Abstract
Rehabilitation of elderly patients with lower limb amputation and additional severe disease gives rise to controversy. End-stage renal disease (ESRD) is an example of such a disease, frequently leading to local complications of prosthetic fitting due to considerable changes in limb volume. In this retrospective study the authors present data on rehabilitation outcome of a large group of patients with end-stage renal failure and amputation of the lower limb due to peripheral arterial occlusive disease. Often diabetes with its additional comorbidities is the common underlying cause for both. From 1987 to 1996, 30 patients (aged 50 to 89, average 65 years) with ESRD and either unilateral or bilateral amputation were referred for in-patient rehabilitation (group I). The control group consisted of 319 patients without severe renal disease (group II). Both groups were similar regarding distribution of age and gender. There was no statistically significant difference with respect to prosthetic restoration and duration of rehabilitation between the two groups. The difference in the overall rehabilitation rate between the groups, with 77% of limb-wearers in group I compared with 62% in group II, was not statistically significant. The percentage of diabetics in group II was 56%, but as high as 77% in group I (p < 0.05), in 57% with signs of diabetic microangiopathy. With belowknee amputation (BKA) in only 34% in group II compared with 77% in group I, this number is disproportionally low (p < 0.05), unfortunately representing the amputation rates of surgical units in the city. When matched for level of amputation, subgroup analysis revealed no significant difference for clinical outcome in terms of prosthetic fitting or length of stay. The authors conclude that rehabilitation of elderly patients with ESRD with lower limb amputation is worthwhile and justifiable in view of anticipated lower budgets.
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