Transarticular versus Transosseous Amputations in Diabetic Foot Osteomyelitis: A Retrospective Comparative Study.

Abstract

Background: Reamputations are frequent after minor amputations performed for diabetic foot osteomyelitis (DFO). Whether the type of amputation is associated with a particular outcome is unknown. The aim of this study was to evaluate whether amputations of the transarticular compared with the transosseous type have different rates of clinical and microbiological failure.

Methods: We actively followed 284 patients with DFO (543 episodes of minor foot amputations: 203 transarticular and 340 transosseous) for 1 year. We assessed the long-term effect of transarticular compared with transosseous amputations on the rates of clinical and microbiological failure using comparative statistics, log-rank survival analyses, Kaplan-Meier curves, and multivariate Cox regressions.

Results: In 122 episodes (22.5%) there was clinical failure that led to reamputation. The difference in the risk of clinical failure of transarticular versus transosseous amputations was nonsignificant (44 [21.7%] versus 78 [22.9%]; Pearson χ2 test: P = .73). Similarly, the difference in microbiological failure (32 episodes, 5.9% overall) between groups was nonsignificant (11 [5.4%] and 21 [6.2%], respectively; P = .72). The mean time between the index surgery and clinical failure was 2.2 months for transarticular and 3.2 months for transosseous amputations (Mann-Whitney U test; P = .39). Survival analyses showed similar evolutions for each group (log-rank test; P = .85). In the multivariate Cox regression analysis, the type of amputation did not significantly influence clinical or microbiological failures.

Conclusions: In DFO, there is no significant difference between transarticular and transosseous amputations within 1 year in the incidence of clinical or microbiological failures.