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Introduction: Clinicians involved in lower-limb prosthetic provision and care do not have an objective method for measuring patients' real-world prosthesis usage. This results in a poor understanding of the full picture of the patient's everyday life impacting the reporting of outcome following prosthetic prescriptions. There is need to understand what information from wearable prosthetic monitors would be relevant to clinicians and how that information should be displayed to enable health care professionals to make informed decisions. Moreover, clinicians' perspectives regarding potential use and application of information from monitoring technologies are important in the development and implementation of this technology to improve evidence-based systems for informed clinical decisions for lower-limb prosthesis users. This study aims to explore clinicians' experiences and perceptions of information obtained from free-living wearable prosthetic monitors used in clinical practice. Methods: Seven clinicians from private practice and academia were recruited to participate in the study. A semistructured interview was held for each participant, which lasted about 30–45 minutes. Data and transcripts were analyzed using inductive thematic analysis method. Results: Themes of objectiveness and motivation were identified as specific applications of monitoring technologies. Other themes such as awareness and integration were identified as the facilitators of monitoring technologies for prosthetic care in clinical settings. Clinicians identified frameworks in which these monitoring technologies could be incorporated into the clinic, how they can receive feedback as a multidisciplinary team, and the inclusion within patients' medical records. Conclusions: This information from prosthetic monitoring technologies could potentially change clinical practice in several ways: by improving the clinical assessment process, improving the prescription process, and improving the rehabilitation process. To improve the clinical assessment process, prosthetic monitoring information can provide real-world data of prosthesis user's utilization, which could be used to quantify patients' self-reports. To improve the prescription process, prosthetic monitoring information can enable clinicians to see if a patient was actively involved in any form of exercise and support them to position their prescription of components within an activity category for their patients. To improve the rehabilitation process, prosthetic monitoring information can be used to plan goals for patients, to measure the progress of patients, and to check for patients' compliance. Clinical Relevance Statement: The impact of these potential changes in clinical practice can ultimately lead to improved clinical decisions in prosthetic care and creation of an evidence-based system. [ABSTRACT FROM AUTHOR]

Aim: A diabetes‐related foot ulcer (DFU) is a major risk factor for lower‐extremity amputation (LEA). To help clinicians predict the risk of LEA in people with DFU, the Diabetic Foot Risk Assessment (DIAFORA) system was developed but has never been externally validated. Methods: In this study, 317 people presenting with a new DFU were included. At baseline, participants were grouped into three groups based on their DIAFORA score: low‐risk (<15), medium‐risk (15–25), and high‐risk (>25). Participants were followed until healing, LEA, death, or at least 3 months. Discriminative accuracy was evaluated using sensitivity, specificity, likelihood ratios (LRs) and the area under the curve (AUC). Results: All 317 participants completed at least 3 months of follow‐up for a median duration of 146 days, during which 12.6% underwent minor amputation and 2.5% major amputation. People in the low‐ and medium‐risk categories had major amputation rates of 0.9% and 2.1%, respectively, and negative LR of major LEA of 0.10 and 0.38, respectively, while the people in the high‐risk category had an amputation rate of 25.0% and a positive LR of 12.9. The DIAFORA risk groups had a sensitivity of 75.0% and a specificity of 65.7%, with a corresponding AUC of 0.78 (95% CI 0.68–0.87) for the prediction of major LEA. Conclusion: The DIAFORA score is a useful tool for risk stratification of people presenting with a newly occurred DFU, with the external validation presenting results similar to those presented in the original study. The DIAFORA score may guide clinicians towards more individualized DFU treatment regimens. [ABSTRACT FROM AUTHOR]

Purpose: Rehabilitation experiences of lower limb amputees with poorer physical health have not been fully explored. This study aimed to qualitatively explore experiences of rehabilitation amongst patients who had recently undergone amputation due to complications of vascular disease. Methods: Semi-structured, face-to-face interviews were conducted with 14 patients participating in the PLACEMENT randomised controlled feasibility trial (ISRCTN: 85710690; EudraCT: 2016-003544-37), which investigated the effectiveness of using a perineural catheter for postoperative pain relief following major lower limb amputation. Framework analysis was used to identify key themes and compare participant data. Findings: Three main themes and corresponding sub-themes were identified: (i) other patients as inspiration; (ii) other patients as competition; and (iii) imagined futures. Perceptions relating to other patients played a key role in rehabilitation, providing a source of motivation, support, and competition. Participants' imagined futures were uncertain, and this was compounded by a lack of information and delays in equipment and/or adaptations. Conclusions: Findings highlight the importance of fellow patients in supporting rehabilitation following lower limb amputation. Enabling contact with other patients should thus be a key consideration when planning rehabilitation. There is a clear unmet need for realistic information relating to post-amputation recovery, tailored to the needs of individual patients. IMPLICATIONS FOR REHABILITATION: There is a clear unmet need for patient information on rehabilitation following major lower limb amputation. Information about future mobility - particularly prosthesis use - should be realistic and individually tailored. The key role of fellow patients should be fully considered when planning post-amputation rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Complicated field extrication may require the assistance of a surgical team to perform an on-scene limb amputation. Although a rare event, when needed, an organized and efficient response is critical to successful outcomes. Methods: The Los Angeles County Hospital Emergency Response Team (HERT) program and the organization of the team is described, and a multidisciplinary quality improvement process reviewed and analyzed two cases and identified areas for performance improvement. Results: Experience shapes policy and procedures within the HERT program. The timeliness of HERT activation has a major influence on the success of extrication, and regular drills of the multidisciplinary team consisting of trauma surgeons, emergency physicians, nurses, paramedics, and fire department allow for rapid, effective activation. Post-event quality improvement process reviews the timeline of events, provider activation, communication across field and hospital providers, in-hospital events, and medical decision making throughout. Critical analysis of every step helps prepare for any subsequent encounter. Conclusion: A well-organized and rehearsed protocol to streamline activation and transportation of a well-trained, designated team, in addition to pre-packaged surgical supplies and an effective communication tree are essential elements of a HERT program. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to develop new evidence-based and consensus-based recommendations for the initial inhospital management of lower-extremity injuries in patients with multiple and/or severe trauma. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with multiple and/or severe Injuries. Methods: MEDLINE and Embase were systematically searched to May 2021. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions for the initial surgical and non-surgical management of fractures, dislocations or vascular injuries of the lower extremities in patients with multiple and/or severe trauma. We considered patient-relevant clinical outcomes such as mortality, complication rates, length of stay, and function. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Results: Eleven studies were identified. They addressed time to definitive fixation (n = 10 studies) and amputation (n = 1). Two new recommendations were developed, one was modified. All recommendations achieved strong consensus. Conclusion: This systematic literature review and subsequent expert consensus process resulted in the following new key recommendations. It is recommended that isolated and multiple lower-extremity fractures are managed with primary definitive fixation in patients whose condition is stable. Patients condition is not considered stable should be managed with primary temporary fixation. In addition, it is recommended that dislocations of the lower extremities are reduced and immobilised as early as possible. [ABSTRACT FROM AUTHOR]

Purpose: The objective was to analyze the treatment and complications of the patients after a major amputation of the upper and lower extremities. Risk factors and predictors of a prolonged hospital stay should be outlined. Methods: This is a retrospective study of a national Level-1 Trauma center in Germany. In a 10-year period, patients were identified by major amputations in the upper and lower extremities. The medical reports were considered and the results were split into four main groups with analysis on basic-, clinical data, the course on intensive care unit and the outcome. A recovery index was established. The patients' degree of recovery was summed up. Statistical analysis was performed. Results: 81 patients were included. A total of 39 (48.1%) major amputations were carried out on the lower leg and 34 (42.0%) involved the thigh. There were two instances (2.5%) of hip joint disarticulation. 6 major amputations were done on the upper extremities (n = 3 on the upper arm, n = 3 on the forearm). 13.83 ± 17.10 days elapsed between hospital admission and major amputation. The average length of hospital stay was 38.49 ± 26,75 days with 5.06 ± 11.27 days on intensive care unit. Most of the patients were discharged home followed by rehabilitation. A significant correlation was found between the hospital length of stay and the increasing number of operations performed (p = 0.001). The correlation between the hospital length of stay and the CRP level after amputation was significant (p = 0.003). Conclusions: Major amputations in trauma patients lead to a prolonged stay in hospital due to severe diseases and complications. Especially infections and surgical revisions cause such lengthenings. [ABSTRACT FROM AUTHOR]

