FOOT & ANKLE INTERNATIONAL Copyright Q 2002 by the American Orthopaedic Foot & Ankle Society, Inc. Benefits of Early Prosthetic Management of Transtibial Amputees: A Prospective Clinical Study of a Prefabricated Prosthesis Lew C. Schon, M.D.*; Kelly W. Short, PT; Olga Soupiou, R.N.; Kenneth Noll, CO; John Rheinstein, CP Baltimore, MD ABSTRACT To evaluate the use of an immediate postoperative pros- thesis (IPOP) for transtibial amputees, we compared patient outcomes from a prospective clinical study of 19 patients managed with an IPOP with those of a retrospec- tive review of a matched historic control group of 23 patients managed with standard soft dressings. Data were analyzed with the Student's t-test, and significance was set at P=0.05. The [POP patients had no surgical revisions, whereas the patients with standard soft dressings had 11. This was a significant difference. IPOP patients also had significantlyfewer postoperative complications and short- er times to custom prosthesis than did controls. Key Words: Amputation; Transtibial; Prosthesis,Prospective INTRODUCTION Postoperative management of patients with amputa- tions varies from center to enter.^,^ A popular standard of treatment is to apply a soft dressing (SD) and elastic bandages to the residuum and await complete tissue healing and reduction in swelling before applying the first temporary prosthesis. In the 1960s, an alternative technique using an immediate postoperative prosthesis (IPOP) made from plaster was introduced. Since that time, it has been successfully used in many hospitals From the Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland 'LC. Schon is a coinventor of the Air-Limb,TM a prefabricated adjustable pneumatic prosthesis manufacturedby Aircast, Summit, NJ. He will receive royalties. Corresponding Author: Lew C. Schon, M.D. c/o Lyn Camire, Editor Union Memorial Orthopaedics The Johnston Professional Bldg. #400 3333 North Calvert Street Baltimore, MD 21218 Phone: (410) 554-6668 Fax: (41 0) 554-2832 E-mail: lync@ helix.org ~~rld~ide,~.~,~~~~,~~~~~,~~,~~ despite the fact that the method is labor-intensive, requires three or four cast changes, precludes continual wound observation, and may be contraindicated for some higher-risk patient^.^ Nevertheless, various studies1.3~6,7~9'15~18,23326 have demon- strated the benefits of IPOP systems. These include pain reduction, edema control, fewer complications, faster time to custom prosthetic fitting, reduced cost, decreased time for rehabilitation, and decreased length of hospitalization compared with management with SDs. Recently, a removable, adjustable, prefabricated IPOP has been introduced that may offer some poten- tial advantages over the plaster systems. The hypotheses of the current investigation were that, compared with an SD protocol, a removable, adjustable, prefabricated IPOP or early postoperative prosthesis with pneumatic air bladders (Air-Limb,TM Aircast, Summit, NJ) would reduce postoperative complications, reduce falls, and permit controlled ambulation without compromising the residuum (Figs. 1, 2). MATERIALS AND METHODS Patient Population /POP group. From October 1998 to February 2000, 31 patients underwent transtibial amputation. Study exclusion criteria included a patient undergoing a guillo- tine amputation, a patient incapable of ambulating (or without the potential to ambulate) with or without assis- tance, pendulous thigh, lower thigh ulceration, and residual limb less than three inches long or more than eight inches long as measured from the midpatella ten- don to the distal residuum. Therefore, with Institutional Review Board appr~val,~' consecutive, consenting patients were prospectively enrolled in the study before unilateral amputation. One patient was excluded from the study after amputation because the residuum was too large to fit into the IPOP. The remaining 18 men and 12 women, with an average age of 53 years (range, 23 to 79 years), formed our study IPOP group (Table 1). Primary reasons for amputation included infection (16), ischemia (4), acute trauma (4), chronic pain (S), and