A simplified technique for above-knee amputation in patients with multiple implants: En bloc resection utilizing a...

The current manuscript describes a technical modification for above-knee amputation in the setting of multiple retained distal femoral implants. By performing a controlled circumferential osteotomy utilizing a Gigli saw around a retrograde intramedullary nail, lateral locking distal femoral plate, and total knee arthroplasty femoral component, the distal femur and retained implants were removed simultaneously with the distal femur. This approach may help avoid sequential implant-by-implant dissection and extensile exposure in carefully selected patients. Soft-tissue balance was obtained with adductor myodesis and quadricepsplasty. This method provides a pragmatic option for complex revision cases with exposed hardware, infection risk, fixed contracture, or nonfunctional limb status when limb salvage is no longer feasible. Removing complex revision arthroplasty and fixation components can be technically challenging; in selected cases, this technique may offer a practical approach to en bloc implant removal.