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Portela FSO, Louzada ACS, da Silva MFA, Teivelis MP, Kuzniec S, Wolosker N. Editor's Choice - Analysis of Lower Limb Amputations in Brazil's Public Health System over 13 Years. Eur J Vasc Endovasc Surg 2024; 68:91-98. [PMID: 38395382 DOI: 10.1016/j.ejvs.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Understanding the causes of amputation is crucial for defining health policies that seek to avoid such an outcome, but only a few studies have investigated the epidemiology of patients submitted to amputations in developing countries. The objective of this study was to analyse all lower limb amputations performed in the public health system in Brazil over a 13 year period, evaluating trends in the number of cases, patient demographics, associated aetiologies, hospital length of stay, and in hospital mortality rate. METHODS This was a retrospective, population based analysis of all lower limb amputations performed in the Brazilian public health system between 1 January 2008 and 31 December 2020. Using a public database, all types of amputations were selected, defining the number of procedures, their main aetiologies, anatomical level of limb loss, demographic data, regional distribution, and other variables of interest. RESULTS A total of 633 455 amputations were performed between 2008 and 2020, mostly (55.6%) minor amputations, predominantly in males (67%). There was an upward trend in the number of amputations, determined mainly by the increase in major amputations (50.4% increase in the period). Elderly individuals have the highest rates of amputation. Diabetes mellitus (DM) is becoming the main primary diagnosis associated with amputations over the years. The highest in hospital mortality rate occurred after major amputations and was associated with peripheral arterial disease (PAD). CONCLUSION Amputation rates in Brazil show an upward trend. DM is becoming the most frequent associated primary diagnosis, although PAD is the diagnosis most associated with major amputations and in hospital death.
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Affiliation(s)
| | | | | | | | | | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
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Coman HF, Stancu B, Andercou OA, Ciocan R, Gherman CD, Rusu A, Gavan NA, Bondor CI, Gavan AD, Bala CG, Necula A, Ana T, Tatiana T, Haldenwang PL. Five-Year Trends of Vascular Disease-Related Amputations in Romania: A Retrospective Database Study. J Clin Med 2024; 13:2549. [PMID: 38731078 PMCID: PMC11084782 DOI: 10.3390/jcm13092549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Lower extremity amputations (LEAs) are a burdensome complication of peripheral artery disease (PAD) and/or arterial embolism and thrombosis (AET). We assessed the trends in PAD- and/or AET-related LEAs in Romania. Methods: This retrospective study (2015-2019) analyzed data on minor and major LEAs in hospitalized patients recorded in the National School for Public Health, Management, and Health Education database. The absolute numbers and incidences of LEAs were analyzed by diagnosis type, year, age, sex, and amputation level. Results: Of 38,590 vascular disease-related amputations recorded nationwide, 36,162 were in PAD and 2428 in AET patients. The average LEA incidence in the general population was 34.73 (minimum: 31.96 in 2015; maximum: 36.57 in 2019). The average incidence of major amputations, amputations above the knee, hip amputations, amputations below the knee, and minor amputations was 16.21 (15.62 in 2015; 16.84 in 2018), 13.76 (13.33 in 2015; 14.28 in 2018), 0.29 (0.22 in 2017; 0.35 in 2019), 2.15 (2.00 in 2015; 2.28 in 2019), and 18.52 (16.34 in 2015; 20.12 in 2019), respectively. Yearly PAD- and/or AET-related amputations were significantly higher in men versus women. The overall number of LEAs increased with age, particularly in patients ≥ 70 years. The increase in the total number of amputations was mainly due to a constant rise in minor amputations for both groups, regardless of gender. Conclusions: PAD- and/or AET-related LEAs in Romania increased from 2015 to 2019, with men having a greater incidence than women. Raising awareness and effective management strategies are needed to prevent LEAs.
