OA And the Amputee: Why More Lower-Limb Amputees Are Seeking Osteoarthritis Knee Treatments

​Since 2008, April has been designated as national Limb Loss Awareness Month in the U.S. According to the Amputee Coalition, an estimated 2 million Americans are living with an amputation today, and 500 more people lose a limb every day.  By 2050, the number of people with limb loss and limb difference is projected to increase to 3.6 million.  

The Amputee Coalition also reports that over half – 54% to be exact -- of all amputations in the U.S. are due to circulatory diseases. These diseases often occur because of diabetes and obesity, which can reduce blood flow to the extremities. About 45% of amputations are the result of accidents. The balance are people who were born with a congenital condition or survived cancer but had to lose all or part of their limb as a result of their disease. Amputations of the lower limbs are by far the most common, with 71% of amputations being below-the-knee. 

Thanks to the rise of online communities on the internet and social networks, people affected by limb loss have access to more information and support than in the past.  In particular, more amputees are learning about their prosthetic options, and more people are opting for a prosthesis than ever before. It is estimated that  84% of lower extremity amputees now use a prosthesis at least five hours a day. 

Over the past 20 years, amputees have benefited from amazing advancements in prosthetics technology. There are even bionic prosthetics that have on-board microprocessor computers built right into them. These bionic prosthetics might even be considered "smart" – artificial intelligence permits real-time learning, so the prosthesis can automatically adjust to the terrain underfoot, as well as to an amputee's pace and walking style, or what is known as gait. Many of the leading bionic prosthetics, such as Rheo Knee® and Proprio Foot®, both by Össur, are designed to help amputees experience enhanced levels of freedom, control, and mobility. 

Today, more amputees are living a full life with a prosthetic than at any other time in history, with many reporting having an active and satisfying quality of life. These numbers are continuing to grow in parallel with the  evolution of new and even more advanced prosthetics technology and medical treatments. Many people say their prosthetic has changed their life, and some might even argue that there has never been a better time in history to live with limb loss. 

Unfortunately, with record number prosthetic users, researchers have noticed a troubling trend: lower extremity amputees who use a prosthesis are two times more likely to experience pain in their sound side – that is, the side that has not been amputated – than individuals who have two biological legs. 

A typical scenario can happen like this: depending on various factors, an amputee  may be unbalanced in how they bear the weight of their body, or their walking style or gait may be uneven. They may consciously or unconsciously make adjustments every time they move. And while these adjustments, which are called compensations, might not seem to pose any issues at first, they are practiced repeated and continually over time  and may become problematic to the amputee's long-term health and mobility. 

Whether they  make adjustments because their prosthetic limb does not fit properly, they have developed poor habits, or they are trying to cope with other physical limitations, an amputee's compensations often result in an overreliance on the biological or "sound side" limbs. It may be especially pronounced in the hip and knee, which bear the greatest proportion of the body's weight during walking. 

Unfortunately, placing continual physical strain on an amputee's biological or "sound side" can contribute to a skyrocketing incidence of secondary conditions, including recurring pain throughout various parts of the body, or musculoskeletal issues. 

In fact, pain is often the first indication that an amputee is developing a secondary condition but it is a warning sign that is often disregarded. Some people may shrug off early experiences of pain as common or expected, but this can be a dangerous line of thinking. Not acknowledging pain delays both diagnosis and proper treatment. And left untreated, pain in an amputee's sound side knee joint can eventually impact – and increase -- their level of disability.

In the U.S., the most common cause of disability among adults, whether they are amputees or not, is Osteoarthritis (OA.) One of the most common causes of knee pain, OA is a condition in which the joint cartilage wears away over time, ultimately leaving a painful bone-on-bone experience. People with OA knee pain typically experience increasing pain, as well as swelling, stiffness, weakness or cracking in the affected joint. OA is a progressive disease, meaning it also tends to worsen over time.

An estimated 27 million people have OA today, and one of the causes is overuse of the joint. Being overweight, having had a prior knee injury and not being physically active are also factors that can increase a person's risk for developing knee OA.  

Unfortunately, there are no proven ways to prevent or cure OA. Left untreated, OA becomes increasingly debilitating, limiting a person's physical activities and negatively impacting their quality of life. The most severe cases usually require a surgical procedure called Total Knee Replacement (TKR).

And if millions of able-bodied people find it challenging to cope with OA knee pain, imagine how much more devastating it can be for amputees. 

Researchers have shown that amputees have a natural tendency to over-rely on their biological or sound limb, and this is a leading factor for developing knee pain. Because of this natural overuse and increased stress on the sound side of the body, the rate of OA diagnoses in lower extremity amputees is astoundingly high. Researchers report a whopping 75% of amputees reporting feeling knee pain, and that the rate of OA was 65% higher in amputees than in non-amputees. Experts also say that people with below-knee amputations have 10-17 times higher rates of knee OA than people who have not had an amputation. 

Having OA in their biological knee means amputees may experience increased pain and difficulty with mobility as well as reduced independence overall. Experiencing such pain and limitations, particularly in the remaining biological limb, can feel overwhelming and scary for an amputee. Coupled with the fact that many amputees may brush off pain as "par for the course," either because they are aging or because they wear a prosthesis, can delay a proper diagnosis of OA. 

Because of the strong reliance upon their remaining joints and absolute need to maintain mobility, the primary goal of an amputee who has been diagnosed with OA must be finding proper means of protecting their sound side joints from further injury and disease. Properly diagnosing the cause of joint pain in the early stages yields better results, so it is especially critical to speak with your doctor or prosthetist as soon as the discomfort is apparent.  

Addressing OA on an amputee's sound side is important to helping a person deal with their symptoms and maintain an active lifestyle with little to no disruption. In addition to getting a prompt diagnosis, amputees should explore any and all appropriate treatments for OA, including nonsurgical options such as the Unloader One® knee brace from Össur, which has been clinically proven to reduce the pain associated with unicompartmental knee OA. For many people, wearing an Unloader One brace has helped them manage the symptoms in moderate to severe OA cases. It has even reduced peoples' reported reliance on medications for their condition. 

In field and clinical studies, 25% of people reported a reduced use of pain medications after wearing an Unloader One knee brace. Even more impressively, 31% reported a reduced use of over-the-counter anti-inflammatory medicines, and 35% reported a reduction in their reliance on prescription anti-inflammatories, after using an Unloader One knee brace. The Unloader One's ability to help alleviate an amputee's pain while not interfering with daily activities helps enable those with OA to live their best lives without limitations.

The Unloader One was designed to withstand athletic activities across a variety of environments, and features a streamlined, low profile design so that it may be worn comfortably and discretely under clothes, providing relief while maintaining a natural silhouette.

The bottom line: a diagnosis of osteoarthritis in an amputee's remaining limb can be devastating. Thankfully, effective treatment options like the Unloader One brace can help them continue to enjoy an active lifestyle while managing their OA symptoms.  If you have been diagnosed with knee or hip OA and are experiencing pain, ask your doctor whether an Unloader One brace might be appropriate for you.