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Mingjui Hung - One of the best experts on this subject based on the ideXlab platform.
outcomes and characteristics of patients undergoing percutaneous angioplasty followed by below Knee or above Knee Amputation for peripheral artery diseasePLOS ONE, 2014Co-Authors: Chuntai Mao, Minglung Tsai, Chaoyung Wang, Mingshien Wen, Ichang Hsieh, Mingjui HungAbstract:
Objective Little is known about long-term outcomes among patients who receive percutaneous angioplasty (PTA) for peripheral artery disease (PAD) then undergo below-Knee or above-Knee Amputations. We sought to determine clinical outcomes associated with below-Knee or above-Knee Amputation, along with possible explanatory factors and treatment strategies. Methods Using data from Taiwan’s National Health Insurance Research Database from 1997 to 2010, 7,568 adult patients were divided into three groups: lower extremity preserved (LE), below-Knee Amputation (BK) and above-Knee Amputation (AK). We assessed outcomes including major adverse cardiovascular events (MACE) and associated risk factors. Results Overall MACE was significantly higher in the AK group compared to the LE and BK groups, over a mean follow-up of 2.45 years (hazard ratio [HR]: 1.81; 95% confidence interval [CI]: 1.50–2.18 for AK vs. LE; HR: 1.67; 95% CI: 1.36–2.06 for AK vs. BK). However MACE were similar for the BK and LE groups (HR: 1.08; 95% CI: 0.98–1.20). Overall mortality was highest in the AK group (HR: 1.65, 95% CI: 1.34–2.04 for AK vs. BK). As for patient characteristics, atrial fibrillation was more prevalent in the AK group than in the BK group (17% vs. 7%). Independent risk factors associated with death after above- or below-Knee Amputation included advanced age, heart failure, dialysis, male gender and high patient volume. Conclusion The MACE rate was highest in the AK group, whereas the LE and BK groups were similar in this regard. Furthermore, overall mortality increased with larger area of Amputation.
Ronald P Williams - One of the best experts on this subject based on the ideXlab platform.
does limb salvage surgery offer patients better quality of life and functional capacity than AmputationClinical Orthopaedics and Related Research, 2012Co-Authors: Farbod Malek, Jeremy S Somerson, Shannon Mitchel, Ronald P WilliamsAbstract:
Introduction Patients with aggressive lower extremity musculoskeletal tumors may be candidates for either above-Knee Amputation or limb-salvage surgery. However, the subjective and objective benefits of limb-salvage surgery compared with Amputation are not fully clear.
Matthew R Williams - One of the best experts on this subject based on the ideXlab platform.
Journal of Neuroengineering and Rehabilitation, 2016Co-Authors: Matthew R Williams, Susan E Dandrea, Hugh M HerrAbstract:
An above Knee Amputation can have a significant impact on gait, with substantial deviations in inter-leg symmetry, step length, hip exertion and upper body involvement even when using a current clinical standard of care prosthesis. These differences can produce gait that is less efficient and less comfortable, resulting in slower and shorter distance walking, particularly with long term use. A robotic variable impedance prosthetic Knee (VI Knee) was tested with five individuals (N = 5) with unilateral Amputation above the Knee at fixed speeds both above and below their normal walking speed. Subject gait was measured as they walked along an instrumented walkway via optical motion capture and force plates in the floor. Each subject’s gait while using the VI Knee was compared to that while using their standard of care Knee (OttoBock C-Leg). Significant differences (p < 0.05) in walking between the standard of care and variable impedance devices were seen in step length and hip range of motion symmetries, hip extension moment, Knee power and torso lean angle. While using the VI Knee, several subjects demonstrated statistically significant improvements in gait, particularly in increased hip range of motion symmetry between affected and intact sides, greater prosthesis Knee power and in reducing upper body involvement in the walking task by decreasing forward and affected side lean and reducing the pelvis-torso twist coupling. These changes to torso posture during gait also resulted in increased terminal stance hip flexion moment across subjects. Detriments to gait were also observed in that some subjects exhibited decreased step length symmetry while using the VI Knee compared to the C-Leg. The Knee tested represents the potential to improve gait biomechanics and reduce upper body involvement in persons with above Knee Amputation compared to current standard of care devices. While using the VI Knee, subjects demonstrated statistically significant improvements in several aspects of gait though some were worsened while using the device. It is possible that these negative effects may be mitigated through longer term training and experience with the VI Knee. Given the demonstrated benefits and the potential to reduce or eliminate detriments through training, using a powered device like the VI Knee, particularly over an extended period of time, may help to improve walking performance and comfort.