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Affiliation(s)
- Horațiu F. Coman
- Vascular Surgery Clinic, Cluj County Emergency Hospital, 400347 Cluj-Napoca, Romania;
| | - Bogdan Stancu
- Second Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Octavian A. Andercou
- Second Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Razvan Ciocan
- Department of Surgery—Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (R.C.); (C.D.G.)
| | - Claudia D. Gherman
- Department of Surgery—Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (R.C.); (C.D.G.)
| | - Adriana Rusu
- Department of Diabetes and Nutrition Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.R.); (C.G.B.)
| | | | - Cosmina I. Bondor
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Alexandru D. Gavan
- Department of Medical Devices, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Cornelia G. Bala
- Department of Diabetes and Nutrition Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.R.); (C.G.B.)
| | - Alexandru Necula
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Trif Ana
- Vascular Surgery Department, “Nicolae Stăncioiu” Heart Institute, 400001 Cluj-Napoca, Romania;
| | - Trif Tatiana
- Anesthesia and Intensive Care Department, Regional Institute of Gastroenterology & Hepatology “Prof. Dr. Octavian Fodor”, 400394 Cluj-Napoca, Romania;
| | - Peter L. Haldenwang
- Department for Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr-University of Bochum, 44789 Bochum, Germany;
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Evrard J, Heremans F, Ronsse R. On the Usability of Polymer-Based Artificial Tendons for Elastic Energy Storage in Active Ankle Prostheses. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941222 DOI: 10.1109/icorr58425.2023.10304699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
In the recent past, the development of lower-limb prostheses has taken a new turn with the emergence of active systems. However, their intrinsic wearable nature induces strict requirements regarding weight and encumbrance. In order to reduce the load - and thus the bulkiness - of their active part, several prototypes leverage the concept of compliant actuation, consisting in including an elastic element in parallel and/or in series with the actuator. In this paper, we explore the usability of polymer compliant ropes placed in parallel with the actuator of an ankle prosthesis. Ropes are intrinsically light and compact, and thus offer several advantages as compared to more traditional coil or leaf springs. Polymer materials were selected for their high energy density and yield strength. We conducted a set of experimental tests with several ropes, pretension levels, and periodic loading profiles. Results show that polymer-based ropes have a high potential for ankle assistance devices, since they can store the required energy in a low volume. However, further research should be conducted to improve their efficiency, since we estimated that only about 50% of the stored energy can be released, with few variations as a function of the rope preconditioning and loading profile.
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Rusu E, Coman H, Coșoreanu A, Militaru AM, Popescu-Vâlceanu HC, Teodoru I, Mihai DA, Elian V, Gavan NA, Radulian G. Incidence of Lower Extremity Amputation in Romania: A Nationwide 5-Year Cohort Study, 2015-2019. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1199. [PMID: 37512011 PMCID: PMC10385247 DOI: 10.3390/medicina59071199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The primary objective of this study was to investigate the incidence of lower extremity amputations (LEAs) in a representative population from Romania, in both diabetic and non-diabetic adults, including trauma-related amputations. The secondary objective was to evaluate the trends in LEAs and the overall ratio of major-to-minor amputations. Material and Methods: The study was retrospective and included data from the Romanian National Hospital Discharge Records, conducted between 1 January 2015 and 31 December 2019. Results: The overall number of cases with LEAs was 88,102, out of which 38,590 were aterosclerosis-related LEAs, 40,499 were diabetes-related LEAs, and 9013 were trauma-related LEAs, with an ascending trend observed annually for each of these categories. Of the total non-traumatic amputations, 51.2% were in patients with diabetes. Most LEAs were in men. The total incidence increased from 80.61/100,000 in 2015 to 98.15/100,000 in 2019. Conclusions: Our study reported a 21% increase in total LEAs, 22.01% in non-traumatic LEAs, and 19.65% in trauma-related amputation. The minor-to-major amputation ratio increased over the study period in patients with diabetes. According to these findings, it is estimated that currently, in Romania, there is one diabetes-related amputation every hour and one non-traumatic amputation every 30 min.
