Major lower limb amputation at Muhimbili national hospital and Muhimbili orthopaedic institute: indications, complications and early functional recovery

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University of Dar es Salaam
Major lower limb amputation (MLLA) is a worldwide problem and associated with significant morbidity and mortality. The indications, complications and outcome of amputation vary significantly around the worldwide; however published data on this matter especially in developing countries like Tanzania are scarce. This study was therefore designed to evaluate the indications, complications and early functional recovery after MLLA, at Muhimbili National Hospital (MNH) and Muhimbili Orthopedics Institute. (MOI) A prospective analytical study of patients, who had undergone MLLA from October 1st 2004 to Sept 30th 2005 were included, and followed up for four months. Their socio-demographic data, indications, outcome in term of complications, mortality and duration of hospital stay and early function outcome were recorded and analyzed. A total of 83 patients did undergo MLLA during the study period. Majority of them were uneducated and unemployed young males with a mean age of 45.3years (Range of 7 to 83yrs). Seventy percent of the MLLA were below knee amputations (BKA), 20% above knee amputations (AKA) and the remaining were knee (4.7%) and hip (2.4%) disarticulation with few foot amputations. There were 4 bilateral lower limb amputations of which two occurred during the study period. Closed amputations constituted 70% of all amputations. Trauma was the commonest cause of amputation (48.2%), followed by peripheral vascular diseases (PVD) (38.8%), while malignancy constituted only 10.6 %. Three patients were lost for follow up and 6 (7.5%) died (n=80). Among the 49(59%) patients with co morbid conditions, anaemia (31.32%) and diabetes mellitus (26.50%) were the commonest observed conditions. Stump infection and phantom pain were also the commonest complications. The mean hospital stay was 32 days with significant difference among MLLA due to trauma and PVD (P value 0.003), as well as those with stump infection (P=0.01) Only 32.5% of patients could stand on unaffected leg without support two weeks after amputation. Nevertheless at 8 and 16 weeks after amputation, majority were ambulant with crutches. 34.7% of the amputees were highly dependent with activities of daily living at eight weeks while only 13% were so at sixteen weeks. None of the amputees were using prosthetic limb and none was back to their pre morbid activities except for three students who went back to school, at the end of this study.
Available in printed form, East Africana Collection, Dr. Wilbert Chagula Library, Class mark (THS EAF RD775.L8)
Limb deformities, Extremities (Anatomy) abnormalities, Amputation
Lupondo, V. M (2006) Major lower limb amputation at Muhimbili national hospital and Muhimbili orthopaedic institute: indications, complications and early functional recovery. Master dissertation, University of Dar es Salaam. Dar es Salaam.