Operative and rehabilitation outcomes after transfemoral amputation with or without adductor myodesis

Abstract: BACKGROUND: Transfemoral amputation (TFA) often results in poor functional outcomes, including low ambulation rates and prosthetic use. Myodesis is a surgical adjunct to TFA designed to provide muscle stabilization. However, there are limited data characterizing functional outcomes after TFA with myodesis. METHODS: A retrospective review was conducted for all patients who underwent TFA between September 2016 and August 2023 at a single Veterans Affairs Hospital. Patients who underwent TFA with adductor myodesis (TFA + M) were compared to patients who underwent TFA without myodesis (TFA). Endpoints included standard preoperative, intraoperative, and postoperative variables with the addition of select postrehabilitation outcomes. Subgroup analysis was performed based on indication for amputation (orthopedic versus vascular/diabetic). RESULTS: Seventy-six patients underwent 77 amputations (45 TFA and 32 TFA + M). TFA + M required a longer operative time compared to TFA (143 vs. 99 min, P < 0.001). Fifteen patients (2 TFA and 13 TFA + M) underwent amputations for orthopedic indications. Orthopedic cases had significantly fewer comorbidities and improved preoperative and postoperative functional scores compared to operations performed for vascular/diabetic indications. Subgroup analysis of the 43 TFA and 19 TFA + M operations performed for vascular/diabetic indications showed that patients undergoing TFA + M were more likely to be referred to amputee clinic, yet there was no significant difference in postoperative K-level or receiving a prosthesis. CONCLUSION: The addition of adductor myodesis to TFA significantly increased operative time without improving perioperative or functional outcomes in patients undergoing amputation for vascular/diabetic indications. Future studies are needed to determine if there is a benefit in patients undergoing amputation for orthopedic indications.