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Affiliation(s)
- Emilia Rusu
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Malaxa Clinical Hospital, 030167 Bucharest, Romania
| | - Horațiu Coman
- Department of Vascular Surgery, Vascular Surgery Clinic, Cluj County Emergency Hospital, 400347 Cluj-Napoca, Romania
| | - Andrada Coșoreanu
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Malaxa Clinical Hospital, 030167 Bucharest, Romania
| | - Ana-Maria Militaru
- Department of Diabetes, Nutrition and Metabolic Diseases, Malaxa Clinical Hospital, 02441 Bucharest, Romania
| | | | - Ileana Teodoru
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, "Prof. Dr. Nicolae Paulescu" National Institute for Diabetes, Nutrition and Metabolic Diseases, 030167 Bucuresti, Romania
| | - Doina-Andrada Mihai
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, "Prof. Dr. Nicolae Paulescu" National Institute for Diabetes, Nutrition and Metabolic Diseases, 030167 Bucuresti, Romania
| | - Viviana Elian
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, "Prof. Dr. Nicolae Paulescu" National Institute for Diabetes, Nutrition and Metabolic Diseases, 030167 Bucuresti, Romania
| | | | - Gabriela Radulian
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, "Prof. Dr. Nicolae Paulescu" National Institute for Diabetes, Nutrition and Metabolic Diseases, 030167 Bucuresti, Romania
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Schindler M, Baertl S, Walter N, Lang S, Szymski D, Alt V, Rupp M. Retrospective analysis of mortality and quality of life after hip disarticulation or hemipelvectomy: a report on 15 patients. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04783-4. [PMID: 36723759 PMCID: PMC10374469 DOI: 10.1007/s00402-023-04783-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip disarticulation and hemipelvectomy are defined as major ablative amputations of the lower limb. Due to the small number of patients, little is known about the outcome and follow-up. AIMS We aimed to assess (1) reasons for performed major ablative surgeries such as hip disarticulation and hemipelvectomy in a German center for trauma and orthopedic surgery. (2) In addition, mortality and quality of life after hip disarticulation and hemipelvectomy as well as (3) patient and treatment characteristics should be investigated. METHODS During a period of twelve years, 15 patients underwent hip disarticulation or hemipelvectomy. Mortality, EQ-5D-3L quality of life by EQ-5D-3L and time-trade-off (TTO), VAS, cause of disarticulation, length of hospital stays, revisions, comorbidities, Charlson comorbidity index (CCI), and ASA score were evaluated retrospective for all patients. RESULTS The overall mortality rates were 26.7% at 30 days, 60.0% after one year and 66.7% after three years. The five surviving patients reported about moderate problems in the EQ-5D-3L. The average VAS score reached 45 (range 15-65). The mean TTO was 9.8 (range 6-12). Indications for amputation were infection (n = 7), tumor (n = 6), trauma (n = 1) and ischemia (n = 1). CONCLUSION Hip disarticulation and hemipelvectomy are followed by a high postoperative mortality. Quality of life of the affected patients is impaired in long-term follow-up. Especially amputations performed due to infections show high mortality within one month after surgery despite average young age and low CCI. Surgeons should be aware of this devastating outcome and extraordinary vigilant for these vulnerable patient cohorts.
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Affiliation(s)
- Melanie Schindler
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Susanne Baertl
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Eidmann A, Kamawal Y, Luedemann M, Raab P, Rudert M, Stratos I. Demographics and Etiology for Lower Extremity Amputations-Experiences of an University Orthopaedic Center in Germany. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020200. [PMID: 36837401 PMCID: PMC9965459 DOI: 10.3390/medicina59020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023]
Abstract
Background and Objectives: Currently, the worldwide incidence of major amputations in the general population is decreasing whereas the incidence of minor amputations is increasing. The purpose of our study was to analyze whether this trend is reflected among orthopaedic patients treated with lower extremity amputation in our orthopaedic university institution. Materials and Methods: We conducted a single-center retrospective study and included patients referred to our orthopaedic department for lower extremity amputation (LEA) between January 2007 and December 2019. Acquired data were the year of amputation, age, sex, level of amputation and cause of amputation. T test and Chi² test were performed to compare age and amputation rates between males and females; significance was defined as p < 0.05. Linear regression and multivariate logistic regression models were used to test time trends and to calculate probabilities for LEA. Results: A total of 114 amputations of the lower extremity were performed, of which 60.5% were major amputations. The number of major amputations increased over time with a rate of 0.6 amputation/year. Men were significantly more often affected by LEA than women. Age of LEA for men was significantly below the age of LEA for women (men: 54.8 ± 2.8 years, women: 64.9 ± 3.2 years, p = 0.021). Main causes leading to LEA were tumors (28.9%) and implant-associated complications (25.4%). Implant-associated complications and age raised the probability for major amputation, whereas malformation, angiopathies and infections were more likely to cause a minor amputation. Conclusions: Among patients in our orthopaedic institution, etiology of amputations of the lower extremity is multifactorial and differs from other surgical specialties. The number of major amputations has increased continuously over the past years. Age and sex, as well as diagnosis, influence the type and level of amputation.
