Selection of patients for through-the-knee amputation

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Rehabilitation Medicine

Background:

• Through-the-knee amputation (disarticulation of the knee) is a surgical procedure.
• Peripheral vascular insufficiency is a common comorbidity in patients undergoing amputation.
• Functional prosthesis use and wound healing are critical outcomes post-amputation.

Purpose of the Study:

• To evaluate the outcomes of through-the-knee amputation in adult patients.
• To assess wound healing, prosthesis function, and joint contracture development.
• To compare through-the-knee amputation with below-the-knee and above-the-knee amputations.

Main Methods:

• Retrospective review of 46 adult patients undergoing through-the-knee amputation over a four-year period.
• Classification of patients based on potential for functional prosthesis use and wound healing capacity.
• Follow-up assessment of wound healing, joint contracture, and prosthesis utilization.

Main Results:

• In 34 patients with peripheral vascular insufficiency, 30 achieved wound healing and no joint contracture after through-the-knee amputation.
• Twelve patients, deemed suitable for prosthesis use but not for below-the-knee healing, had 8 (67%) successful wound healing with prosthesis use.
• Four patients (33%) in the second group required revision to above-the-knee amputation due to healing failure.

Conclusions:

• Through-the-knee amputation provides good muscular balance and low risk of joint contracture.
• The residual limb offers excellent surface area for sitting balance and transfer.
• This amputation level allows for direct load transfer and functional prosthesis use in select patients.