Analysis of prognostic factors for locomotion in patients after amputation of the tibia performed due to atherosclerotic critical limb ischemia.

Background. Our study aimed to analyze retrospectively the locomotion performance in patients following below-the-knee amputation (BKA) for atherosclerotic critical limb ischaemia (CLI) in relation to factors which may influence the final outcome. Material and methods. Two groups of patients were analyzed: Group I (n = 53), which underwent fitting of prosthesis and rehabilitation immediately after healing of the stump ("early prosthesising"), and Group II (n = 45), in whom prosthesis fitting and rehabilitation were begun after some time spent on a waiting list (from amputation to admission for rehabilitation). Eight parameters which, according to the authors' experience, may influence the effect of prosthesis fitting and rehabilitation in respect to locomotion possibilities were analyzed using survival curves and Cox multi-variant analysis. Results. In Group I the outcome was judged good or very good in over half of the patients (56.9%), while in Group II the respective results did not reach one-third (28.8%). It was demonstrated that early prosthesis fitting and rehabilitation increase more than four-fold the chance to achieve very good or good locomotion performance and shortens two-fold the time needed to reach this goal. Conclusions. The most important factors slowing the recovery of ambulatory functions are: delay in fitting the prosthesis, knee joint flexion contracture of the amputated limb, and concomitant diseases resulting from the generalized character of atherosclerosis.