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The Design of a Smart Lower-Limb Prosthesis Supporting People with Transtibial Amputation—A Data Acquisition System. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For people with amputated lower limbs, it is imperative to make high-performance prostheses that reproduce, as accurately as possible, the functions of the amputated limb. In this case, a preliminary study of the lower limbs from a kinematic and dynamic point of view is necessary. This paper proposes a prosthesis design and a system for acquiring the information needed to determine the stepping phase kinematic and dynamic parameters of the legs. This system consists of a sensory system attached to the legs and a acquisition data unit built around a microcontroller. The sensory system is based on a sensory system for determining the weight distribution on the sole, made of resistive pressure sensors. The sensory system will be subjected to measurement repeatability and homogeneity tests to evaluate and validate the accuracy and error of the proposed solution. The data obtained by the sensory system is transmitted in real-time, via wi-fi, to a computer system for interpretation. After processing and interpreting the data using standard data sets for comparison, the position of the legs, the type of gait and the phase of movement can be determined. Constructively, the system is configurable and can be adapted to any person, male or female, regardless of shoe size.
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Lauwers P, Wouters K, Vanoverloop J, Avalosse H, Hendriks J, Nobels F, Dirinck E. Temporal trends in major, minor and recurrent lower extremity amputations in people with and without diabetes in Belgium from 2009 to 2018. Diabetes Res Clin Pract 2022; 189:109972. [PMID: 35760154 DOI: 10.1016/j.diabres.2022.109972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
AIMS This study assessed temporal trends in the incidence of lower extremity amputations (LEA) in Belgium from 2009 to 2018, and subsequent secondary amputation rates. METHODS Nationwide data on LEA were collected. Sex- and age-adjusted annual incidence rates were calculated. Time trends were analysed in negative binomial models. The incidence of secondary interventions, defined as either any ipsilateral reamputation or any contralateral amputation, was studied with death as competing risk. RESULTS 41 304 amputations were performed (13 247 major, 28 057 minor). In individuals with diabetes, the amputation rate (first amputation per patient per year) decreased from 143.6/100.000 person-years to 109.7 (IRR 0.97 per year, 95 %CI 0.96-0.98, p < 0.001). The incidence of major LEAs decreased from 56.2 to 30.7 (IRR 0.93, 95 %CI 0.91-0.94, p < 0.001); the incidence of minor amputations showed a non-significant declining trend in women (54.3 to 45.0/100 000 person years, IRR 0.97 per year, 95 %CI 0.96-0.99), while this remained stable in men with diabetes (149.2 to 135.3/100 000 person years, IRR 1.00 per year, 95 %CI 0.98-1.01). In individuals without diabetes, the incidence of major amputation didn't change significantly, whereas minor amputation incidence increased (8.0 to 10.6, IRR 1.04, 95 %CI 1.03-1.05, p < 0.001). In individuals with diabetes, one-year secondary intervention rates were high (31.3% after minor, 18.4% after major LEA); the incidence of secondary amputations didn't change. CONCLUSIONS A significant decline in the incidence rate of major LEA was observed in people with diabetes. This decline was not accompanied by a significant rise in minor LEA. The incidence of secondary interventions remained stable.
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Affiliation(s)
- Patrick Lauwers
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B 2650 Edegem, Belgium.
| | - Kristien Wouters
- Antwerp University Hospital, Clinical Trial Center (CTC), CRC Antwerp, Drie Eikenstraat 655, B 2650 Edegem, Belgium
| | - Johan Vanoverloop
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Bolwerklaan 21 B 7, 1210 Brussels, Belgium
| | - Hervé Avalosse
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Bolwerklaan 21 B 7, 1210 Brussels, Belgium; Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Haachtsesteenweg 579 B 40, B 1031 Brussels, Belgium
| | - Jeroen Hendriks
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B 2650 Edegem, Belgium
| | - Frank Nobels
- Onze Lieve Vrouw Ziekenhuis Aalst, Department of Endocrinology, Moorselbaan 164, B 9300 Aalst, Belgium
| | - Eveline Dirinck
- Antwerp University Hospital, Department of Endocrinology, Diabetology and Metabolism, Drie Eikenstraat 655, B 2650 Edegem, Belgium
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