Secondary Condition Prevention: Lower Limb Amputation and Long-Term Prosthesis Use
|Jennifer Rowland, Ph.D.|
People with lower limb amputation are at risk for secondary conditions such as osteoarthritis, osteopenia/osteoporosis, and back pain due to improperly fitting prosthetic devices (Gailey et al., 2008). Because many people with lower limb amputation wear prostheses for several hours during the day for mobility and to perform activities of daily living, a properly fitting prosthesis is important. Osteoarthritis of the knee and hip that often results in pain during walking is common for people with lower limb amputation because of the imbalance that may occur between weight-bearing on the leg with the prosthetic device as compared with the leg without the prosthetic device.
Other common secondary conditions are osteopenia and osteoporosis, characterized by low bone mass. A related secondary condition is the risk of fall-related fractures that may occur as a result of low bone mass, which is an example of ways that certain secondary conditions could potentially lead to the risk for developing other types of secondary conditions (i.e., falls). However, one of the most limiting secondary conditions for people with lower limb amputations is back pain. Several researchers have reported persistent, limiting back pain among populations of people with amputations (Ehde et al., 2000; Kulkarni et al., 2005), which was found to be severe in some cases. Among the reasons for improperly fitting prosthetic devices are:
- Improper socket fit and prosthetic alignment: interferes with ability to walk;
- Posture and leg-length discrepancy: can affect ability to stand and walk with equal weight-bearing between the lower limbs.
The NCHPAD fact sheet “Amputation and Exercise” (http://www.ncpad.org/51/385/Amputation~and~Exercise) examines exercises that can be performed to increase strength and flexibility. Because of the potential for a variety of secondary conditions related to muscular imbalance and insufficient bone mass, regular exercise following a change to correct improperly fitted prosthetic devices can lead to long-term health and the prevention of secondary conditions.
Also see the following NCHPAD publication on amputation and secondary conditions in youth:
- Amputation and Secondary Conditions: Physical Activity Can Reduce Secondary Conditions in Youths With Limb Differences at http://www.ncpad.org/280/1774/Amputation~and~Secondary~Conditions~~Physical~Activity~
Ehde, D. M., Czerniecki, J. M., Smith, D. G., Campbell, K. M., et al. (2000). Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Archives of Physical Medicine & Rehabilitation, 81, 1039-1044.
Gailey, R., Allen, K., Castles, J., Kucharik, J., & Roeder, M. (2008). Review of the secondary physical conditions associated with lower limb amputation and long-term prosthesis use. Journal of Rehabilitation Research & Development, 45(1), 15-30.
Kulkarni, J., Gaine, W. J., Buckley, J. G., Rankine, J. J., & Adams, J. (2005). Chronic low back pain in traumatic lower limb amputees. Clinical Rehabilitation, 19,81-86.
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