Magnitude of use of prostheses among patients with unilateral lower limb amputation due to peripheral vascular diseases at Muhimbili complex

Abstract

Introduction Amputation is a surgical operation by which the diseased or the injured limb or part of it is cut off. The disadvantage of amputation over other ablative surgery is that, the effects is immediately visible to a patient and produce a psychological sense of loss even though there is a possibility of restoring functions with prosthesis replacement. The study aimed at assessing the magnitude of the use of prostheses among individuals with unilateral lower limb amputation secondary to peripheral vascular diseases done at Muhimbili complex. Methodology The study was a descriptive prospective hospital based, conducted on 58 patients who underwent unilateral lower limb amputation due to PVD at Muhimbili complex between April 2017 and February 2018. The participants were enrolled by convenience sampling after reaching the inclusion criteria and written consent obtained. The participants were followed up for three months after surgery. A Structured questionnaire were used to collect information, the use of prostheses were assessed using HOUGHTON SCALE. Data were analyzed using statistical package for social sciences, approval for the study was sought from Muhimbili University of Health and Allied Sciences ethical committee. Permission to conduct the study was granted by the Executive Directors of Muhimbili Orthopaedic Institute and Muhimbili national hospital. Result A total of 58 participants were recruited in ten months of recruitment, of which they were 31 females (53.45%), 29 participants (50%) resides in Dar es salaam while other half were from other regions within Tanzania. Most study participants fell into age group of 54 years and above, with this age group having the largest proportion (53.45%) among other participants. 52 participants (89.66%) had closed amputation while 6 (10.34%) had open amputation. When inquired about accompanied diseases, 11 participants (18.97%) had no comorbidities, while 47 (81.035 %) had comorbidities such as diabetes, anemia, cardiac and sepsis. The magnitude of prosthetic fitting was 75% with a 95% CI 61.1%-85.5% in the population. The level of amputation was a significant factor in which above knee amputation use of prosthesis was 75.7% while 91.67% participants with below knee did not use prosthesis. Sex predicts the use of prosthesis, in which 22 users were female (59.4%), no other factor that seems to be a barrier to the use of prosthesis. At the end of the study Majority of prosthesis users were householdlimited community (43.2%). The magnitude of re-amputation was 8.2% with a 95% CI 3% - 20.4%, while the mortality rate among study participants was 15.5% with a 95% CI 8.1% to 27.6%. Conclusion Majority of amputees were fitted with prosthesis, in which level of amputation was a significant factor to be fitted. Majority of AKA were fitted and used prosthesis, mostly female amputees. Closed amputation was the commonest procedure, predominantly AKA hence the magnitude of re-amputation was low. Mortality among study participants was relatively high, as was realized the age groups of 54 and above were majority of the study participants and most of them had comorbidities, mostly being diabetes. At the end of the study majority of the participants uses prosthesis both in household and limited community areas while very few were household limited user.