Unilateral leg amputees suffer from an increased risk of gonarthrosis. The risk of substantial joint damage ca be decreased by an early diagnosis, therapy and long-term monitoring to regularly assess the knee joint's condition. To adapt the acoustic-kinetic analysis to unilateral amputees, a hand rig with Hottinger Quantum X440B and 2SMR sensors was added to the measurement setup. It helps the probands to keep their balance and to achieve a fluent motion during their test exercise of 3 knee bends in 10 seconds. The measurement setup comprises a ZebrisR system to measure the vertical ground force, two Zebris SyncR Cams to assess the sagittal knee angle, the frontal horizontal knee shift and - in case of the amputees- the data of the hand forces via the Hottinger sensors. It is crucial to establish if the test exercise is adequate for the amputees and if the probands can perform the exercise regularly and over a long period of time with less than 10% - 20% variation. To this end a case study out of a pilot study of 18 case conditions and 108 measurements is presented to clarify the approach. The proband is female, 43 years old, with a unilateral amputation at the thigh. She does not suffer from arthrosis. She performed the test routine six times over a period of five weeks. The kinetic analysis resulted in a characteristic pattern, comparable to non-amputated patients. The results showed a good recurrence and therefore indicate that the test exercise of 3 knee bends in 10 seconds with hand support will be the exercise prospective studies. [ABSTRACT FROM AUTHOR]

Background: Bone defects and nonunion following initial treatment remain significant clinical challenges. The Ilizarov method constitutes a fundamental approach for addressing bone defects, and its integration with adjunctive techniques, such as the accordion maneuver, antibiotic spacers, or internal fixation, has become increasingly widespread. Despite this, limited research exists on the clinical outcomes specifically related to the use of the Ilizarov method combined with the accordion technique for treating long bone defects in the lower limbs. Objective: This study seeks to systematically review the application of the Ilizarov method in combination with the accordion technique for addressing long bone deficiencies in the lower limbs. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed in alignment with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), involving searches of Medline, Embase, Web of Science, and the Cochrane Library, with the search process concluding on August 20, 2024. The study population consisted of patients with bone defects who underwent treatment using the Ilizarov method in conjunction with the accordion technique. The methodological quality of the included studies was evaluated using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. This study recorded and analyzed the participant count for each study that met the inclusion criteria, along with the number of patients who achieved bone healing, the bone and functional outcomes, and complications such as pin infections, pain, and refracture. Results: Drawing from eight studies involving 80 patients with bone defects treated through the Ilizarov method combined with the accordion technique, this systematic review evaluated the method's impact on bone regeneration. Of these patients, 24% presented with femoral defects, while 76% had tibial defects. The mean patient age was 32.8 years, with an average follow-up of 25.2 months. The accordion technique involved daily distraction and compression adjustments ranging from 0.25 to 1 mm, typically in more than two cycles, effectively promoting bone healing. The bone healing rate was high, with the majority of patients rated as having excellent or good functional recovery, according to standards such as ASAMI and Paley. Common complications included superficial pin tract infections (33.75%) and deep pin tract infections (6.25%), both of which were generally manageable with routine treatment. The accordion technique showed promising results in shortening healing time and enhancing the quality of bone healing. Conclusion: This systematic review demonstrates that despite variations in parameter settings across studies, the Ilizarov method combined with the accordion technique consistently shows strong efficacy and safety in promoting bone regeneration and functional recovery. While some complications may arise, they are generally well-managed with standard care. This approach represents a reliable option for complex bone reconstruction, with future research needed to optimize parameters and further enhance clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Outcome measurement provides clinicians, services and funders with useful information. However, little is known about the experience of participating in outcome measurement during lower limb prosthetic rehabilitation from the patient's perspective. Materials and methods: Thirty-two participants who underwent lower limb amputation within 5 years, and had experience of taking part in outcome measurement during prosthetic rehabilitation, were recruited from UK limb fitting centers and social media. Data were collected using focus groups and interviews and analysed using reflexive thematic analysis. Results: Four themes were identified. (1) How does participating in outcome measurement make me feel? (2) Do the outcome measures used in routine clinical care capture an accurate picture of my recovery? (3) Who is outcome measurement for? and (4) are prosthetic services measuring what is meaningful? These themes suggest outcome measurement is not a neutral activity for patients following lower limb amputation. Conclusions: Harnessing the positive impacts of measuring outcomes could be used for motivation, to support adjustment and recovery, to improve communication and to support shared decision-making. This could make outcome measurement more meaningful and patient-centered. However, there may be potential for patients to respond negatively to outcome measures and clinicians should consider their impact on psychosocial factors. IMPLICATIONS FOR REHABILITATION: Outcome measurement in prosthetic rehabilitation can provide clinicians, service providers and funders with important information. Adopting a patient-centred approach could make the process more meaningful and therefore beneficial for patients themselves. Measuring what is important to patients by considering a holistic approach beyond physical domains may make outcome measurement more meaningful. Patient centred approaches may include talking to patients about outcome measurement, using it to support motivation, goal setting and decision-making, as well as exploring outcome ranges to account for, or even capture variability. However, the potential for negative responses should not be overlooked, and clinicians should consider the psychosocial impact of outcome measurement on this patient group, especially when using performance-based measures. [ABSTRACT FROM AUTHOR]

Background: The management of docking site healing in bone transport remains a significant challenge in orthopedic surgery. Traditional assessment methods rely heavily on qualitative radiographic evaluations. This study investigates the utility of pixel value ratio (PVR), an objective quantitative measure, in assessing bone healing at the docking site during bone transport. Methods: This retrospective study included 47 patients who underwent bone transport for lower limb reconstruction between January 2015 and January 2020. Patients were categorized into bone union (n = 35) and nonunion (n = 12) groups based on docking site outcomes. PVR was calculated using two methods (PVR1 and PVR2) at six time points over 24 months post-docking. Subgroup analyses were performed based on gender, age, and surgical site. Results: Of 47 patients, 35 achieved bone union and 12 experienced nonunion. Both PVR1 and PVR2 were consistently lower in the union group compared to the nonunion group at all time points (p < 0.001). In the union group, PVR1 ranged from 1.064 ± 0.050 to 1.108 ± 0.062, while PVR2 ranged from 0.926 ± 0.079 to 0.946 ± 0.062. In the nonunion group, PVR1 ranged from 1.204 ± 0.057 to 1.273 ± 0.020, and PVR2 from 1.039 ± 0.060 to 1.148 ± 0.022. Subgroup analyses revealed that males had significantly lower PVR values compared to females, and tibial cases had lower PVR values compared to femoral cases in both union and nonunion groups (p < 0.05). All juvenile patients achieved union, compared to 71.4% of adults (p < 0.01). Conclusion: PVR demonstrates significant potential as an objective tool for assessing docking site healing in bone transport procedures. The distinct patterns observed between union and nonunion cases provide a foundation for developing clinical guidelines to monitor and predict healing outcomes. Integration of PVR assessment into clinical practice could improve decision-making and optimize treatment protocols in bone transport procedures. [ABSTRACT FROM AUTHOR]

Background: Tourniquets are widely used in limb fracture surgeries. Controversies still exist about the pressure inflated, including unified tourniquet inflation pressure (UTIP) and personalized tourniquet inflation pressure (PTIP). This study evaluated the hemostatic effect between UTIP and PTIP based on systolic blood pressure (SBP) in extremity fracture patients. Materials and methods: Patients with fresh extremity fractures requiring tourniquets during surgeries were prospectively enrolled and randomly assigned to the UTIP and PTIP groups. The inflation pressure was set to 250 mmHg for the upper extremities and 300 mmHg for the lower extremities in the UTIP group and SBP plus 50 mmHg for the upper extremities and SBP plus 100 mmHg for the lower extremities in the PTIP group. The primary outcome was a hemostatic effect evaluated by the surgeon (satisfied or dissatisfied). Other secondary outcomes included postoperative changes in limb swelling and tourniquet-related complications. Results: A total of 144 patients were enrolled and randomly assigned to the UTIP group or the PTIP group, and each group has 72 patients (36 upper limb and 36 lower limb). Totally, the hemostasis effect of the PTIP group was worse than that of the UTIP group by non-inferiority test. The hemostatic effect of upper limb fractures with SBP plus 50 mmHg for tourniquet inflation pressure was also worse than that with 250mmHg; however, there was no statistically significant difference between 300mmHg and SBP plus 100 mmHg in the lower limb group hemostasis effect due to a lack of power. Also, no difference was observed in the incidence of complications (p = 1.000) and postoperative changes in limb swelling during 2 days after surgery (upper limb: P1 = 0.546, P2 = 0.545; lower limb: P1 = 0.408, P2 = 0.857) between the PTIP and UTIP group. Conclusion: In the surgery of limb fractures, setting SBP + 50mmHg as tourniquet pressure may not be sufficient for upper limbs. Also, we found no difference between the SBP + 100mmHg and the unified 300mmHg for lower limb surgeries. [ABSTRACT FROM AUTHOR]