Alan Dardik - One of the best experts on this subject based on the ideXlab platform.
North American Journal of Medical Sciences, 2014Co-Authors: Roland Assi, Yorg Al Azzi, Clinton D Protack, Willis T Williams, Michael R Hall, Daniel J Wong, Penny Vasilas, Alan DardikAbstract:
Background: Despite low peri-operative mortality after major lower extremity Amputation, long-term mortality remains substantial. Metabolic syndrome is increasing in incidence and prevalence at an alarming rate in the USA. Aim: This study was to determine whether metabolic syndrome predicts outcome after major lower extremity Amputation. Patients and Methods: A retrospective review of charts between July 2005 and June 2010. Results: Fifty-four patients underwent a total of 60 major lower extremity Amputations. Sixty percent underwent below-Knee Amputation and 40% underwent above-Knee Amputation. The 30-day mortality was 7% with no difference in level (below-Knee Amputation, 8%; above-Knee Amputation, 4%; P = 0.53). The mean follow-up time was 39.7 months. The 5-year survival was 54% in the whole group, and was independent of level of Amputation (P = 0.24) or urgency of the procedure (P = 0.51). Survival was significantly decreased by the presence of underlying chronic kidney disease (P = 0.04) but not by other comorbidities (history of myocardial infarction, P = 0.79; metabolic syndrome, P = 0.64; diabetes mellitus, P = 0.56). Conclusion: Metabolic syndrome is not associated with increased risk of adverse outcomes after lower extremity Amputation. However, patients with chronic kidney disease constitute a sub-group of patients at higher risk of postoperative long-term mortality and may be a group to target for intervention.
Smith, George E - One of the best experts on this subject based on the ideXlab platform.
Through-Knee versus above-Knee Amputation for vascular and non-vascular major lower limb Amputations (Review)'Wiley', 2021Co-Authors: Crane Hayley, Boam Gemma, Carradice Daniel, Vanicek Natalie, Twiddy Maureen, Smith, George EAbstract:
BackgroundDiabetes and vascular disease are the leading causes of lower limb Amputation. Currently, 463 million adults are living with diabetes, and 202 million with peripheral vascular disease, worldwide. When a lower limb Amputation is considered, preservation of the Knee in a below‐Knee Amputation allows for superior functional recovery when compared with Amputation at a higher level. When a below‐Knee Amputation is not feasible, the most common alternative performed is an above‐Knee Amputation. Another possible option, which is less commonly performed, is a through‐Knee Amputation which may offer some potential functional benefits over an above‐Knee Amputation.ObjectivesTo assess the effects of through‐Knee Amputation compared to above‐Knee Amputation on clinical and rehabilitation outcomes and complication rates for all patients undergoing vascular and non‐vascular major lower limb Amputation.Search methodsThe Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases; the World Health Organization International Clinical Trials Registry Platform; and the ClinicalTrials.gov trials register to 17 February 2021.We undertook reference checking, citation searching, and contact with study authors to identify additional studies.Selection criteriaPublished and unpublished randomised controlled trials (RCTs) comparing through‐Knee Amputation and above‐Knee Amputation were eligible for inclusion in this study. Primary outcomes were uncomplicated primary wound healing and prosthetic limb fitting. Secondary outcomes included time taken to achieve independent mobility with a prosthesis, health‐related quality of life, walking speed, pain, and 30‐day survival.Data collection and analysisTwo review authors independently reviewed all records identified by the search. Data collection and extraction were planned in line with recommendations outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to assess the certainty of evidence using the GRADE approach.Main resultsWe did not identify RCTs that met the inclusion criteria for this review.Authors' conclusionsNo RCTs have been conducted to determine comparative clinical or rehabilitation outcomes of through‐Knee Amputation and above‐Knee Amputation, or complication rates. It is unknown whether either of these approaches offers improved outcomes for patients. RCTs are needed to guide practice and to ensure the best outcomes for this patient group
Through-Knee versus above-Knee Amputation for vascular and non-vascular major lower limb Amputations (Protocol)'Wiley', 2021Co-Authors: Vanicek Natalie, Crane Hayley, Boam Gemma, Carradice Daniel, Twiddy Maureen, Smith, George EAbstract:
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects of through-Knee Amputation compared to above-Knee Amputation on clinical and rehabilitation outcomes and complication rates in all patients undergoing vascular and non-vascular major lower limb Amputations