Surgical revision of post-traumatic lower limb amputations: risk factors and remote functional impact.

Background: Lower limb amputations performed following trauma are associated with a high risk of revision surgery.
Purposes: The aim of this study was to determine risk factors for revision surgery following post-traumatic lower limb amputations.
Patients and method: A single-centre retrospective study was conducted between January 2010 and February 2020 on patients who had undergone traumatic lower-limb amputation. The primary endpoint was late revision surgery more than 6 months after the initial amputation. A functional assessment was also performed at the last follow-up. The minimum follow-up period was 1 year.
Results: A total of 86 patients and 96 amputations were included. The rate of revision surgery more than 6 months after amputation was 38.3%. Aetiologies included resurfacing (28.7%), heterotopic ossification (20.2%), late infection (11.7%) and neuroma (9.6%). Patients aged over 30 years had fewer late revisions (OR=0.26 [0.08–0.79]; p=0.021 for the group between 30 and 49 years and 0.12 [0.03–0.42]; p=0.002 for the group > 50 years). A Simplified Acute Physiology Score (SAPS) II greater than 45 was a protective factor against late revisions (0.15 [0.03–0.65]; p=0.016). Amputation of at least two limbs increased the probability of late revision surgery (OR=7.07 [1.83–33.06]; p=0.007) and reduced the probability of being fitted with a splint at 90 days (HR=0.25 [0.10–0.65]; p=0.004). The majority (94%) of patients were fitted with prostheses and 71.2% had returned to work by final follow-up (mean 7 years [SD = 2.7]).
Discussion: Young age appears to be a determining factor in the development of late stump complications: the high functional requirements of patients in the active phase of their lives implies greater use of the prosthesis and potential overloading of the stump. A critical SAPS II reduces life expectancy: functional requirements are lower, and late stump revisions are less frequent. Because of the severity of the trauma, amputation of at least two limbs delays management and lengthens the time to functional recovery.
Conclusion: The risk factors identified can’t be modified but provide more precise information on the care pathway to be considered for our patients.