Other Special Projects - Center for Limb Loss and MoBility
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Center for Limb Loss and MoBility


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Other Special Projects

Functional Outcome Prediction in the Dysvascular/Diabetic Amputee During the Pre-amputation Period

A transfemoral amputee

A transfemoral amputee.

Amputations are not procedures of choice but are often necessary and valuable tools for returning a patient to a more active lifestyle. The choice of level for a major lower extremity amputation requires balancing the advantages of preserving the knee joint against the risks of failure to heal and subsequent revision. For patients with arteriosclerotic vascular disease or diabetes, successfully predicting wound healing after transtibial amputation is very challenging. It is essential to involve the patient or their surrogate in deciding the course of treatment and level of the amputation. This study compares mobility, quality of life and satisfaction with life among dysvascular and diabetic patients undergoing their first unilateral major lower extremity amputation. It will also determine which pre-amputation prognostic factors predict favorable mobility, quality of life, and life satisfaction among amputees.

Principal Investigator: Joseph Czerniecki, MD
Project Description: Functional Outcome Prediction in Dysvascular-Diabetic Amputee

Transtibial Amputation Management Strategies

Soft and Rigid dressings

Soft (left) and rigid (right) dressings

Patients with transtibial amputations frequently experience problems with pain, edema, contractures, and complications requiring additional surgery, limited return to function, limited satisfaction and high rehabilitation costs. Definitive evidence is lacking on the optimal post-operative transtibial management strategy. The primary aim of this project is to assess standardized procedures and data management protocols in a pilot study of transtibial amputees randomized to one of three types of management strategy (soft dressing, rigid plaster dressing or rigid dressing with pneumatic airbladders) and to measure six primary outcomes: pain, time to primary healing, edema, rehabilitation success, limb complications and restoration of functional ability.

Principal Investigator: Bruce Sangeorzan, M.D.
Project Description: Transtibial Amputation Management Strategies

Treatment Outcomes of Ankle Osteoarthritis

An ankle arthroplasty

An ankle arthroplasty.

Ankle osteoarthritis is characterized by joint pain, tenderness, limitation of movement, and variable degrees of inflammation. These factors combined and left untreated will severely limit a person’s mobility and willingness to participate in activities. Two common surgical procedures chosen to alleviate pain and to increase mobility are ankle arthrodesis (ankle fusion) and ankle arthroplasty (ankle replacement). Success rates for these procedures are variable and the amount of information available regarding long-term follow-up is limited. The extent to which a person is able and willing to move around the world is often an indicator of his/her condition. This study will examine walking activity levels, health status and activity, in patients before surgery and during the first three years after corrective surgery for ankle arthritis.

Principal Investigator: Bruce Sangeorzan, M.D.
Project Description: Treatment Outcomes of Ankle Osteoarthritis

Comparing ankle arthrodesis to ankle arthroplasty

An ankle arthrodesis.

An ankle arthrodesis.

End-stage ankle arthritis (ESAA) is a debilitating condition associated with severe pain, limited mobility, and reduced quality of life. Patients seeking surgery for ESAA have two primary treatment options: ankle arthrodesis (or "ankle fusion") and ankle arthroplasty (or "ankle replacement"). Each surgery has benefits and drawbacks, but few studies have directly compared the outcomes of these surgeries. The purpose of this study is to conduct a Randomized Controlled Trial (RCT) with a back door for patient-preference enrollment comparing ankle arthroplasty to ankle arthrodesis for treatment of ESAA. We will compare subjects' pain, mobility, and general health before and after each surgery. We will also determine whether certain patient characteristics are associated with more successful outcomes.

Principal Investigator: Bruce Sangeorzan, M.D.
Project Description: Comparing ankle arthrodesis to ankle arthroplasty

Training Program for Fellows (post-PhDs)

Objectives: To provide postdoctoral level health services education, training and mentoring to PhDs with strong methodological skills who are interested in VA health services research careers.

Methods: 1. Recruit strong candidates from across the US who are interested in an academic career. 2. Work with fellows on design, conduct and analysis of their research proposals. 3. Assist postdoctoral fellows with manuscript preparation and presentations at HSR&D and other national meetings. 4. Assist postdoctoral fellows in proposal development and review strategies. 5. Mentorship is an integral part of this fellowship.

Principal Investigator: Gayle Reiber, M.P.H., Ph.D.
Project Description: Training Program for Fellows