Functional Outcomes of Individuals Undergoing the Ewing Amputation.

Objective: To assess the postoperative performance of patients who have undergone the Ewing amputation (EA) on physical function tests and patient-reported outcome measures compared to their own preoperative state, as well as to normative data from non-EA transtibial amputees (TTAs) and able-bodied community adults (ABAs).

Design: Intervention cohort study with follow up of approximately one year.

Setting: Tertiary/quaternary care academic medical center.

Participants: Patients aged 18-65 who were candidates for elective transtibial amputation following failed attempts at limb salvage.

Intervention: The Ewing amputation - a novel approach to transtibial amputation incorporating the construction of agonist-antagonist myoneural interfaces (AMIs).

Main outcome measures: Performance-based physical function tests and patient-reported outcomes measures.

Results: A total of 22 patients with 26 EAs were studied. Over half of the studied EA patients were biological males (13, 59%) and the mean age of the intervention population was 40.6±12.9 years. All EA patients progressed to prosthetic fitting, with a mean time of 65±25 days. Functional testing was performed at a mean interval of 112±69 days prior to and 347±141 days following amputation. EA patients demonstrated statistically significant (p<0.01) improvements on all functional outcome measures and patient reported outcomes measures with the exception of Functional Reach (p=0.1222) when compared to themselves prior to amputation. EA patients demonstrated statistically significantly better performance on the 10-Meter Walk Test (10MWT), Timed Up and Go (TUG), 6-Minute Walk Test (6MWT) and Functional Reach Test than normative data from the TTA population (p<0.05), and equivalent performance to ABA patients on the 10MWT and TUG (p>0.5).

Conclusions: Patient performance on functional outcome measures improved after undergoing the Ewing amputation and associated rehabilitation interventions. Additionally, EAs performed better on several physical function outcome measures postoperatively when compared to TTAs and equivalent to ABAs on several of the same measures.