Rehabilitation of lower extremity amputation due to peripheral arterial occlusive disease in patients with end-stage renal failure

Rehabilitation of elderly patients with lower limb amputation and additiona l severe disease gives rise to controversy. End-stage renal disease (ESRD) is an example of such a disease, frequently leading to local complications of prosthetic fitting due to considerable changes in limb volume. In this r etrospective study the authors present data on rehabilitation outcome of a large group of patients with end-stage renal failure and amputation of the lower limb due to peripheral arterial occlusive disease. Often diabetes wit h its additional comorbidities is the common underlying cause for both. Fro m 1987 to 1996, 30 patients (aged 50 to 89, average 65 years) with ESRD and either unilateral or bilateral amputation were referred for in-patient reh abilitation (group I). The control group consisted of 319 patients without severe renal disease (group II). Both groups were similar regarding distrib ution of age and gender. There was no statistically significant difference with respect to prosthetic restoration and duration of rehabilitation betwe en the two groups. The difference in the overall rehabilitation rate betwee n the groups, with 77% of limb-wearers in group I compared with 62% in grou p II, was not statistically significant. The percentage of diabetics in gro up II was 56%, but as high as 77% in group I (p < 0.05), in 57% with signs of diabetic microangiopathy. With below-knee amputation (BKA) in only 34% i n group II compared with 77% in group I, this number is disproportionally l ow (p < 0.05), unfortunately representing the amputation rates of surgical units in the city. When matched for level of amputation, subgroup analysis revealed no significant difference for clinical outcome in terms of prosthe tic fitting or length of stay. The authors conclude that rehabilitation of elderly patients with ESRD with lower limb amputation is worthwhile and jus tifiable in view of anticipated lower budgets.