Comparing surgical outcomes in end-bearing amputation stumps: a prospective cohort study of different surgical techniques

Ifeanyi Agwulonu; Oluwaseyi Idowu; Chinoso Osuala; Moses O. Oyewunmi; Badmus Hakeem

doi:10.18203/2320-6012.ijrms20253130

Authors

Ifeanyi Agwulonu Department of Surgery, Orthopedic and Traumatology Unit, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
Oluwaseyi Idowu Department of Orthopedic and Traumatology, National Orthopaedic Hospital Igbobi, Nigeria
Chinoso Osuala Department of Orthopedic and Traumatology, Ebonyi State Teaching Hospital, Abakaliki, Nigeria
Moses O. Oyewunmi Department of Surgery, Orthopedic and Traumatology Unit, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
Badmus Hakeem Department of Orthopedic and Traumatology, Hospital for Trauma and Surgery, Lekki, Nigeria

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253130

Keywords:

Below-knee amputation, Fascia to fascia, Stump stability, Prosthetic fitting, Fascia to periosteum, Myodesis, Myoplasty

Abstract

Background: Lower limb amputation outcomes are influenced by surgical technique, which impacts stump stability, prosthetic fitting, and complication rates. This study compared postoperative outcomes of fascia-to-fascia (including fascia-to-periosteum), myodesis, and myoplasty in below-knee amputations.

Methods: A five-year retrospective cohort study at two Nigerian tertiary centers included 96 adults who underwent unilateral below-knee amputation between January 2019 and December 2024. Data on patient characteristics, operative details, and outcomes were analyzed using Chi-square/Fisher’s exact tests and Kruskal-Wallis tests.

Results: Mean age was 46.9±12.8 years; 69.8% were male. Fascia to fascia achieved the best prosthetic fitting (48.4%) and stump stability (49.1%), with the lowest reoperation (6.7%) and infection rates (15.2%). Myodesis had the highest reoperation and infection rates, while myoplasty had the shortest surgery time and lowest pain. fascia-to-fascia (including fascia-to-periosteum), took longest to perform (125±15 minutes) and had the highest pain scores.

Conclusions: Fascia to fascia fixation appears superior for long term stump integrity and prosthetic function, which is particularly valuable in resource limited Nigerian settings. Nevertheless, its association with greater pain and longer operative time highlights the need for targeted strategies to optimise analgesia and surgical efficiency without compromising outcomes.

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