Analyzing Risk Factors for Sequential Above Knee Amputation after Below Knee Amputation in Surgical Treatment of Ischemic and/or Infectious Foot Disease

Abstract

Category: Diabetes Introduction/Purpose: Some patients with below knee (BK) amputation for treatment of ischemic and/or infectious foot disease eventually further progress to above knee (AK) amputation. We aimed to analyze predictors for sequential AK amputation after BK amputation. Methods: We retrospectively reviewed medical records and find 55 patients with BK amputation for surgical treatment of ischemic and/or infectious foot from 2013 to 2018. Twelve patients with sequential AK amputation after BK amputation were designated as group I, and 43 patients successfully treated with BK amputation only were designated as group II. Two groups were compared for various demographic, laboratory and physical state. Then, multivariate logistic regression analysis was done to find predictors for sequential AK amputation after BK amputation. Results: In univariate analysis between two groups, only 'knee contracture' showed significant difference between two groups (p= 0.003). In multivariate logistic regression analysis performed with variables showing p <0.1 during univariate comparison, knee contracture was found to be predictor for sequential AK amputation after BK amputation (odds ratio= 34.740, p= 0.041). Conclusion: Patients with intractable ischemic and/or infectious foot disease with knee contracture, optimal level of amputation may be above knee level. Careful decision on amputation level can reduce surgical burden for intractable ischemic and/or infectious foot patients.