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643 - Effectiveness of a Knee Scooter in Improving Ambulation in Patients with Below-Knee Amputation: A Case Report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

NM

Nathan Michalak, MD

Resident
New York Medical College (Metropolitan)
New York, New York, United States

Co-Author(s)

JK

Jun Beom Ku, MD

Resident
New York Medical College (Metropolitan)
New York, New York, United States

Corresponding Author(s)

RH

Robert Holland, MD

Chief of Service
New York Medical College (Metropolitan)
New York, New York, United States

Case Diagnosis: A 45 year-old female with diabetes mellitus, morbid obesity (BMI 40.12) presented with right leg necrotizing fasciitis requiring below knee amputation (BKA) and was subsequently admitted to acute inpatient rehabilitation. Initially, she was only able to ambulate 15 feet with rolling walker and hopping gait pattern. Ambulation was limited by persistent trepidation and fatigue, and the patient requested wheelchair follow for frequent rest breaks. Additionally, the patient displayed decreased foot clearance secondary to decreased left leg strength and complained of muscle soreness and myofascial pain in the shoulders, arms, abdomen and lumbar spine. To address these challenges, ambulation with a knee scooter was trialed, during which the patient was able to ambulate 150 feet independently without developing a flexion contracture or any wound complications. The patient was ultimately discharged with a knee scooter.

Case Description: Due to the morbid obesity and deconditioned state, the patient struggled with standard gait training. Despite therapeutic exercise and strength training of the upper extremities, she was unable to adequately support her body with bilateral upper extremities during hopping gait. She required an oversized wheelchair which was difficult to maneuver and utilize over long distances and would not be accommodated in her home. The patient reported improved satisfaction and mobility with use of the knee scooter compared to other methods of ambulation.

Discussions: A knee scooter is a novel ambulating method that is underutilized in patients with BKA. The ease of use and low physical demand may serve as a more effective bridge to prosthesis or benefit those who are not candidates for a transtibial prosthesis. In addition, early weight bearing on the patella does not appear to affect wound healing.

Conclusions: A knee scooter may be an alternative method of locomotion in patients with a BKA who demonstrate poor tolerance to hopping gait or wheelchair level ambulation.