Team Approach to Short versus Below-Knee Amputation Yields Equivalent Patient-Reported Outcomes in Both Groups.

Abstract

The choice between limb salvage with the controversial midfoot amputation or below-knee amputation (BKA) is largely subjective. We seek to compare patient-reported outcomes measures (PROMs) and complication rates of the Chopart and Lisfranc midfoot amputations to BKA. A single-center retrospective cohort study was performed from October 2017 to September 2023 of adult patients undergoing Lisfranc, Chopart, or BKA. Lisfranc and Chopart amputations were grouped as midfoot amputations and compared to BKA. Patient demographics, comorbidities, adverse outcomes, and PROMs were compared. The Lower Extremity Functional Scale (LEFS), PROM Information System Pain Intensity (PROMIS-3a), Self-Reporting Questionnaire-20 (SRQ-20), and Connor-Davidson Resilience Scale (CD-RISC) were collected from ambulatory patients at least 6 months after surgery. A TOTAL OF 73 PATIENTS WERE INCLUDED: 18 underwent midfoot amputation (6 Lisfranc and 12 Chopart), and 55 BKA. The average age was 62.5±12.0 years with an average Charlson Comorbidity Index of 5.0 [IQR: 4.0] and a median follow-up duration of 40.6 [27.8] months. Midfoot amputees had insignificantly higher rates of postoperative complication (16.7% vs 3.6%, p=0.092) and significantly higher rates of recurrence requiring revision surgery (44.4% vs 18.2%, p=0.025). PROMs were similar between groups. Multivariate regression analysis revealed that function was independently associated with peripheral vascular disease (B=-10.1, p=0.047) and psychological distress (B=-2.4, p=0.002), but not amputation type (p=0.978). With a team-based approach that prioritizes function and patient preference, patient-reported function is impacted by comorbidity and mental health, not by amputation level.