Five-Year Survival After Transmetatarsal Amputation (TMA)

This summary is based on a retrospective review that examined the five-year mortality rate following a Transmetatarsal Amputation (TMA). A TMA is a minor limb amputation, which is a limb salvage procedure.

Key Findings on Mortality

The study found that the mortality rate following a TMA is significantly lower than that of a Below-Knee Amputation (BKA), demonstrating that TMAs increase patient longevity.

• TMA 5-Year Mortality: The study found a 39% five-year mortality rate following the TMA procedure.

  
  

  • This compares to prior literature showing the five-year survival rate for BKA ranging as low as 28% up to 82% , or a mortality rate ranging from 40% to 82%.

    
    

• Early Mortality: Of the patients who were deceased, 33% expired within the first 12 months of the TMA. The one-year mortality rate for the overall patient population was 14%.

  
  

• Patient Longevity: Only 9.3% of the departed patients lived past 5 years.

  
  

Patient Demographics and Co-Morbidities

The study reviewed the records of 129 patients who underwent TMA between 2009 and 2011.

Co-Morbidity	Percentage of All Patients (n=129)	Percentage of Deceased Patients (n=54)
Hypertension (HTN)	89.9%	47 (36.4%)
Diabetes (DM)	79% , 79.1%	42 (41.1%)
Neuropathy	68% , 68.2%	37 (42.04%)
Smoking Status	62.3%	33 (40.7%)
Peripheral Vascular Disease (PVD)	53% , 52.7%	29 (42.6%)
Renal Disease	45% , 44.96%	33 (56.89%)
Coronary Artery Disease (CAD)	36%	18 (39.1%)

The Impact of Renal Disease

The study specifically noted that mortality was higher in patients with renal disease compared to other diseases.

• Of the 129 total patients, 45% had renal disease.

  
  

• Of the deceased patients, a greater percentage suffered from renal diseases (57%) compared to other co-morbidities.

  
  

• More patients that expired had renal disease (56.89%).

  
  

Higher Amputation After TMA

A total of 31 patients (24.03%) in the study required higher amputations after the TMA , which included 26 BKAs (Below-Knee Amputations) and five AKAs (Above-Knee Amputations).

Conclusion

The results support that a TMA is a viable limb salvage procedure that should be considered when applicable, given its association with increased patient longevity compared to major limb amputations like BKAs. The research also highlights that co-morbidities, particularly renal disease, are strongly associated with decreased survival rates after lower extremity amputation.