Letters to the Editor   |    
Below-the-Knee Compared with Above-the-Knee Amputation
Jacquelin Perry, MD, ScD1
1 Pathokinesiology ServiceRancho Los AmigosNational Rehabilitation Center7601 East Imperial HighwayDowney, CA 90242pklab@larei.org
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The author did not receive grants or outside funding in support of her research or preparation of this work. She did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 May 01;87(5):1162-a-1163
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To The Editor: Recently my attention was directed to the article "Functional Outcomes Following Trauma-Related Lower-Extremity Amputation" (2004;86:1636-45, 2503), by MacKenzie et al. This multicenter study included a monumental mass of data and imparts valuable information about the psychological impact of traumatic amputations, but the authors also offered two major, unsupported conclusions.First, the outcome of above-the-knee amputations was presented as superior to those of below-the-knee amputations, but this conclusion is contradicted by other data. The SIP (Sickness Impact Profile) scores showed that the outcomes of the above-the-knee amputations equaled or exceeded those of the below-the-knee amputations. This interpretation, however, is refuted by a statement in the text that "none of the differences... was significant at the p < 0.05 level." Another contradiction is found in the statement: "the walking speed of the patients with a below-the-knee amputation was significantly faster than that of the patients with an above-the-knee amputation." Sixty-two percent of the patients with a below-the-knee amputation had a walking speed equal to or faster than 4 ft/sec compared with 43.5% of those with an above-the-knee amputation, and 23.1% of those with an above-the-knee amputation were unable to walk independently over uneven ground compared with 11.3% of those with a below-the-knee amputation.
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