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Amputation

Double amputation

03/27/2007

Question:

My father will be having his second amputation next week. He lost his right leg above the knee in October 2006. Just began using a prosthesis and began problems with the left leg, began that he lost his toes, then partial foot. Due to vascular problems. He is 67, the surgeon says he will try but not promise to stay below the knee. My question will he ever be able to use two prosthesis and walk with help of a walker?

Answer:

It is certainly possible for a person who has had both legs amputated to walk with prostheses. A person's overall medical status will determine the likelihood of success. Of most importance is the condition of the person's heart and lungs: Someone with vascular disease severe enough to result in amputation of one or both legs will also have vascular disease affecting the coronary arteries to their heart. A cardiac stress test is sometimes useful - but not always necessary - to determine if the heart will be capable of handling the significantly increased physical demands of walking with one or two prostheses (a stress test in such situations can be done using an upper body ergometer vs. a chemical stress test).

Alternatively, or in addition, following above knee amputation on both sides, "stubby" prostheses - each of which consists of a prosthetic socket and foot but no knee unit - are usually provided initially to gauge how likely it will be for this person to eventually walk with "articulated" (meaning having a knee joint) prostheses.

If your father ends up having a below knee amputation on the other side, this would reduce the amount of energy required to walk with prostheses (an above-knee prosthesis on one side and a below-knee prosthesis on the other). In this case, however, a trial with stubby prostheses wouldn't be an option.

There are several levels of ambulatory ability, which include "exercise-level", household, limited community ambulation, and unlimited community ambulation. Whether a person will require a walker - vs. one or two crutches or canes - depends on their balance, quality of prosthetic fit/function, and overall upper body strength and function. The sooner a person can resume attempting to walk, the more likely they will be successful.

Input from your father's surgeon, his primary care physician, a physical therapist, a prosthetist, and if available, a PM&R (physical medicine and rehabilitation) physician, will all be useful to maximize his functional recovery following his upcoming surgery.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University