A review of through-knee amputation

Abstract

Objectives Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a through-knee amputation approach. This article seeks to (1) determine the number of through-knee amputation performed compared with other major lower limb amputations in England over the past decade; (2) identify the theoretical concepts behind through-knee amputation surgical approaches and their potential effect on functional and clinical outcomes and (3) provide a platform for discussion and research on through-knee amputation and surgical outcomes. Methods National Health Service Hospital Episodes Statistics were used to obtain recent numbers of major lower limb amputations in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on through-knee amputation surgery. Results In the past decade, 4.6% of major lower limb amputations in England were through-knee amputations. Twenty-six articles presenting through-knee amputation surgical techniques met our criteria. These articles detailed three through-knee amputation surgical techniques: the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur. Conclusions Through-knee amputation has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional and biomechanical outcomes of through-knee amputation frequently fail to distinguish between the three distinct and differing approaches, making direct comparisons difficult. Future studies that compare through-knee amputation approaches to one another and to other amputation levels are needed.

Knee disarticulation vs. transfemoral amputation after failed transtibial amputation: Surgical outcome and prosthetic fitting in patients with peripheral vascular disease

“…26,27 Several reviews describe a wide range of ambulating after KD, from 13% to 75%. 11,28 Corresponding data for TFA are 15%-50%. 27,[29][30][31] Differences can be explained by patient selection in studies, as well as lack of routines for referrals to amputee clinics or the acute situation at surgery, which could have affected the choice of amputation level.…”

Modified Gritti–Stokes amputation: tips and tricks

“…Panhelleux et al are pointing out the difficulty in summarizing the literature comparing traditional TKA, GSA, and AKA, and the impossibility of providing a valuable answer on the superiority of one surgical technique. Even focusing on the GSA, the surgical technique vary widely in different series, especially regarding femoral-patellar arthrodesis and its outcome (13).…”

Study and analysis of the mechanical properties and pressure socket for through-knee amputation

“…If the socket's lateral wall is improperly configured to transfer force, the force will be transferred as a shear force in the tissue of the stump's end. Many different approaches have been taken in fitting the knee disarticulation prosthesis [6]. In terms of patient outcomes, TK amputation surgical approaches are improving infection, survival, morbidity, and dehiscence rates [7,8] and decreasing the reported pain levels [6].…”

“…Many different approaches have been taken in fitting the knee disarticulation prosthesis [6]. In terms of patient outcomes, TK amputation surgical approaches are improving infection, survival, morbidity, and dehiscence rates [7,8] and decreasing the reported pain levels [6]. The condyles of the femur are then used as a weight-bearing surface.…”