Health-related quality of life in patients with transtibial amputation and reconstruction with bone bridging of the distal tibia and fibula

Foot Ankle Int. 2006 Nov;27(11):907-12. doi: 10.1177/107110070602701107.


Background: Bone-bridging (arthrodesis of the distal tibia and fibula) at the time of transtibial amputation is a controversial operative technique that is anecdotally reported to improve the weightbearing capacity of the residual limb and to decrease residual limb discomfort.

Methods: Thirty-two consecutive patients with multiple diagnoses had transtibial amputation with a distal tibial-fibular bone-bridge, all done by a single surgeon (MAP). At an average of 16.3 months after surgery all patients completed the Prosthetics Evaluation Questionnaire (PEQ), a validated outcomes instrument specifically created to evaluate quality of life and functional demands in patients with a lower extremity amputations. Their responses were compared with those of 17 preselected, highly functional transtibial amputees from two academic medical centers who previously had transtibial amputations using a traditional non bone-bridge operative technique; their time since amputation averaged 14.7 years.

Results: The "nonselected" consecutive patients with a bone-bridged residual limb scored higher (more favorable) in the Ambulation (p = 0.037) and Frustration (p < 0.001) domains of the PEQ and lower (less favorable) in the Appearance (p = 0.025) subscale. Their scores were similar in the other six domains.

Conclusions: Patients of multiple ages with multiple diagnoses who had bone-bridging of the distal tibia and fibula at the time of transtibial amputation had scores on a validated outcomes instrument that were better than or comparable to those of a selected group of highly functional transtibial amputees. The results of this study suggest that bone-bridging at the time of transtibial amputation may enhance patient-perceived functional outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amputation, Surgical / methods*
  • Amputees* / psychology
  • Arthrodesis*
  • Artificial Limbs*
  • Data Interpretation, Statistical
  • Fibula / surgery*
  • Follow-Up Studies
  • Frustration
  • Humans
  • Middle Aged
  • Quality of Life* / psychology
  • Surveys and Questionnaires
  • Tibia / surgery*
  • Time Factors
  • Treatment Outcome
  • Walking