March 2011

Mortality data favor transmetatarsal amputation in patients with diabetes

In the moment: Footcare

Transmetatarsal amputations offer lower mortality rates and time to failure than other distal alternatives to transtibial amputation in patients with diabetes, according to research from the University of Rochester in New York.

Investigators retrospectively reviewed records of 83 patients who had undergone a below-knee or partial foot amputation secondary to osteomyelitis or a non-healing diabetic ulcer, and mortality rates were calculated based on survival analysis.

Mortality rates at one and three years were significantly lower for transmetatarsal amputations than for transtibial, Chopart, or partial or full calcanectomy. Five year mortality for transmetatarsal amputation was still lower than for the other procedures, although the difference was not statistically significant.

Of the 21 patients who underwent transmetatarsal amputations, only two required proximal reamputation, with a time to failure of 2.3 years. The group of 11 Chopart amputations had a similar time to failure of 2.4 years, but all other procedures failed within eight months or less.

The results were presented in February at the annual AAOS meeting.

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