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Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy

Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy

Published on: February 17, 2023

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

Daniel J Cognetti^1,2,3, 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

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 amputation energy expenditure patient-specific pilot study ratio transtibial

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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.