Background and Aims: The COVID‐19 pandemic significantly disrupted lower limb diabetes care. We aimed to map trends in diabetes‐related lower limb amputation and hospitalisation rates through the COVID‐19 pandemic. Methods: We performed a retrospective cohort study of all individuals who underwent a lower limb amputation for a diabetes‐related foot complication from 2018 to 2021 at the Royal Melbourne Hospital, a quaternary hospital in Australia. Hospitalisation rates with a diabetes‐related foot complication were collected for comparison. The start of the COVID‐19 epoch was defined as 16 March 2020, when a state of emergency was declared in Melbourne. Results: During the study period, 360 lower limb amputations for diabetes‐related foot complications were performed in 247 individuals. The median monthly number of amputations remained stable prior to and during the COVID‐19 epoch; there was a median of 8.0 amputations per month (interquartile range (IQR) = 6.5–11) before COVID‐19, compared to 6.5 amputations (IQR = 5.0–8.3) during the COVID‐19 epoch (P = 0.23). Hospitalisation with a diabetes‐related foot complication significantly increased from a median monthly rate of 11 individuals (IQR = 9.0–14) before COVID‐19 to 19 individuals (IQR = 14–22) during the COVID‐19 epoch (p < 0.001). Conclusions: Despite increased hospitalisations for diabetes‐related foot complications during COVID‐19, there was not a corresponding increase in amputation rates. Face‐to‐face care of diabetes‐related foot complications was prioritised at this centre and may have contributed to stable amputation rates during the pandemic. [ABSTRACT FROM AUTHOR]

Objective: Venous aneurysms are rare vascular abnormalities associated with venous thromboembolism. In this study, we presented our experience in managing thrombosed lower extremity venous aneurysms and evaluate the impact of vitamin D deficiency and genetic thrombophilic risk factors on patient management and outcomes. Methods: A single-center retrospective observational analysis was conducted on ten patients with thrombosed lower limb venous aneurysms who underwent surgical procedures at our hospital from July 2014 to February 2023. Collected data included venous duplex ultrasonographic imaging and laboratory tests including genetic thrombophilic risk factors and assessments of vitamin D levels. Results: There were 5 males and 5 females. The mean age was 46.6 ± 12.1 years. The aneurysms were located in the popliteal vein in three patients, the great saphenous vein in six, and the small saphenous vein in one. Venous duplex imaging revealed saccular aneurysms in eight patients and fusiform aneurysms in two, with a mean diameter of 37.2 ± 10.6 mm, ranging from 23 to 52 mm. Laboratory tests indicated vitamin D deficiency in all of the patients, and genetic thrombophilic risk factors were identified in two cases. Surgical interventions consisted of tangential excision with lateral venorrhaphy in three patients and total excision and ligation in seven patients. The postoperative period was favorable for all patients. Conclusions: Surgical treatment of thrombosed venous aneurysms in the lower extremities is essential to prevent complications such as thromboembolism. A comprehensive approach, including knowledge of genetic risk factors and vitamin D levels, may improve patient outcomes. [ABSTRACT FROM AUTHOR]

Lower extremity edema and compression are potential causes of poor soft tissue healing and flap failure for patients who suffer lower extremity trauma. This review summarizes techniques aimed at reducing edema and mechanical pressure in these patients as well as those undergoing soft tissue coverage techniques. We conducted a literature review for postoperative nursing management to reduce edema in the lower extremity, following traumatic injury. To assist orthopaedic nurses in acute care settings, this review presents techniques for reducing edema and mechanical pressure in patients recovering from lower extremity trauma. The accompanying figures demonstrate how to apply these techniques. Techniques such as rope suspension, mini water mattresses, and pillow or blanket stacking were identified as measures that can reduce edema and compression for patients recovering from lower extremity trauma as well as those requiring soft tissue coverage procedures. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament injury poses a major effect on the quality of life of patients. Anterior cruciate ligament reconstruction (ACLR) remains the mainstay of treatment. Purposes: To (1) test for the correlation of patients' characteristics such as body mass index (BMI), age, smoking status, and postoperative infrapatellar numbness with the subjective outcome of primary ACLR and (2) investigate whether postsurgical complications can be related to the studied patients' characteristics. Study Design: Case series; Level of evidence, 4. Methods: Demographic data and operational notes from patients who underwent primary ACLR at the institute between 2011 and 2022 were extracted. Patients' surgical outcomes were evaluated subjectively using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). Pre- and postoperative scoring were completed at postoperative follow-up in December of 2022, patients completed both the IKDC and the KOOS questionnaires. Patients were asked to rate their knee function out of 10 before and after surgery. This rating was based on the patients' self-assessment of their functional ability without the use of a formal instrument. Knee function was assigned as better, worse, or the same through a comparison of patients' reported scores before and after surgery. Results: Male patients comprised 108 (98.2%) of the total cohort, the mean ± SD age at the time of surgery was 27.92 ± 7.39 years, and BMI was 26.54 ± 3.89. The mean follow-up time was 48.92 ± 27.99 months. Most patients did not need postsurgical intervention (n = 97; 88.2%), while 4 (3.6%), 7 (6.4%), and 2 (1.8%) needed revision, debridement, or both, respectively. The mean IKDC score and KOOS, respectively, were 74.37 ± 20.17 and 85.50 ± 14.83. Patients' BMI had a significant effect on IKDC score (74.68 ± 20.0; P <.001), and infrapatellar numbness after surgery also affected patients' IKDC score (P =.002) and KOOS (P =.043). The age at the time of ACLR was associated with contralateral leg surgery (P =.017). Conclusion: This study showed that higher BMI and infrapatellar numbness negatively affect the subjective outcomes after primary ACLR. Older age at the time of primary ACLR was associated with a higher likelihood of surgery in the contralateral leg. [ABSTRACT FROM AUTHOR]

Objective: To gather preliminary evidence on short- and long-term care priorities for people with lower extremity amputations. Design: A three-round modified Delphi study using semi-structured interviews. Participants: A convenience sample of 20 adult participants who had undergone lower extremity amputations at a tertiary public hospital. Main Measure: Consensus on each care priority was defined a priori as an agreement of more than 50%. Semi-structured interviews were conducted to understand the rationales for endorsing the care priorities. Results: Consensus was reached on 24 short-term care priorities and 12 long-term care priorities in the biomedical, practical and psychological and spiritual domains. The rationales for endorsing each of the care priorities generated three themes: preparedness; mental health, psychological and spiritual well-being; and participating in life, with respect and dignity. Conclusions: Our results highlight the substantial need to improve patient access to education and planning support prior to undergoing limb amputation, and optimising post-amputation rehabilitation programmes, enabling people with amputations to participate in meaningful life roles that provide them with purpose, dignity, and self-respect. The knowledge of care priorities revealed in this study may promote effective patient-centred care and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Having a lower extremity amputation is a life‐changing decision for people living with a diabetes‐related foot ulcer. Although previous research has described both positive and negative lifestyle and function outcomes of diabetes‐related amputations, limited research has been conducted on the decision‐making processes leading up to the amputation. This study aimed to explore the perspectives of persons, healthcare practitioners and experts (including academics and specialists) on decision‐making for people with a diabetes‐related foot ulcer who may require a non‐emergency amputation. Methods: A qualitative descriptive study using semi‐structured interviews enabled people to share their thought processes when making decisions for amputation. Twenty‐six participants were interviewed, including nine people with a diabetes‐related foot ulcer or amputation, nine health practitioners and eight experts located across five countries. There were 13 female and 13 male participants. Thematic analysis was used for data analysis. Results: Four themes described the decision‐making considerations for amputation: 'Balancing the evidence in decision‐making', 'Trust, respect and timing of conversations inform decision‐making', 'Tailoring decisions for individual circumstance' and 'Reaching the tipping point in decisions for the future'. Work commitments, functional and lifestyle impacts of amputation, the presence of support networks and clinical wound features formed the evidence for a decision for amputation. Conclusion: Understanding quality of life needs ensured that decisions for amputation addressed expectations and lifestyle needs. Living with a diabetes‐related foot ulcer presented daily challenges that pushed people to a tipping point, at which amputation was considered to overcome these hardships and enable them to move on to the next chapter of their life. Further research is required to understand how person‐centred factors can be better incorporated alongside objective clinical assessments in decisions for amputation. Patient or Public Contribution: People with diabetes‐related foot ulcers, health practitioners and experts shared their perspectives on the decision‐making process for amputation through one‐to‐one interviews. Consideration of the person in the context of their life, environment and personal needs alongside the pathological factors is warranted. Practitioner Points: The decision for amputation incorporates a balance between health concerns, health practitioner assessments and the quality of life expectations and lifestyle needs of the person with DFU.Open discussions about living situation and future goals can determine readiness for amputation and initiate consideration of amputation as a possible option.'Leaving the door open' for people with DFU to have ongoing conversations about amputation supports people to feel in control of their decisions. [ABSTRACT FROM AUTHOR]

