initiated within one week, and the direct fit method was used for socket fabrication. In contrast, delaying compression therapy beyond one week nearly doubled the time to prosthetic fitting, with a median fitting time of 76 days. Combining the sagittal incision technique with early post-operative silicone liner compression therapy and the direct fit fabrication method significantly reduced the time to prosthetic fitting in patients who underwent TTA. This approach has the potential to enhance rehabilitation outcomes and improve the quality of care for individuals undergoing TTA.