Review Question - QID 213903

A vascular patient with an AKA will have the slowest self-directed walking speed and highest relative energy cost while utilizing a prosthesis.

In general, more proximal amputations are associated with greater energy expenditures (with the exception of a Syme's amputation) and slower self-directed walking speeds. Vascular patients also have greater energy expenditures for the same level of amputation when compared to trauma patients. Amputation levels should be as distal as possible to preserve function and fit a prosthesis. Patients with traumatic BKA and AKA have been cited at expending 25% and 65% increased energy above baseline, respectively. Interestingly, patients with an AKA have been found to utilize more energy for ambulation than patients with bilateral BKAs (65% above baseline versus 41%).

Pinzur et al. explored the energy demands for walking with various amputation levels in patients with peripheral vascular disease (PVD) compared to a control group with PVD. The authors measured cardiac function and oxygen consumption at rest, normal walking speed, and maximal walking speed in patients with the following amputations: midfoot, Syme's, below-, through-, and above-knee. They found that more proximal amputation levels were associated with significant impairments in walking short or long distances in this population.

Jeans et al. reviewed the effect of amputation level on energy expenditure during walking in children. Seventy-three amputees of various levels and a control group participated in this study and oxygen consumption was measured as the children walked for 10 minutes at a self-selected speed. The authors found that children with through-knee or BKAs were able to maintain a normal walking speed without significantly increasing their energy costs, whereas children with AKAs had significantly slower walking speeds and increased energy costs.

Illustration A is a bar graph comparing the gait velocity of vascular and traumatic amputees (Waters RL, Perry J, Antonelli D, Hislop H. Energy cost of walking of amputees: the influence of level of amputation. J Bone Joint Surg Am. 1976;58(1):42-46.).

Incorrect Answers:
Answers 2, 3, 4, 5: In order of walking speed utilizing a prosthesis, from fastest to slowest, would be a trauma patient with a BKA, vascular patient with a Syme's amputation, trauma patient with an AKA, vascular patient with a BKA, and vascular patient with an AKA. This generally corresponds to the relative energy cost as well (vascular patients with more proximal amputations have increased relative energy costs and energy demands above baseline).