Purpose: A systematic review and meta-analysis investigating the duration and frequency of lower extremity prosthesis use and what factors were associated with changes in their use. Materials and methods: A search of PubMed, CINAHL, and Scopus over 20 years revealed 2409 articles. After review, 29 studies remained, representing 4814 participants with lower limb loss. Quality, funding, publication, and quantitative analyses were addressed. Results: The mean prosthesis use was 9.6 (5.3) hours/day and 6.4 (1.9) days/week. Distal amputation sites averaged more hours/day of prostheses use than proximal amputations (13.2 [3.2] vs. 10.8 [5.0], p <.001). After hemipelvectomy or hip dislocations, average prostheses use was less hours/day (6.0 [4.7]) than after transfemoral (12.9 [4.8]) or transtibial amputations (14.0 [4.5]) (p <.05). Pooled effects revealed an association between comorbidities and abandonment (OR 0.35, p =.03). The data supported six empirical evidence statements concerning age, sex, social support, amputation proximity, balance, skin condition, comorbidities, pain, falls, and fitness in association with changes in prosthesis utilization. Conclusions: The study provided systematic data on lower-extremity prosthesis use, thus helping to inform clinical decision-making and patient education. It also elucidated a path for future studies focused on modifiable factors related to prosthesis use and related outcomes. Implications for rehabilitation: Lower limb loss can trigger costly and debilitating sequela, which could be mitigated by increased prosthesis use and functionality, but there is no consensus on how often prostheses are being used and what affects changes in their use. When counseling patients on what they can expect after a lower extremity amputation and to set goals, the aggregated means of 9.6 (5.3) hours per day and 6.4 (1.9) days per week can be informative. Individuals who use a lower extremity prosthesis or may have to use one in the future can increase their prosthesis use and mobility by limiting further health deterioration. Rehabilitative care involving the multidisciplinary prioritization of proper socket fit, fitness training, gait training, and social support is associated with increased prosthetic device usage. [ABSTRACT FROM AUTHOR]

Background: Abnormal gait kinematics are common in youth with cerebral palsy (CP), but prior studies have not analyzed their longitudinal change throughout childhood. This study examines how age and orthopaedic surgery influence gait kinematics throughout childhood in those with ambulatory CP. Methods: In this institutional review board-approved prospective cohort study, children with spastic CP (GMFCS I–III) were recruited at age 17–40 months. Instrumented gait analysis was performed at 3-year intervals from age 4 to 21 years, collecting longitudinal kinematic data in bare feet at a self-selected speed. The change in Gait Profile Score (ΔGPS) between each pair of gait analyses (intervals) was analyzed by age distribution (<10, 10–15, ≥15 years) and by presence/absence of orthopaedic surgery. Results: The study included 31 children (GMFCS: I [13], II [14], III [4]). A baseline instrumented gait analysis was performed at age 5.8 ± 1.6 years with subsequent analysis at 2.5 ± 1.3-year intervals. Examining ΔGPS from baseline to final outcome, 87% of limbs were improved/unchanged; 298 intervals of ΔGPS were analyzed and classified as nonsurgical or surgical. Analysis revealed greater GPS improvement in intervals with surgery versus intervals without (p = 0.0004). Surgical intervals had significantly greater GPS improvement in the <10- vs. >15-year-old groups, p = 0.0063. Conclusions: Improvement in gait kinematics in children with CP is significantly influenced by age and timing of orthopaedic surgical intervention for gait correction, and was most pronounced for children <10 years old. Although surgery was associated with improved outcomes in all age groups, these improvements were significantly less for children >10 years old. These results reinforce the importance of considering the timing of orthopaedic surgery. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the outcomes that are most important to prosthesis users and funders. A Prosthetic Interventions Core Outcome Set (PI-COS) will help researchers and practitioners measure outcomes that are the most important to prosthesis users and funders. Materials and methods: Prosthesis users and funders rated the importance of 121 International Classification of Functioning, Disability, and Health (ICF) second-level categories using a two-round Delphi survey. A Consensus Meeting using the nominal group technique resolved rating differences between groups. The ICF second-level categories were ranked according to importance and a K-Means Cluster Analysis helped establish the PI-COS. Results: 65 users and 8 funders completed the Delphi surveys, followed by a Consensus Meeting. 26 ICF second-level categories were considered important to prosthesis users and funders and a PI-COS of 14 ICF second-level categories drawn predominantly from five ICF chapters was established: Sensory Functions and Pain (b2), Neuromusculoskeletal and Movement-related Functions (b7), General Tasks and Demands (d2), Mobility (d4), and Products and Technology (e1). Conclusions: The PI-COS describes the outcomes that are most important to prosthesis users and funders. The PI-COS can help focus on the most important outcome measures in clinical practice and research, including future prosthetic health economic evaluations. [ABSTRACT FROM AUTHOR]

Background: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. Methods: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. Results: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. Conclusion: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore healthcare professionals' (HCPs) perceptions and experiences related to 3D scanning and 3D printing for fabricating lower limb prosthetic sockets. Materials and methods: This study used a qualitative descriptive approach. Participants were recruited through HCPs' professional associations, social media posts, and snowball sampling. Purposive sampling was used to attain variation in provider type. One-on-one telephone interviews were conducted using a semi-structured interview guide. Inductive thematic analysis was performed to identify the main themes. Results: Three themes were identified: (1) 3D scanning of the residual limb for designing prosthetic sockets is perceived as clean, quick, and convenient; (2) concerns about the strength and safety of 3D printed sockets for long-term use; (3) Adoption of 3D scanning and 3D printing technology for fabricating prosthetic sockets. Conclusion: We identified perceived benefits and challenges with digital technologies for fabricating prosthetic sockets. To increase adoption, more research demonstrating its efficacy compared to conventional methods, increasing 3D printing material quality, and improving software training programs are needed. Implications for Rehabilitation: 3D printing and 3D scanning are emerging digital technologies that can be used as alternative methods for prosthetic socket manufacturing in the field of rehabilitation. Our research identified perceived benefits of using digital technologies for fabricating prosthetics sockets (3D scanning is perceived as clean, quick, and convenient) and perceived challenges (concerns about the strength and safety of 3D printed sockets for long-term use and a prolonged learning curve). To increase adoption of these digital technologies, more training should be provided to prosthetists and support provided to integrate new processes into staff workloads. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia (SA) is a conventional method for proper nerve block in abdominopelvic and lower extremity surgeries. Compared to general anesthesia, SA has reduced perioperative complications significantly. The hyperbaric type of bupivacaine hydrochloride (HB) induces spinal anesthesia more efficiently with a lower incidence of life-threatening adverse reactions like Perioperative hemodynamic changes and respiratory depression. More investigations are needed to define the best dosage that provides adequate anesthesia while reducing adverse effects for each surgical procedure. Methods: This double-blinded randomized clinical trial compared the consequences of the (12.5mg,15mg,20mg) dosages of HB-bupivacaine in elective lower limb orthopedic surgery. Using block randomization, we allocated 60 participants to three (n = 20) study groups. Utilizing the same protocol of anesthesia induction, outcome variables assumed and measured as the incidence of the adverse effects (Hypotension, Anxiety, Bradycardia, Nausea and Vomiting(N/V), Hypoventilation, and Decreased o2 saturation), and the requirement for intervention to control the unwanted reaction. Addressing that, outcome variables were measured 10 times perioperatively. One-way ANOVA test, the chi2 test, or repeated measures ANOVA test with the Bonferroni adjustment were utilized as appropriate. Results: We found that the incidence of hypotension (P-value:0.02) and the N/V (P-value < 0.001) are associated with the HB-bupivacaine dosage. Contrary, our findings indicate that the incidence of apnea, bradycardia, and hypoventilation did not exhibit a significant dose-dependent pattern between the groups. Repeated measures analysis revealed significant intergroup differences for Herat rate, systolic, diastolic, and mean arterial pressure (group*time Pvalue < 0.001). The observed differences were more prominent 10–30 min after injection of HB-bupivacaine. The regression model claimed that gender (P-value:0.002) and drug dosage (P-value:0.03) significantly predict the incidence of adverse effects. Conclusion: Our results, suggest that the administration of the 12.5mg HB-bupivacaine provides adequate anesthesia while minimizing the risk of adverse events for lower limb orthopedic surgeries lasting up to 180 min. Trial registration: The study was registered at the Clinical Trial Registry Center (IRCT20160202026328N7), Registered on 2022.01.10. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical effect of posterior perforator tibial artery flaps on repairing soft tissue defects of limbs. Methods: From June 2012 to June 2021, 14 cases of soft tissue defects of limbs were repaired with pedicled or free flaps of posterior perforator tibial artery. Among them, there were 9 cases of pedicled flaps and 5 cases of free flaps. The donor sites were closed directly or covered with skin grafting. The defects area varied from 3 × 5 cm to 7 × 16 cm. All cases were followed up for 1 year to 2 years. Results: All flaps survived completely except 3 cases with distal end necrosis and the 3 cases healed after dressing change. There were not any other complications at both donor and recipient sites. Appearance of the recipient sites was close to the surrounding skin. All patients were satisfied with the results. Conclusion: Posterior perforator tibial artery flaps have the advantages of relatively simple technique, few damage, few complications and satisfying appearance. It is a good choice for soft tissue defects of limbs. [ABSTRACT FROM AUTHOR]

