Reoperation and Reamputation After Transmetatarsal Amputation: A Systematic Review and Meta-Analysis

Jakob C. Thorud, Daniel Jupiter, Jonathan Lorenzana, Tea Tu Nguyen, Naohiro Shibuya

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations. A search of the Medline, CINAHL, and Cochrane Central databases yielded 159 abstracts. After review, 24 reports were included in the study. A total of 391 (26.9%) reoperations were identified after 1453 transmetatarsal amputations. Any level reamputation occurred in 152 (29.7%) of 365 transmetatarsal amputations and major amputation occurred in 380 (33.2%) of 1146 transmetatarsal amputations. Using a random effects model, the reoperation rate was estimated at 24.43% (95% confidence interval 11.64% to 37.21%), the reamputation rate was estimated at 28.37% (95% confidence interval 19.56% to 37.19%), and the major amputation rate was estimated at 30.16% (95% confidence interval 23.86% to 36.47%). These findings raise questions about the conventional wisdom of performing primary transmetatarsal amputation in lieu of other minor amputations, such as partial first ray amputation, and suggest that the choice between transmetatarsal amputation and other minor amputations might be a decision that depends on very patient-specific factors.

Original languageEnglish (US)
Pages (from-to)1007-1012
Number of pages6
JournalJournal of Foot and Ankle Surgery
Volume55
Issue number5
DOIs
StatePublished - Sep 1 2016

Fingerprint

Reoperation
Amputation
Meta-Analysis
Confidence Intervals

Keywords

  • diabetic foot
  • limb salvage
  • midfoot amputation
  • minor amputation
  • peripheral vascular disease

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Reoperation and Reamputation After Transmetatarsal Amputation : A Systematic Review and Meta-Analysis. / Thorud, Jakob C.; Jupiter, Daniel; Lorenzana, Jonathan; Nguyen, Tea Tu; Shibuya, Naohiro.

In: Journal of Foot and Ankle Surgery, Vol. 55, No. 5, 01.09.2016, p. 1007-1012.

Research output: Contribution to journalReview article

Thorud, Jakob C. ; Jupiter, Daniel ; Lorenzana, Jonathan ; Nguyen, Tea Tu ; Shibuya, Naohiro. / Reoperation and Reamputation After Transmetatarsal Amputation : A Systematic Review and Meta-Analysis. In: Journal of Foot and Ankle Surgery. 2016 ; Vol. 55, No. 5. pp. 1007-1012.
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abstract = "Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations. A search of the Medline, CINAHL, and Cochrane Central databases yielded 159 abstracts. After review, 24 reports were included in the study. A total of 391 (26.9{\%}) reoperations were identified after 1453 transmetatarsal amputations. Any level reamputation occurred in 152 (29.7{\%}) of 365 transmetatarsal amputations and major amputation occurred in 380 (33.2{\%}) of 1146 transmetatarsal amputations. Using a random effects model, the reoperation rate was estimated at 24.43{\%} (95{\%} confidence interval 11.64{\%} to 37.21{\%}), the reamputation rate was estimated at 28.37{\%} (95{\%} confidence interval 19.56{\%} to 37.19{\%}), and the major amputation rate was estimated at 30.16{\%} (95{\%} confidence interval 23.86{\%} to 36.47{\%}). These findings raise questions about the conventional wisdom of performing primary transmetatarsal amputation in lieu of other minor amputations, such as partial first ray amputation, and suggest that the choice between transmetatarsal amputation and other minor amputations might be a decision that depends on very patient-specific factors.",
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