Sports and physical functioning of children with amputations were significantly worse after amputations near the knee when compared with ankle-level amputations, according to a study published in the January issue of the Journal of Pediatric Orthopaedics.

Researchers considered whether children with amputations have differences in subjective function based on amputationlevel and whether children with more proximal amputations would report poorer function and quality of life. An Institutional Review Board (IRB)-approved, retrospective chart review of patients age 0 to 21 years old with lower-limb amputations was performed. Demographic information, type of amputation, type of prosthesis, and the Pediatric Outcomes Data Collection Instrument (PODCI) were collected from parents and children over ten?years of age. Patients were divided into four groups based on the level of amputation(ankle, transtibial, knee, transfemoral). PODCI scores were compared between groups. PODCI subscores were also compared between unilateral versus bilateral amputations, high-demand versus low-demand prostheses, and congenital versus acquired amputations.

Researchers identified 96 patients for analysis (39 ankle, 21 transtibial, 27 knee, and nine transfemoral amputations). The sports/physical functioning subscale of the PODCI showed the only statistically significant difference between amputation level and outcome with ankle-level amputations reporting higher scores than knee-level amputations (parent: 78.3 ± 16.4 versus 60 ± 25.3; child: 87.4 ± 15.3 versus 65.4 ± 31.5). Although not significantly different from either the ankle, knee, or transfemoral groups, patients with transtibial amputations reported intermediate scores (parent: 68.5 ± 27.5; child: 78.9 ± 25.5), the study found.

There were no significant differences among amputation level for PODCI transfers, pain/comfort, global function, or happiness subscales. In subgroup analysis, patients with same-level congenital amputations had similar scores to patients with acquired amputations. When compared with unilateral knee amputation patients, patients with bilateral knee amputations had significantly worse transfer (62.4 versus 88.3), sports/physical functioning (34.2 versus 66.2), and global domains (58.4 versus 80.5).

Though not statistically significant at all levels, the data suggested a graded decline in sports/physical functioning in patients with higher level amputations. Amputation level, however, did not affect pain, happiness, or basic mobility, the study found.