Background: It has been argued that the use of artificial turf football fields in the National Football League (NFL) increases player injury risk compared with natural grass surfaces. Purpose/Hypothesis: The purpose of this study was to quantify the rate of lower extremity injuries occurring in NFL players on artificial turf compared with natural grass surfaces and characterize the time missed due to injury and proportion of injuries requiring surgery. It was hypothesized that lower extremity injuries requiring surgical intervention would occur at a higher rate on artificial turf than on natural grass. Study Design: Descriptive epidemiology study. Methods: Lower extremity injury data for the 2021 and 2022 NFL seasons were obtained using publicly available records. Data collected included injury type, player position, player age, playing surface, weeks missed due to injury, and whether the patient underwent season-ending or minor surgery. Multivariable logistic regression was performed to determine the risk of season-ending surgery according to playing surface. Results: When combining injuries for the 2021 and 2022 seasons (N = 718 injuries), the incidence rate of lower extremity injury was 1.22 injuries/game for natural grass and 1.42 injuries/game for artificial turf. The odds of a season-ending surgery were found to be significantly higher on artificial turf compared with natural grass (odds ratio = 1.60; 95% CI, 1.28-1.99; P <.05), while additional variables, including weather, age, position, week of injury occurrence, and history of prior injury, did not influence the odds of season-ending surgery. Conclusion: The 2021 and 2022 NFL seasons of our analysis demonstrated a higher incidence rate of injuries on artificial turf surfaces compared with natural grass surfaces. In addition, the odds of injury requiring season-ending surgery were found to be significantly higher on artificial turf compared with natural grass. [ABSTRACT FROM AUTHOR]

The health benefits of physical activity are well recognised. This study assessed whether golfers were more physically active after lower limb arthroplasty when compared to those that did not play golf (primary outcome). In addition pre and postoperative changes in health-associated quality of life (HAQoL) and joint specific outcomes between golfers and none golfers were assessed (secondary outcomes). There were 304 patients [THA (n = 155) or TKA (n = 149)] prospectively registered during a 4-month period undergoing lower limb arthroplasty. The mean age was 70.0 (range 37–92, standard deviation 10.2) years and included 188 (61%) females and 120 (39%) males. They completed pre and postoperative questionnaires assessing recreational activity, physical activity, HAQoL (EuroQol [EQ]), joint specific health (Oxford scores), and satisfaction. Golfers (n = 33, 10.9%) were more likely to achieve longer than 3 hours of moderate activity during a week (48.5% vs 38.0%, odds ratio (OR) 3.4, p = 0.045) and achieved their recommended activity level (96.8% vs 77.7%, OR 8.6, p = 0.015) compared to non-golfers following arthroplasty. Postoperative EQ5D (p = 0.034) and EQVAS (p = 0.019) were significantly greater in golfers. The joint specific Oxford hip score was greater in golfers compared to non-golfers (mean difference 5.6, p = 0.022), however no difference was observed in the Oxford knee score following TKA (p = 0.495). Golfers were more likely to achieve their weekly recommended level of physical activity and had a greater HAQoL relative to those that did not play golf following lower limb arthroplasty. More specifically after THA golfers also had a greater postoperative joint specific outcome, but no such advantage was observed in those following TKA. Level II, diagnostic study. • Golfers are more likely to achieve recommended levels of physical activity. • There was no difference in satisfaction according to golf participation. • Golf could be recommended after surgery to maintain physical activity. [ABSTRACT FROM AUTHOR]

The article examines the decreasing incidence rates of lower extremity amputations (LEA) among diabetes patients in Denmark and highlights the need for further reductions. Topics discussed include the regional disparities in amputation rates, the impact of improved treatment and patient education on reducing LEA, and the importance of preventive foot examinations in diabetes care.

Background: High tibial osteotomy (HTO) aims to realign the varus knee to alleviate stress in the medial compartment. However, detailed information on the impact of HTO on stress distribution across the tibiofemoral joint surface still needs to be completely elucidated. Purpose/Hypothesis: The present study aimed to analyze the subchondral bone density distribution to validate the alignment threshold causing paradoxical changes. We hypothesized that there would be a paradoxical stress change in the medial compartment beyond a specific threshold for lower limb realignment after HTO. Study Design: Case series; Level of evidence, 4. Methods: A retrospective clinical study of 32 knees from 30 patients who underwent medial opening-wedge HTO between 2015 and 2019 was conducted at Hokkaido University Hospital. The subchondral bone density across the tibiofemoral joint was analyzed using computed tomography–osteoabsorptiometry before and after HTO. The high-density area (HDA) within the medial and lateral compartments and their subregions, which were quartered in the coronal plane, was specifically examined. Results: The hip-knee-ankle angle, medial proximal tibial angle (MPTA), joint line obliquity (JLO), and joint line convergence angle significantly changed after HTO (P <.01). The HDA of the medial compartment to the total HDA ratio decreased from 83% to 77%. Paradoxically, the HDA in the most central subregion of the medial compartment increased from 24% to 30%. There were significant differences between MPTA and JLO in patients with and without paradoxical changes in the HDA. MPTA and JLO cutoff values causing paradoxical changes in the HDA were 94° and 4°, respectively. Conclusion: There was a paradoxical stress increase in the M4 region at the medial compartment associated with the MPTA and JLO beyond specific thresholds. Therefore, surgical planning should be cautiously performed to prevent overcorrection, which can lead to adverse stress distribution changes. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between various clinical factors and physical function in the early postoperative period in patients with soft tissue sarcomas (STSs) by subjective and objective evaluations. The 90 patients enrolled in this study were classified into five groups according to tumor location: retroperitoneal, gluteal, groin, thigh, and lower leg. The Musculoskeletal Tumor Society (MSTS) score was evaluated at discharge; the timed up-and-go test (TUGT) was performed preoperatively and at discharge. Group comparisons by tumor location were performed. To identify significant factors associated with physical dysfunction, multivariate analysis was performed using an MSTS score of <80% and a change in pre and postoperative TUGT score. There were no significant differences between the tumor location and physical function. The change in pre- and postoperative TUGT scores was significantly associated with an MSTS score of <80%. Quadriceps and tibialis anterior muscle resections were significantly associated with the change in pre- and post-operative TUGT scores. The quadriceps and tibialis anterior muscles may affect physical dysfunction after surgery for STSs. Early postoperative rehabilitation should include the identification of resected muscles and functional improvement of residual muscles, possibly with orthotic support for knee extension and ankle dorsiflexion. Surgical intervention for soft tissue sarcomas often leads to functional impairment of lower extremities. The Musculoskeletal Tumor Society scoring system and timed up-and-go test (TUGT) can be used as subjective and objective evaluations of physical function in patients with tumors in the lower extremities. The quadriceps and tibialis anterior muscle resections were significantly associated with change in the pre- and postoperative TUGT scores in the early postoperative period in patients with soft tissue sarcomas (STSs). For early postoperative rehabilitation of STSs, identification of resected muscles and functional improvement of residual muscles, possibly with orthotic support for knee extension and ankle dorsiflexion are recommended. [ABSTRACT FROM AUTHOR]

Objective: To determine predictive factors of successful rehabilitation in patients with lower limb amputation who use a prosthetic device. Methods: A retrospective observational and non-probabilistic study was carried out among 70 patients who underwent transfemoral (AK) or transtibial amputation (BK) of vascular, oncologic, or traumatic origin at the Instituto Nacional de Rehabilitación "Dra. Adriana Rebaza Flores" AMISTAD PERU-JAPON, Lima-Peru, from 2018 and 2019. Patients were interviewed, and clinical charts were reviewed. Successful rehabilitation was evaluated using Houghton's instrument. Results: 81.42% were males; the mean age was 48.76 ± 15.19 years; 35.71% had between 48 and 57 years of age. Successful rehabilitation was associated with age (p<0.01), BK amputation (p<0.001), traumatic origin (p=0.014), and absence of comorbidities (p<0.04). The only predictive factor of successful rehabilitation was BK amputation [OR=2.84, p<0.02). Conclusions: Factors associated with successful rehabilitation were age below 48 years, BK amputation, traumatic origin, and fewer comorbidities, but the only determinant was the level of amputation. [ABSTRACT FROM AUTHOR]

