JAN. 17, 1953
THE ELDERLY AMPUTEE
THE ELDERLY AMPUTEE
S. McKENZIE, M.B., Ch.B.
(From the Ministry of Pensions Limb Fitting Centre,
Since the advent of the National Health Service the
Ministry of Pensions Limb Service has been called upon
to treat large numbers of elderly patients, and it was
therefore felt that a more detailed study of the results
obtained by current methods would be of value and
perhaps form a guide to the minutiae of technique and
selection in future.
At the inception of the N.H.S. the experience of the
Limb Service in the rehabilitation of elderly patients
was not extensive, the technique of rehabilitation having
been evolved primarily in relation to active ex-Service
This technique had, however, met with success,
and we were encouraged to adopt the same methods,
modified only in so far as the programme was adapted
to the physical capacity of the higher age groups and
the more enfeebled.
Enough time has now elapsed to
respect of the first 6,000 N.H.S. patients accepted for
prosthetic treatment at Roehampton.
were "primary" cases-that is, patients who had not
yet worn a prosthesis-aged 65 or more, representing
some 30% of all the primary lower-limb cases received
during the same period.
4,000 to 5,000 major amputations are performed each
year in the British Isles in times of peace, so that the
Limb Service can expect some 1,350 new elderly patients
The wastage from death and intercurrent
portion are successfully equipped with prostheses; but
elderly patients requiring continued supervision by the
Limb Service throughout the years cannot be expected
to be less than 5,000 to 6,000 at any given time.
assess results in
Of these, 344
It has been estimated that
is, of course, considerable, and only a
The technique adopted in the treatment of this age group
has followed the same general plan as that used in the past.
Patients are seen as out-patients in the limb centre as soon
as possible after reference from hospital.
cases to be seen by the limb surgeon at an early stage,
while others wait until the patient has been discharged
to his home.
At first the limb surgeon makes
examination and assesses the capabilities.
or general treatment is indicated he will normally refer the
patient back to his hospital with suitable recommendations,
unless he feels that the special experience of the Roehamp-
ton staff is required.
At the earliest possible stage a pylon
is ordered for thigh cases, while below-knee cases normally
are fitted direct with the permanent prosthesis.
1950), and are very light.They can be made in a very
short time, and rehabilitation can begin at an early date
referred to this centre have not persisted with stump exer-
cises and bandaging, the details of which technique have
been published by the Ministry of Pensions (1951).
sion of this treatment, or failure to persist in
in a flabby stump with terminal oedema and general debility
with lack of muscular tone, and in delays and difficulties in
limb-training which are in some cases insuperable.
There seems to
a local and general
If further stump
are provided with "durestos" sockets (Scales,
so promote morale.
It is found that many patients
Training in walking is started as soon as possible after
delivery of the pylon. We find it better for morale if this
is carried out by daily attendances on an out-patient basis,
and only those who have too far to travel or have compli-
cating factors are admitted to the hospital.
between handrails, progressing to walking with sticks, stair-
climbing, walking on slopes and cambers, etc., and instruc-
tion in meeting all the ordinary needs of existence.
conjunction with this, group therapy is employed in the
form of suitably modified remedial exercises designed to
promote general improvement in muscle tone, to improve
reactions, and to stimulate morale.
tinued until the patient is fully independent or until no
further progress can be made.
knee amputee may have two weeks' and the double-thigh
subject four or more weeks' training.
After training, the patient is kept under observation by
a follow-up, and the permanent prosthesis
when function merits
Further training is given after
delivery of the permanent prosthesis.
The training is con-
Thus the single below-
An attempt has been made to assess results obtained in
the 344 cases under review in relation to the age and sex
of the patient, the site of amputation, the cause of amputa-
tion, and the presence or absence of complications.
habilitation was regarded as successful in 171 (49.7%). No
very exacting criteria have been taken, but cases were con-
sidered to be successful if appreciable and regular daily
use has been made of the prosthesis for a period of not
less than six months ftoin completion of fitting and instruc-
tion.Failure occurred in 101 cases (29.4%).
vened during rehabilitation procedures or within six months
of completion in 31 cases (9%).
in 16 cases (4.6%), the result remains uncertain in 5 cases
(1.5%), and follow-up has failed to trace 20 patients (5.8%).
Fitting was not attempted
TABLE I.-Results in Relation to Age
attempted. U= Uncertain.
Table I shows, as would be expected, an increasing failure
rate with age.
The high proportion of successes in the
oldest group is probably not significant, owing to the small
numbers involved, except to show that age itself is no bar
to successful rehabilitation. The o4dest patient to be treated
was a woman born in 1860 who had had the right leg
amputated' above the knee when she was 5 years old but
had never worn a prosthesis.
haps not strictly a primary case, as she had not recently
had a debilitating illness or undergone major surgery.
has been included, however, on the ground that it was her
first attempt with a prosthesis.
in November, 1948, and with an articulated prosthesis seven
She made uninterrupted progress despite
domestic difficulties, and when last seen in September, 1951,
she was "making better use of her leg than many half her
At the other end of the scale six of the youngest
attempted, and ovxer 25% have failed to learn to manage
The oldest double-thigh amputee to make
successful use of prostheses was 81.
To this extent she was per-
She was fitted with a pylon