Hannah Levine, MD
Resident Physician
MedStar Georgetown University Hospital/National Rehabilitation Hospital
Wellington, Florida, United States
Herminio Navia, MD
Resident
MedStar National Rehabilitation Network
Washington, District of Columbia, United States
Howard A. Howard A Gilmer, DO
Medical Director, Amputee Rehabilitation Program
National Rehabilitation Hospital
Arlington, Virginia, United States
Ill-fitting prosthetic associated with GLP-1 agonist use
Case Description: A 57-year-old male with obesity, diabetes mellitus and prior traumatic right below-knee amputation in 2000 initially presented to amputee clinic with poorly fitting prosthetic which fit well for three years prior. His socket was too large compared to his residual limb, and he received a new socket. As he lost more weight over the next year, despite numerous adjustments, his new socket no longer fit despite max padding. He developed a 4-cm posteromedial knee wound. The patient then revealed he was taking a GLP-1 agonist for diabetes. His wound became infected, requiring hospitalization for surgical debridement and intravenous antibiotics, and acute rehabilitation. Eighteen months after initial presentation, he had more frequent follow-ups and is still pending full resolution of wound before trialing a third socket.
Discussions:
Socket fit adjustment is a common follow-up for prostheses. Newly amputated limbs are affected by post-amputation edema and muscle atrophy. Mature limb size fluctuates based on physical activity, diet, and comorbidities that exacerbate weight gain, like diabetes. However, only a small minority currently have significant weight loss after amputation. New treatments such as GLP-1 agonists that cause substantial weight loss are now being prescribed to patients with amputations and comorbid diabetes. At this clinic, there have recently been several emerging cases in which patients present with prosthetics that no longer fit and are found to be on GLP-1 agonists. Then, rapidly changing residual limbs impede socket replacement. This phenomenon has not yet been significantly documented in current literature.
Conclusions: As GLP-1 agonist use increases, physiatrists can anticipate rapid and significant weight change and redistribution affecting residual limbs. This can complicate prosthetic fit for those with prior stable prostheses or new amputations. Early recognition and more frequent adjustment follow-ups can improve functional outcomes and prevent complications like residual limb infections.