Background Chronic hip pain is one of the most common and difficult-to-treat causes of disability. Our study's primary aim was to investigate the effects of ultrasound and fluoroscopy-guided radiofrequency thermocoagulation of the femoral and obturator nerve articular branches on chronic hip pain, and the secondary aim was to determine its effects on hip function and quality of life. Methods Fifty-three patients with hip pain lasting more than three months were enrolled in the study. VPS scale and WOMAC, SF-12 questionnaires were applied to the patients before and in the first, third, and sixth months following the procedure. Results Of the patients, 60.4% were female, and 39.6% were male. Hip pain was caused by osteoarthritis in 77.1%, postoperative hip pain in 12.5%, malignancy in 8.3%, and avascular necrosis in 2.1%. The VPS scores were 8.9 ± 1.1 (mean±SD) in the baseline period, 2.4 ± 2.5 in the first postoperative week, 3.8 ± 2.5 in the first month, 5.1 ± 2.8 in the third month, and 5.8 ± 2.7 in the sixth month, with a significant decrease in VPS score (P  < .001). One patient developed a motor deficit that improved spontaneously. Conclusions We concluded that radiofrequency thermocoagulation application to the articular branches of the femoral and obturator nerves provides pain relief, hip function improvement, and better quality of life (better physical component scores but no improvement in mental component scores in SF-12) for up to 6 months in chronic hip pain. [ABSTRACT FROM AUTHOR]

To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = −0.08, (95% CI: −0.13, −0.02), p = 0.011] were independently associated with admission time. People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population. It is expected that the rate of inpatient prosthetic rehabilitation admissions due to lower limb amputations will increase amongst those over eighty. An analysis of participant characteristics of people admitted to inpatient prosthetic rehabilitation over time will inform modification and developments to future programs. Future prosthetic rehabilitation programs should consider an increased number of comorbidities when developing prognostic expectations for participants. A shortened interval between amputation surgery and admission should be considered when developing prosthetic rehabilitation programs. [ABSTRACT FROM AUTHOR]

This study analysed the incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers. This study systematically searched both Chinese and English databases, including CNKI, Wanfang, VIP, PubMed, EMBASE and Web of Science, to identify cohort studies related to lower extremity amputation and associated risk factors in patients with diabetic foot ulcers up to October 2023. The patients were stratified based on whether they underwent lower extremity amputation, and relevant data, including basic information, patient characteristics, complications, comorbidities and pertinent laboratory test data, were extracted from the included studies. The literature quality assessment in this study utilized the Newcastle‐Ottawa Scale to screen for high‐quality literature, resulting in the inclusion of 16 cohort studies, all of which were of at least moderate quality. Meta‐analysis of outcome indicators was conducted using the Stata 14.0 software. The results indicate that the overall amputation rate of lower extremities in patients with diabetic foot ulcers is 31% (0.25, 0.38). Among the 16 variables evaluated, gender (male), smoking history, body mass index (BMI), hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels were found to be correlated with the occurrence of lower extremity amputation in patients with diabetic foot ulcers. However, no significant correlation was observed between age, diabetes type, duration of diabetes, stroke, glycosylated haemoglobin, creatinine and total cholesterol levels and lower extremity amputation in patients with diabetic foot ulcers. This meta‐analysis indicates that the overall amputation rate in patients with diabetic foot ulcers is 31%. Factors such as gender (male), smoking history, high BMI, hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels are identified as significant risk factors for lower extremity amputation in diabetic foot ulcer patients. These findings suggest that attention should be focused on these risk factors in patients with diabetic foot ulcers to reduce the risk of lower extremity amputation. Therefore, preventive and intervention measures targeting these risk factors are of significant importance in clinical practice. (Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42024497538]). [ABSTRACT FROM AUTHOR]

Surgical site infections (SSIs) following major lower limb amputation (MLLA) in vascular patients are a major source of morbidity. The objective of this systematic review was to determine the incidence of SSI following MLLA in vascular patients. This review was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42023460645). Databases were searched without date restriction using a pre‐defined search strategy. The search identified 1427 articles. Four RCTs and 21 observational studies, reporting on 50 370 MLLAs, were included. Overall SSI incidence per MLLA incision was 7.2% (3628/50370). The incidence of SSI in patients undergoing through‐knee amputation (12.9%) and below‐knee amputation (7.5%) was higher than the incidence of SSI in patients undergoing above‐knee amputation, (3.9%), p < 0.001. The incidence of SSI in studies focusing on patients with peripheral arterial disease (PAD), diabetes or including patients with both was 8.9%, 6.8% and 7.2%, respectively. SSI is a common complication following MLLA in vascular patients. There is a higher incidence of SSI associated with more distal amputation levels. The reported SSI incidence is similar between patients with underlying PAD and diabetes. Further studies are needed to understand the exact incidence of SSI in vascular patients and the factors which influence this. [ABSTRACT FROM AUTHOR]

A common methodological limitation of research that guides surgical procedure selection for children's elective lower limb orthopaedic surgeries is inconsistent outcome selection. Improving outcome consistency can be achieved through the development of a core outcome set (COS). The aim of this study is to identify which outcomes are considered important for children's elective lower limb orthopaedic surgeries by allied health professionals (AHPs) and explore why they select these outcomes, to inform a COS development project. Online semi-structured interviews were conducted with relevant AHPs. Participants were selected using maximum variation purposive sampling; selection was based on profession and inpatient/outpatient role. The data set was analysed using an inductive and deductive approach to thematic analysis. Four physiotherapists, three orthotists, three prosthetists, and two occupational therapists were interviewed. Most identified outcomes of importance related to "activities and participation". From the data, we conceptualised that AHPs with effective multidisciplinary communication focused on child-centred outcomes, while clinicians with limited multidisciplinary teamwork focused on role-based outcomes. There is concurrence between outcomes identified as important in this study, and other qualitative studies in similar populations. These important outcomes were seldom measured in previous studies or in routine clinical practice. Allied health professionals (AHPs) prioritise activity and participation outcomes after children's elective lower limb orthopaedic surgery. It is important to the rehabilitation of children after elective lower limb orthopaedic surgery that all involved AHPs collaborate with the wider multidisciplinary team. Multidisciplinary team communication encourages collaborative outcome identification, and discourages role defined outcome focus. [ABSTRACT FROM AUTHOR]

General principles of cartilage repair therapies have not changed in the last years. Recommendations for cartilage repair include symptomatic ICRS grade 3 and 4 classified cartilage defects. However, what has changed in the last years is a better understanding of underlying or concomitant pathologies. Since a more precise analysis and stringent therapy of concomitant pathologies has been performed, an increase in success rates especially in formerly difficult entities could be observed. The most important concomitant pathologies in cartilage therapies of the hip-, knee- and ankle joint are axis deviations, instabilities, meniscus pathologies or prearthrotic deformities like hip dysplasia and femuroacetabular impingement syndrome. To increase the efficiency of cartilage repair procedures these pathologies should be corrected either prior to, or at latest concomitant to any cartilage repair surgery. Therefore, this article is intended to give an overview of the most important concomitant pathologies in cartilage repair of the lower extremities and their possibilities of correction. [ABSTRACT FROM AUTHOR]

Background: Knowledge about factors associated with long-term outcomes, after severe traumatic injury to the lower extremity, can aid with the difficult decision whether to salvage or amputate the leg and improve outcome. We therefore studied factors independently associated with capability at a minimum of 1 year after amputation or free flap limb salvage. Methods: We included 135 subjects with a free flap lower extremity reconstruction and 41 subjects with amputation, between 1991 and 2021 at two urban-level 1 trauma centers with a mean follow-up of 11 ± 7 years. Long-term physical functioning was assessed using the Physical Component Score (PCS) of the Short-Form 36 (SF36) and the Lower Extremity Functional Scale (LEFS) questionnaires. Independent variables included demographics, injury characteristics, and the Mental Component Score (MCS) of the SF36. Results: Greater mental health was independently and strongly associated with greater capability, independent of amputation or limb reconstruction. Mental health explained 33% of the variation in PCS and 57% of the variation in LEFS. Injury location at the knee or leg was associated with greater capability, compared to the foot or ankle. Amputation or limb reconstruction was not associated with capability. Discussion: This study adds to the growing body of knowledge that physical health is best regarded through the lens of the bio-psycho-social model in which mental health is a strong determinant. This study supports making mental health an important aspect of rehabilitation after major lower extremity injury, regardless of amputation or limb salvage. [ABSTRACT FROM AUTHOR]

