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Amputation

Would amputation work?

07/06/2008

Question:

I have had RSD in my left knee and leg for nearly 7 yrs and also fractured the femur in the same leg and now have a titanium plate holding the lower part of my femur together. As I am unable to use the leg I am now starting to think about the possibility of having the leg amputated near to my hip joint and having a full leg prothesis. I would like to know if this would at all be possible.

Answer:

A decision regarding possible amputation needs to be based on input from your physicians, particularly your orthopedic surgeon, but also, from your primary care physician, and any pain physician(s) with whom you've (presumably) already consulted. All non-surgical options (numerous different medications, doses, and combinations from numerous different categories of oral medications, lumbar paravertebral sympathetic blocks, and such implantable technologies as a spinal cord stimulator or morphine pump) should have been tried and exhausted before considering such a drastic and irreversible intervention as amputation surgery.

It is unfortunately unlikely that amputating a painful limb will eliminate your pain symptoms, which could remain unchanged - or even worsen - following an amputation for RSD: with chronic pain, the ongoing pain signals are actually based in/emanating from the central nervous system (spinal cord) - which of course would not be directly affected no matter how high up your leg was amputated - rather than the painful limb.

Walking with an above-the-knee prosthesis on one side requires anywhere from 30-80% more energy compared to an able-bodied person - which may be more than walking (hopping) with a pair of crutches or a walker without placing any weight on one leg. Attempting to walk with a prosthesis designed for amputation at the level of the hip ("hip disarticulation") requires even greater energy expenditure.

The condition of your "good leg", as well as your overall physical and medical condition, needs to be considered in determining whether or not use of a prosthesis would be likely to be successful, and if so, the likelihood regular use of a prosthesis would significantly enhance, or possibly detract from, your ability to walk.

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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