Functional Prosthesis Use in Patients with Vascular and Metabolic Transfemoral Amputation: Outcomes of an Inpatient Rehabilitation Model

Abstract

Introduction: Transfemoral amputation represents one of the leading causes of functional disability among patients with peripheral vascular disease and metabolic disorders, and it is also the most common etiology of lower-limb amputation in Mexico. Several studies have documented high rates of prosthetic abandonment and report that only 40% to 50% of patients achieve adequate functional prosthesis use. In this context, it is important to evaluate the outcomes achieved through rehabilitation programs developed within our healthcare setting.

Objective: To evaluate the proportion of patients with vascular or metabolic transfemoral amputation who achieve functional prosthesis use and to identify factors associated with this outcome in a retrospective cohort undergoing an inpatient rehabilitation program.

Materials and Methods: A retrospective observational study (Research Registry No. INRLII 03/26) was conducted including 118 patients with transfemoral amputation secondary to vascular or metabolic causes. Functional prosthesis use was defined as prosthesis wear for more than eight hours per day. Descriptive analyses of clinical and demographic variables were performed, and comparisons between groups were conducted using the Chi-square test, Fisher’s exact test, and Mann–Whitney U test, according to data distribution.

Results: Functional prosthesis use was achieved by 71.2% of patients, a proportion higher than that reported in most international series of vascular and metabolic amputees. No statistically significant associations were identified between functional prosthesis use and variables such as sex, amputation etiology, laterality, comorbidities, educational level, occupation, or rehabilitation setting following hospital discharge (p > 0.05). In contrast, patients who achieved functional prosthesis use were fitted with a prosthesis at a younger age (54 vs. 58 years; p = 0.013), experienced a shorter interval between amputation and prosthetic fitting (25 vs. 33 months; p = 0.034), and required fewer gait assistive devices at discharge (p = 0.005). No significant differences were observed in functional capacity estimated by metabolic equivalents (METs) (p = 0.225).

Conclusions: The inpatient rehabilitation model evaluated demonstrated rates of functional prosthesis use that were higher than those previously reported in the international literature. Earlier prosthetic fitting and greater functional independence at discharge were associated with a higher likelihood of effective prosthesis utilization. These findings support the implementation of strategies aimed at expediting prosthetic fitting and promoting functional independence during hospitalization.