Rehabilitation after amputation: recovery, prosthetic limbs and aftercare

The NHS lists severe infection in a limb, gangrene (often as a result of peripheral arterial disease), complications from diabetes, serious trauma such as a crush or blast wound, and a deformed limb with limited function as reasons an amputation may be needed. Unless the surgery is an emergency, you will be assessed first to identify the most suitable type of amputation and anything that may affect rehabilitation.

That assessment can include a medical examination of the heart and lungs, a check of the healthy limb (because removing one limb can strain the remaining one), a psychological assessment, and an assessment of the home, work and social environment. You may be introduced to a physiotherapist and to a prosthetist, a specialist in prosthetic limbs, who advises about the types of limbs and devices available.

After surgery the NHS says you may be given oxygen through a mask and fluids through a drip for the first few days, and a urinary catheter may be placed during the operation. The wound is sealed with stitches, covered with a bandage, and a tube may be placed under the skin to drain excess fluid. Painkillers are given, and you are asked to tell your care team if they are not working because you may need a larger dose or a stronger painkiller.

A physiotherapist teaches exercises to help prevent blood clots and improve blood supply while you recover. The NHS says swelling (oedema) of the stump after surgery is normal and may continue after discharge, which is why compression garments are used. You should be given at least 2 garments, which are worn every day and taken off at bedtime.

The NHS describes physical rehabilitation as an important part of recovery that can be long, difficult and frustrating, but worth persevering with. It is tailored to individual needs and aims to let you do as many of your normal activities as possible. You work with physiotherapists and occupational therapists to set realistic goals.

Early on, a leg amputee is encouraged to move around as soon as possible using a wheelchair and is taught transfer techniques, such as getting from bed into a wheelchair. Once the wound has begun to heal, you may start an exercise programme to maintain mobility and muscle strength. If a prosthetic limb is fitted, the physiotherapist teaches you how to use it, for example how to walk on a prosthetic leg or grip with a prosthetic hand.

Before discharge, an occupational therapist may visit your home to see whether it needs adapting, for example with a ramp or stairlift, and such changes can be referred to local social care services. The NHS says you will probably have a follow-up appointment a few weeks after leaving hospital, where you may be given details of the nearest amputee support group.

The NHS says that after an amputation you may be able to have a prosthetic limb fitted, but they are not suitable for everyone. Adjusting to one takes considerable energy because you compensate for the loss of muscle and bone, so frail people or those with a serious health condition such as heart disease may not be suitable. If it is thought that you would find the strain difficult, a cosmetic limb may be recommended, which looks real but cannot be used like a prosthetic limb.

If a prosthesis is suitable, the type recommended depends on the type of amputation, the muscle strength in the remaining section of the limb, your general health, the tasks it is expected to perform, and whether you want it to look as real as possible or are more concerned with function. The NHS says it is possible to have a limb that is both realistic and functional but there may have to be some compromise.

Before fitting, the skin covering the stump may be made less sensitive (desensitisation) by gently tapping with a face cloth, using compression bandages and rubbing and pulling the skin around the bone to prevent excessive scarring. The NHS says that depending on what is available locally it can be several weeks before the first appointment with a prosthetist, while NHS inform in Scotland says it can be several months, so it is reasonable to ask your team what to expect where you live.

The NHS says to gently wash the stump at least once a day, more often in hot weather, with mild unscented soap and warm water, dry it carefully, and not leave it submerged in a bath for long. If you use a prosthetic limb, clean the socket regularly with soap and warm water. Some people find that wearing socks around the stump absorbs sweat, and the NHS advises changing them daily and notes that the number needed may vary as swelling reduces.

Check the stump daily for signs of infection, which the NHS lists as warm, red and tender skin, discharge of fluid or pus, and increasing swelling, and contact the care team if you think you may be developing one. After a leg or foot amputation, protect the remaining leg and foot, particularly when diabetes was the reason, avoiding poorly fitting footwear and having regular foot reviews with a podiatrist or foot care team.

The NHS says many people experience some degree of stump pain or phantom limb pain. Stump pain can come from rubbing or sores where the stump meets a prosthesis, nerve damage during surgery, or neuromas (thickened nerve tissue). Phantom limb sensations seem to come from the amputated limb and can range from brief flashes of mild pain like an electric shock to constant severe pain. They usually improve over time, but treatments are available.

The NHS lists medicines that may help, including NSAIDs such as ibuprofen, anticonvulsants such as pregabalin or gabapentin, antidepressants such as amitriptyline or nortriptyline for nerve pain, opioids such as codeine or morphine, and corticosteroid or local anaesthetic injections. Self-help and complementary approaches it lists include adjusting the prosthesis fit, massage, acupuncture, TENS, mental imagery of using the missing limb and mirror visual feedback.

The NHS says loss of a limb can have a considerable psychological impact, with many people reporting grief similar to bereavement, and that coming to terms with it is often as important as coping with the physical demands. It lists depression, anxiety, denial and grief as common, and says people who lose a limb through trauma have an increased risk of post-traumatic stress disorder. It encourages talking to the care team, particularly if you feel depressed or suicidal, because treatments such as antidepressants or counselling can help.

The NHS names the Limbless Association, the Douglas Bader Foundation, Steel Bones Amputation Foundation and Blesma, the Limbless Veterans, as charities offering advice and support. It says many people enjoy a good quality of life once they have adapted and with appropriate treatment and support.

In the NHS, assessment, surgery, early rehabilitation and prosthetic referral are usually coordinated by the hospital team and a specialist prosthetic and rehabilitation service. Waiting times for a prosthetist appointment depend on the area. Some people also explore privately funded prosthetic components or private physiotherapy, but any socket fitting and follow-up should be coordinated with the NHS rehabilitation team that knows your surgery and health history.