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Optimizing below knee amputation osteotomy length: a ratio-based approach.

Daniel J Cognetti1,2,3, Mikalyn T DeFoor1, Mariah Arave1

  • 1Brooke Army Medical Center, Fort Sam Houston, TX.

OTA International : the Open Access Journal of Orthopaedic Trauma
|November 21, 2025
PubMed
Summary
This summary is machine-generated.

A novel below knee amputation (BKA) ratio was introduced to tailor residual tibia length. This ratio reveals significant variability in limb length based on patient height and sex, challenging a one-size-fits-all approach.

Keywords:
below knee amputationenergy expenditurepatient-specificpilot studyratiotranstibial

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Area of Science:

  • Orthopedics
  • Biomedical Engineering
  • Radiology

Background:

  • Below knee amputation (BKA) length is crucial for prosthetic fit and function.
  • Current methods for determining BKA length may not account for individual patient variations in height and sex.
  • A standardized approach may lead to suboptimal residual limb lengths.

Purpose of the Study:

  • To introduce a novel below knee amputation (BKA) ratio.
  • To evaluate the potential of this BKA ratio for tailoring residual tibia length.
  • To assess variability in residual tibia length among patients of varying height and sex.

Main Methods:

  • Retrospective radiographic review of full-length tibia radiographs.
  • Inclusion of skeletally mature patients without tibial fracture or osseous abnormality.
  • Calculation of the BKA ratio (12 cm osteotomy / tibial length) and comparison of mean values using independent t-tests.

Main Results:

  • A cohort of 100 patients (50 males, 50 females) was analyzed.
  • Mean tibia length differed significantly between males and females (39.5 vs. 36.5 cm, P < 0.0005).
  • The mean BKA ratio was 0.32 ± 0.02, with residual limb lengths varying by 2.9-3.3 cm between shortest and longest tibias.

Conclusions:

  • A one-size-fits-all approach to BKA length results in substantial residual limb length variability.
  • Current BKA length standards may be oversimplified.
  • Further research is needed to determine the clinical relevance of these findings for prosthetic fit and energy expenditure.