The impact of gender, level of amputation and diabetes on prosthetic fit rates following major lower extremity amputation

Background: Diabetes mellitus is a leading cause of major lower extremity amputation. Objective: To examine the influence of gender, level of amputation and diabetes mellitus status on being fit with a prosthetic limb following lower extremity amputation for peripheral arterial disease. Study design: Retrospective analysis of the Scottish Physiotherapy Amputee Research Group dataset. Results: Within the cohort with peripheral arterial disease (n=1735), 64% were men (n=1112) and 48% (n=834) had diabetes mellitus. Those with diabetes mellitus were younger than those without: mean 67.5 and 71.1years, respectively (p<0.001). Trans-tibial amputation:trans-femoral amputation ratio was 2.33 in those with diabetes mellitus, and 0.93 in those without. A total of 41% of those with diabetes mellitus were successfully fit with a prosthetic limb compared to 38% of those without diabetes mellitus. Male gender positively predicted fitting with a prosthetic limb at both trans-tibial amputation (p=0.001) and trans-femoral amputation (p=0.001) levels. Bilateral amputations and increasing age were negative predictors of fitting with a prosthetic limb (p<0.001). Diabetes mellitus negatively predicted fitting with a prosthetic limb at trans-femoral amputation level (p<0.001). Mortality was 17% for the cohort, 22% when the amputation was at trans-femoral amputation level. Conclusion: Of those with lower extremity amputation as a result of peripheral arterial disease, those with diabetes mellitus were younger, and more had trans-tibial amputation. Although both age and amputation level are good predictors of fitting with a prosthetic limb, successful limb fit rates were no better than those without diabetes mellitus. Clinical relevance This is of clinical relevance to those who are involved in the decision-making process of prosthetic fitting following major amputation for dysvascular and diabetes aetiologies.