Objective: To measure and compare the incidence of cast-related pressure injuries at the heel between sponge-incorporated long leg cast and multilayer padding cast following orthopedic lower extremity surgery. Materials and Methods: Patients aged 1 to 18 years who were scheduled for elective lower extremity soft tissue surgery were recruited. They were equally randomized into two groups: sponge-incorporated cast (Group 1) and multilayer padding cast (Group 2). A multilayer padding cast, consisting of five layers of Webril®, was applied to the heel and bony prominence areas. At the 2nd and 4th weeks postoperatively, cast-related heel pressure injuries were evaluated using the 2016 National Pressure Ulcer Advisory Panel (NPUAP) staging system. Changes in alignment and other complications were also recorded. Results: 100 patients were recruited. At two weeks postoperatively, the incidence of cast-related heel pressure injuries in Group 1 was 4/46 cases (8.7%), with all cases being stage 1. In Group 2, there were 6/54 cases (11.1%), with 3 cases in stage 1 and 3 cases in deep tissue pressure injury (p=0.479). At four weeks postoperatively, Group 1 had 6/46 cases (13%), with 4/46 cases (8.7%) being stage 1 and 2/46 cases (4.3%) being deep tissue pressure injuries. Group 2 had 6/54 cases (11.1%) (p>0.99), with all cases being stage 1. There was no statistical difference in loss of alignment. No serious complications, such as compartment syndrome or neurovascular injury, were found. Conclusion: The incidence of cast-related heel pressure injury was comparable between sponge padding cast and a multilayer cotton padding cast. [ABSTRACT FROM AUTHOR]

Aim: To understand the experiences of individuals who undergo LEA due to DFU after disability. Design: A descriptive research design in qualitative research. Methods: Semi‐structured interviews were used in this qualitative descriptive study. Eleven middle‐aged patients (45–59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed. Results: Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self‐concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over‐focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision‐making. [ABSTRACT FROM AUTHOR]

To identify barriers and enablers for access to and participation in rehabilitation for people with LLA in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals. A mixed-method study involving an anonymous cross-sectional screening survey followed by in-depth interviews of rehabilitation professionals in these regions following the COREQ guidelines. Participants were surveyed online using convenience and snowball sampling techniques to inform a purposive heterogenic sample for semi-structured online interviews, between September 2021 to February 2022. Interview transcripts were analysed and thematically coded using the modified Health Care Delivery System Approach (HCDSA) framework. A total of 201 quantitative survey responses shaped the interview questions and participation of 28 participants from 13 countries for the qualitative investigation. Important factors at the patient level were sex, economics, health issues, language differences, and lack of awareness; at the care team level, peer and/or family support, referrals, and the gender of the professional; at the organizational level, service availability, resources, and quality; and at the environmental level, policies, supports, and physical and/or social accessibility. Identified interlinked factors at multiple levels of the HCDSA underpin the need for a systems approach to develop and address regional rehabilitation service provision but requires contextually adapted policy. Amputation rehabilitation practices need improvements in the developing Asian region including evaluation and redesign of, and processes and policies by, policy makers with increased support for those with lower limb amputation. The consistent factors identified in these regions as negatively impacting rehabilitation services suggest opportunities to collaborate and design common mitigation approaches between rehabilitation providers across countries. Unique local factors impacting rehabilitation in different countries suggest the necessity for customization in consultation with rehabilitation practitioners rather than the adoption of generic charitable models by external agencies. Rehabilitation professionals and others responsible for rehabilitation policy and practice should systematically target factors impacting rehabilitation outcomes for improvements at all levels within the health care systems. [ABSTRACT FROM AUTHOR]

There are no reports in the literature of powerlifting success after amputation. We had the unique opportunity to characterize functional outcomes, strength, muscle contractility and size, and corticospinal excitability in an accomplished, competitive powerlifter (best competition squat = 205.0 kg, deadlift = 262.7 kg) with a unilateral, transtibial amputation relative to amputee controls. Four men (age range = 23-49 years) with unilateral, lower-limb amputation (3 transtibial, 1 transfemoral) participated in 1 laboratory visit. We assessed 10-m gait speed, the timed up and go (TUG) test, 5-time sit-to-stand performance (5TSTS), contractile properties of the vastus lateralis (VL) and medial gastrocnemius by tensiomyography, and VL cross-sectional area (CSA) by ultrasonography. Unilateral assessments for the intact limb included isokinetic knee extension and flexion torque and power and transcranial magnetic stimulation derived corticospinal excitability. An interview with the powerlifter provided contextual perspective. Compared with the control subjects, the powerlifter performed the 5TSTS faster (6.8%), exhibited faster VL contraction times (intact limb = 12.2%; residual limb = 23.9%), and showed larger VL CSA for the intact limb (46.7%). The powerlifter exhibited greater knee extension and flexion peak torque and mean power, particularly at 180°·s -1, as well as greater corticospinal excitability for the intact VL (65.6%) and tibialis anterior (79.6%). By contrast, the control subjects were faster in the TUG (18.3%) and comfortable (13.0%) and fast (21.4%) in the 10-m walk test. The major themes of our interview included needing to modify lifting mechanics, persistence, and remarkable pain tolerance. Our findings highlight the impressive neuromuscular adaptations that are attainable after lower-limb amputation. [ABSTRACT FROM AUTHOR]

As United States healthcare transitions from traditional fee-for-service models to value-based care, there is increased need to demonstrate quality care through clinical outcomes. Therefore, the purpose of this study was to create equations to calculate an expected mobility score for lower limb prosthesis users specific to their age, etiology, and amputation level to provide benchmarks to qualify good outcomes. A retrospective cross-sectional analysis of outcomes collected during clinical care was performed. Individuals were grouped based on amputation level (unilateral above-knee (AKA) or below-knee (BKA)) and etiology (trauma or diabetes/dysvascular (DV)). The mean mobility score (PLUS-M® T-score) for each year of age was calculated. AKAs were further stratified into having a microprocessor knee (MPK) or non-microprocessor (nMPK) for secondary analysis. As expected, average prosthetic mobility declined with age. Overall, BKAs had higher PLUS-M T-scores compared to AKAs and trauma etiologies had higher scores compared to DV. For AKAs, those with a MPK had higher T-scores compared to those with a nMPK. Results from this study provide average mobility for adult patients across every year of life. This can be leveraged to create a mobility adjustment factor to qualify good outcomes in lower limb prosthetic care. Normative values of mobility are needed to qualify good outcomes in prosthetic care as healthcare shifts towards value-based care. Understanding where an individual is relative to others with similar characteristics (e.g., age, etiology, gender, amputation level, and device type) can provide clinicians with better benchmarks for individual goal-setting. The ability to generate predicted mobility scores specific to each individual can create a mobility adjustment factor to better qualify good outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to externally validate a reported model for identifying patients requiring extended stay following lower limb arthroplasty in a new setting. Design: External validation of a previously reported prognostic model, using retrospective data. Setting: Medium-sized hospital orthopaedic department, Australia. Participants: Electronic medical records were accessed for data collection between Sep-2019 and Feb-2020 and retrospective data extracted from 200 randomly selected total hip or knee arthroplasty patients. Intervention: Participants received total hip or knee replacement between 2-Feb-16 and 4-Apr-19. This study was a non-interventional retrospective study. Main measures: Model validation was assessed with discrimination, calibration on both original and adjusted forms of the candidate model. Decision curve analysis was conducted on the outputs of the adjusted model to determine net benefit at a predetermined decision threshold (0.5). Results: The original model performed poorly, grossly overestimating length of stay with mean calibration of −3.6 (95% confidence interval −3.9 to −3.2) and calibration slope of 0.52. Performance improved following adjustment of the model intercept and model coefficients (mean calibration 0.48, 95% confidence interval 0.16 to 0.80 and slope of 1.0), but remained poorly calibrated at low and medium risk threshold and net benefit was modest (three additional patients per hundred identified as at-risk) at the a-priori risk threshold. Conclusions: External validation demonstrated poor performance when applied to a new patient population and would provide limited benefit for our institution. Implementation of predictive models for arthroplasty should include practical assessment of discrimination, calibration and net benefit at a clinically acceptable threshold. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic joint infection (PJI) is a devastating complication that develops after total joint arthroplasty (TJA), whose incidence is expected to increase over the years. Traditionally, surgical treatment of PJI has been based on algorithms, where early infections are preferably treated with debridement, antibiotics, and implant retention (DAIR) and late infections with two-stage revision surgery. Two-stage revision is considered the "gold standard" for treatment of chronic prosthetic joint infection (PJI) as it enables local delivery of antibiotics, maintenance of limb-length and mobility, and easier reimplantation. Many studies have attempted to identify potential predicting factors for early diagnosis of PJI, but its management remains challenging. In this observational retrospective study, we investigated the potential role of inflammatory blood markers (neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI)) as prognostic factors in two-stage exchange arthroplasty for PJI. Methods: A single-center retrospective analysis was conducted, collecting clinical data and laboratory parameters from patients submitted to prosthetic explantation (EP) for chronic PJI. Laboratory parameters (PCR, NLR, MLR, PLR, SIRI, SII, and AISI) were evaluated at the explantation time; at 4, 6, and 8 weeks after surgery; and at reimplantation time. The correlation between laboratory parameters and surgery success was evaluated and defined as infection absence/resolution at the last follow-up. Results: A total of 57 patients with PJI were evaluated (62% males; average age 70 years, SD 12.14). Fifty-three patients with chronic PJI were included. Nine patients underwent DAIR revision surgery and chronic suppressive therapy; two patients died. Nineteen patients completed the two-stage revision process (prosthetic removal, spacer placement, and subsequent replanting). Among them, none showed signs of reinfection or persistence of infection at the last available follow-up. The other twenty-three patients did not replant due to persistent infection: among them, some (the most) underwent spacer retention; others (fewer in number) were submitted to resection arthroplasty and arthrodesis (Girdlestone technique) or chronic suppressive antibiotic therapy; the remaining were, over time, lost to follow-up. Of the patients who concluded the two-stage revision, the ones with high SIRI values (mean 3.08 SD 1.7 and p-value 0.04) and MLR values (mean 0.4 SD 0.2 and p-value 0.02) at the explantation time were associated with a higher probability of infection resolution. Moreover, higher variation in the SIRI and PCR, also defined, respectively, as delta-SIRI (mean −2.3 SD 1.8 and p-value 0.03) and delta-PCR (mean −46 SD 35.7 and p-value 0.03), were associated with favorable outcomes. Conclusions: The results of our study suggest that, in patients with PJI undergoing EP, the SIRI and MLR values and delta-SIRI and delta-PCR values could be predictive of a favorable outcome. The evaluation of these laboratory indices, especially their determination at 4 weeks after removal, could therefore help to determine which patients could be successfully replanted and to identify the best time to replant. More studies analyzing a wider cohort of patients with chronic PJI are needed to validate the promising results of this study. [ABSTRACT FROM AUTHOR]

