Knee Disarticulation Versus Transfemoral Amputation: The Prosthetist's Perspective

Area of Science:

• Orthopedics
• Prosthetics and Orthotics
• Rehabilitation Medicine

Background:

• High-level lower extremity amputations, including knee disarticulation (KD) and transfemoral amputation (TFA), present complex decision-making challenges for patients and surgeons.
• Prosthetist expertise is crucial in guiding these decisions, yet preferences and perceived patient preferences for KD versus TFA are not well-documented.

Purpose of the Study:

• To survey prosthetists regarding their preferences for KD versus TFA.
• To ascertain prosthetists' opinions on patient preferences for amputation level.
• To identify common issues associated with KD and TFA to inform clinical decision-making.

Main Methods:

• A blinded electronic mail survey was administered to 102 prosthetists.
• Prosthetists were queried on their preferred amputation level (KD or TFA) and their beliefs about patient preferences.
• Reasons for preferences and perceived advantages/disadvantages were collected.

Main Results:

• No consensus was found among prosthetists regarding preference for KD (53%) versus TFA (47%).
• A majority of prosthetists (54%) believed patients preferred TFA, while 46% believed patients preferred KD.
• Key benefits of KD included distal-end weight-bearing and lower socket profiles; disadvantages involved component limitations, cosmesis, and sitting difficulties.

Conclusions:

• There is no clear consensus among prosthetists on the preferred amputation level between KD and TFA.
• Understanding the reported advantages and disadvantages of KD is essential for patient counseling.
• The findings can aid in developing a decision-making framework for high-level amputations.