As a group, people who have lost a limb as the result of trauma, a tumor or a congenital limb difference tend to do so earlier in life than those who have an amputation related to diabetes or vascular disease. As a result of being younger, more active, and a prosthesis wearer for a greater length of time, many of these people experience secondary medical problems mostly in the joints of the lower limbs and the spine.
Awareness of the potential medical problems that could arise is important especially since it may be possible to prevent or reduce the risk of secondary complications by being proactive with your prosthetic care. It appears that the changes in activities with a prosthesis, such as walking, can have a significant influence on the joints of the lower limbs and the spine.
For instance, some studies have found that osteoarthritis, or degenerative joint disease, is two to three times more likely to occur in amputees than in the nonamputee population. The knee joint appears to have the greatest percentage of osteoarthritic problems followed by the hip, ankle and foot. Furthermore, people with transfemoral (above-knee) amputations have been found to have significantly more problems than those with transtibial (below-knee) or foot amputations.
Even though people walk considerably slower with a prosthesis, the forces at the joints are markedly higher during weight acceptance or when the sound limb is on the ground. The combination of a slower gait and increased forces may contribute to the early sound limb joint degeneration in lower-limb amputees. In contrast, lower gait velocities in nonamputees result in reduced joint reaction forces.
Low back pain is another common problem. In the general population, an estimated 10 to 50 percent of people experience lower back pain. In the amputee population, it is estimated that as high as 75 percent experience back pain. In a recent study, Ehde DM, et al, (2001) reported that 50 percent experienced back pain with mild intensity, 25 percent with moderate intensity and 25 percent with severe intensity. While most respondents reported that their back pain interfered with activity only minimally or not at all, the presence of pain suggests that something is injured.
Scoliosis, or an increased curvature of the spine, can occur over time with prosthesis wearers. One report suggested that approximately 65 percent of amputees have some degree of scoliosis. The type of scoliosis related to amputation typically is related to posture; therefore, good posture, exercise and proper prosthetic fitting can reduce the degree of curvature.
The amputated-side hip can also undergo change over time. Studies have shown that the hip joint bones lose density, or develop osteoporosis, over time. Likewise, several studies have found that osteoarthritis, or degenerative joint disease, is fairly common in the amputated-side hip. It has been suggested that the loss of bone density could be due to the altered weight-bearing status, changes in blood flow because of the amputation, or a combination of things related to wearing a prosthesis and activity.
Although it may appear that the loss or absence of a limb will result in a lifetime of medical problems, studies show that the majority of amputees who lose a limb early in life go on to live long and productive lives. Everyone, regardless of whether he or she is an amputee or not, might develop any of the aforementioned medical problems sometime in his or her life. Because of the prosthesis, however, amputees may have a greater risk.
The good news is that many of the traditional gait deviations once associated with wearing a prosthesis are not as pronounced today because of advanced technology and prosthetic designs. As a result, the stress and strain to the body may not be as great as it was with older prosthetic designs, and, therefore, there may be a reduction in the complications reported in earlier studies. We do not know this for sure; however, because the medical community is more aware today of secondary conditions than they were years ago, steps can be taken to avoid complications associated with amputation. The following are suggestions that you may follow to help reduce the risk of complications related to limb loss.
Ten simple steps that you can take to avoid complications to your sound leg and back:
- Be sure that your prosthesis fits correctly at all times.
- Be sure that your prosthetic and sound limb are of equal height, and avoid having your prosthesis shortened.
- Walk with an equal width of walking base, and don't favor your sound leg.
- Avoid hopping excessively on your sound limb when you are not using your prosthesis. Use crutches around the house when you are not wearing your prosthesis.
- Stand with equal weight distributed between your limbs, and avoid favoring your sound limb.
- Maintain good posture during sitting and standing.
- If pain is present, use a cane to reduce excessive stress to your knee or back.
- Maintain a nutritious diet and retain your appropriate body weight.
- Exercise regularly, incorporating a strengthening, stretching and cardiovascular endurance program.
- Maintain a regular appointment schedule with your doctor, prosthetist and physical therapist.
About the Author
Robert Gailey, PhD, PT, is an associate professor at the University of Miami School of Medicine, Department of Physical Therapy.