Objective: Major lower extremity amputation (LEA) such as below-knee or above-knee amputations can result in more physical disabilities and poorer socioeconomic functions than minor LEAs in diabetic foot ulcer (DFU). Therefore, identification of risk factors for major LEA and investigation of effectiveness of endovascular revascularization are critical for prevention and better prognosis of DFU patients. Methods: From January 2014 to December 2017, a total of 125 patients with DFU treated with any level of amputation were included in this study. Demographic, diabetes-related, DFU-related and -relevant laboratory information were investigated to predict major amputation. To identify risk factors for major amputation, logistic regression analysis was performed for each variable. The effectiveness of endovascular revascularization treatment was analyzed using Kaplan–Meier survival curves. Results: Major amputation was performed for 22 of 125 patients. Multivariate logistic regression analysis indicated that DM duration, peripheral arterial occlusive disease (PAOD) previous amputation, abscess, Wagner grade, CRP and albumin were significant risk factors for major amputation in DFU patients. PAOD was the most important risk factor. Major amputation-free survival rate at 5 years was 97.4% in a non-PAOD group, 58.3% in a PAOD without revascularization group, and 88.0% in a PAOD with revascularization group, showing statistically significant differences among them. Conclusion: The duration of DM, PAOD, previous amputation, abscess, Wagner grade, CRP and albumin were major risk factors for major LEA in DFU patients. The most valuable and critical finding was that revascularization in diabetic foot patients with PAOD significantly improved major amputation-free survival rates. [ABSTRACT FROM AUTHOR]

To perform a detailed psychometric Rasch analysis of the Prosthesis Embodiment Scale (PEmbS) administered in adults with lower limb amputation (LLA). A convenience sample of German-speaking adults with LLA (n = 150), recruited from German state agencies' databases, was asked to complete the PEmbS, a 10-item patient-reported scale assessing prosthesis embodiment. The local dependency between two items was resolved by keeping for the global score only the lower score of these two items (#9 and #10). Collapsing the seven response categories to four (two expressing disagreement and two agreement) eliminated disordered thresholds. After that, the PEmbS demonstrated unidimensionality, acceptable item fit, and good reliability indices. A keyform plot was created to transform raw scores into linear measures of prosthesis embodiment, making it possible to compare the individual's item responses with those expected by the Rasch model, and to manage missing responses. The PEmbS is useful for assessing prosthesis embodiment in people with LLA, both for research and clinical purposes. We propose a revised version of the PEmbS for lower limb amputees; its appropriateness in other LLA contexts requires further investigation. Prosthesis embodiment has been empirically related to positive clinical outcomes in limb amputees. The Prosthesis Embodiment Scale (PEmbS) is a patient-reported scale that has been recently recommended for use in research on prosthesis embodiment. Rasch analysis showed that the revised version of the German PEmbS is a psychometrically sound instrument for the assessment of prosthesis embodiment in lower limb amputees. The PEmbS thus also allows reliable and valid diagnosis of prosthesis embodiment in clinical and rehabilitation contexts. [ABSTRACT FROM AUTHOR]

People with lower-limb loss participate in less physical activity than able-bodied individuals, which increases the mortality risk and incidence of metabolic syndromes. This study evaluated the effect of lower-limb prosthesis osseointegration on physical activity, including daily steps and stepping cadence. Free-living walking activity was assessed from 14 patients scheduled to undergo prosthesis osseointegration at two time points (within 2 weeks prior to osseointegration surgery and 12-months following). Daily step count, stepping time, number of walking bouts, average step cadence per bout, maximum step cadence per bout, and time spent in bands of step cadence were compared before and after osseointegration. Twelve months after prosthesis osseointegration, participants increased daily steps, daily stepping time, average step cadence, and maximum cadence per walking bout compared to pre-osseointegration. Participants engaged in more daily steps, higher stepping cadence, and longer bouts at higher cadence one year following osseointegration compared to when using a socket prosthesis. As a novel intervention that is becoming more common, it is important to understand walking activity outcomes as these are critical for long-term health. People with lower-limb loss participate in less physical activity than able-bodied individuals, which increases the mortality risk and incidence of metabolic syndromes. Daily step count, walking bouts, and step cadence during free-living walking activity are promising measures to capture physical functional performance in patients with lower-limb amputation. This study shows that patients with osseointegrated prostheses increase their stepping activity, including daily steps, number of bouts, and stepping cadence compared to when using a socket prosthesis, which has positive implications on overall patient health. As a novel intervention that is becoming more common, it is important for clinicians, patients, and researchers to understand expectations for walking activity outcomes as a critical factor in long-term patient health after prosthesis osseointegration. [ABSTRACT FROM AUTHOR]

Aims: To investigate if diabetic complications increase the risk of depression and/or anxiety among adults with type 2 diabetes. Methods: This register‐based, prospective study included 265,799 adult individuals diagnosed with type 2 diabetes between 1997 and 2017 without a recent history of depression or anxiety. Diabetic complications included cardiovascular disease, amputation of lower extremities, neuropathy, nephropathy and retinopathy. Both diabetic complications and depression and anxiety were defined by hospital contacts and prescription‐based medication. All individuals were followed from the date of type 2 diabetes diagnosis until the date of incident depression or anxiety, emigration, death or 31 December 2018, whichever occurred first. Results: The total risk time was 1,915,390 person‐years. The incidence rate of depression and/or anxiety was 3368 per 100,000 person‐years among individuals with diabetic complications and 1929 per 100,000 person‐years among those without. Having or developing any diabetic complication was associated with an increased risk of depression and/or anxiety (HR 1.77, 95% CI 1.73–1.80). The risk for depression and/or anxiety was increased for all types of diabetic complications. The strongest association was found for amputation of lower extremities (HR 2.16, 95% CI 2.01–2.31) and the weakest for retinopathy (HR 1.13, 95% CI 1.09–1.17). Conclusion: Individuals with type 2 diabetes and diabetic complications are at increased risk of depression and anxiety. This points towards the importance of an increased clinical focus on mental well‐being among individuals with type 2 diabetes and complications. [ABSTRACT FROM AUTHOR]

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Aims This research investigated the relationships between self-efficacy and social support among users of prostheses post-lower limb amputation. Understanding these relationships is crucial for comprehending how individuals adapt to life post-amputation and how their perceived capabilities and social interactions influence their rehabilitation and overall well-being. Instrument & Methods This descriptive correlational study was conducted in Baghdad City at the Rusafa Health Department from October 1, 2023, to March 24, 2024. The study sample comprised 200 patients selected through the non-probability sampling method. The used questionnaire was validated by experts, and its reliability was confirmed through a pilot study. Data were gathered through interviews and analyzed using descriptive and inferential statistics. Findings A notable percentage of lower limb amputees utilizing prostheses exhibited low self-efficacy (60%) and moderate social support (40.5%). Furthermore, a positive correlation was observed between social support and self-efficacy, particularly in managing fatigue (r=0.133), coping with pain (r=0.198), handling emotional distress (r=0.172), addressing other symptoms (r=0.180) and health issues, and overall self-efficacy (r=0.173). Conclusion Interventions focused on enhancing social support networks significantly enhance self-efficacy and overall well-being in this demographic, ultimately fostering improved adjustment and quality of life post-amputation. [ABSTRACT FROM AUTHOR]