Advantages of the Knee Disarticulation Over Amputations Through the Thigh

Batch, Joseph W.; Spittler, August W.; McFaddin, James G.

doi:10.2106/00004623-195436050-00004

Cited by 22 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most of these amputations are either transtibial or transfemoral, with knee-disarticulation amputations being relatively uncommon and representing less than 2 percent of all amputations [5]. The first knee-disarticulation amputation was documented in the United States in 1825 [1,6–7] and, before the advent of modern anesthesia, was a favored surgical procedure because of its simplicity and speed, decreased risk of infection, and decreased rate of bleeding because the procedure did not violate any muscle bellies or the medullary cavity of any bones [1,6,8–10]. However, by 1940, knee-disarticulation amputations had fallen out of favor because of concerns regarding a bulky distal limb, which many people with amputation did not find aesthetically pleasing; poor prosthetic fit; and improved surgical techniques for transtibial and transfemoral amputations [5,9,11].…”

Section: Introductionmentioning

confidence: 99%

Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

Behr¹,

Friedly²,

Molton³

et al. 2009

JRRD

View full text Add to dashboard Cite

Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These individuals consisted of 14 adults reporting knee-disarticulation amputation in one limb and best-matched cases (14 reporting transfemoral amputation and 14 reporting transtibial amputation) from a larger cross-sectional sample of 472 individuals. Participants were rigorously matched based on time since amputation, reason for amputation, age, sex, diabetes diagnosis, and pain before amputation. Continuous outcome variables were analyzed by one-way analysis of variance. Categorical outcomes were analyzed by Pearson chi-square statistic. Given the relatively small sample size and power concerns, mean differences were also described by estimated effect size (Cohen’s d). Of the 42 participants, 83% were male. They ranged in age from 36 to 85 (median = 55.1, standard deviation = 11.0). Most amputations were of traumatic origin (74%), and participants were on average 12.4 years from their amputations at the time of the survey. Individuals with transtibial amputation reported significantly more prosthesis use than did individuals with knee-disarticulation amputation. Amputation levels did not significantly differ in phantom limb pain, residual limb pain, back pain, and pain-related interference with physical function. Estimates of effect size, however, indicated that participants with knee-disarticulation amputation reported less phantom limb pain, phantom limb pain-related interference with physical function, residual limb pain, residual limb pain-related interference with physical function, and back pain-related interference with physical function than did participants with transtibial or transfemoral amputations. This study demonstrated that patients with knee-disarticulation amputation used prostheses significantly less than did patients with transtibial amputation. However, no evidence was found that patients with knee-disarticulation amputation have worse outcomes in terms of pain and pain-related interference with physical function; in fact, they may have more favorable long-term outcomes.

show abstract

Section: Introductionmentioning

confidence: 99%

Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

Behr¹,

Friedly²,

Molton³

et al. 2009

JRRD

View full text Add to dashboard Cite

show abstract

“…Through-knee amputation was associated with poorer outcomes in the LEAP Study when compared with transfemoral and transtibial amputation levels [4,7]. Through-knee amputation is an amputation level that is through a natural tissue plane that can be rapidly accomplished in a forward-deployed austere environment; however, the results of this as a final amputation level in a military population have not been well studied [1,5,11]. The current study found no difference in gait parameters between through-knee and transfemoral amputees.…”

Section: Discussionmentioning

confidence: 99%

Are Gait Parameters for Through-knee Amputees Different From Matched Transfemoral Amputees?

Schuett

Wyatt

Kingsbury

et al. 2018

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Through-knee amputation is a common amputation level after battlefield injuries during the medical evacuation process. However, there are limited data comparing through-knee amputation with transfemoral amputation as a definitive amputation level in terms of gait parameters. Questions/purposes (1) Does through-knee amputation result in improved gait velocity when compared with matched transfemoral amputees? (2) Do through-knee amputees have a faster gait cadence than matched transfemoral amputees? (3) Do through-knee amputees have a different stride length or stride width than matched transfemoral amputees? (4) Does through-knee amputation result in decreased work of ambulation when compared with matched transfemoral amputees? Methods Between January 2008 and December 2012, six male active-duty military patients who had undergone unilateral through-knee amputations as a result of trauma underwent gait studies at our institution. Of those, four of six underwent gait analysis after being able to walk for at least 3 months without assistive devices, and this group was studied here. Most through-knee amputees who were not included had elective revisions of their amputations from through-knee to a transfemoral amputation before completing 3-month gait data. Each of the amputees studied was matched to a transfemoral amputee based on height, body mass index, and contralateral amputation level resulting in a case-control study of active-duty Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

show abstract

“…Despite all these advantages, most surgeons rarely perform KD. This aversion is due to their lack of experience with the surgical procedure and their fear for wound complications [5][6][7], although recent studies refute these considerations [2,[7][8]. Moreover, because of the bulbous end of the residual limb and the lack of space for a knee joint, surgeons are aware of KD prosthesis fitting problems [7,[9][10].…”

Section: Introductionmentioning

confidence: 99%

Cosmetic effect of knee joint in a knee disarticulation prosthesis

Laat¹,

Pluijm²,

Kuijk³

et al. 2014

J Rehabil Res Dev

View full text Add to dashboard Cite

Abstract-Despite numerous advantages, knee disarticulations (KDs) are rarely performed because of the anticipated KD prosthesis fitting problems that include the positioning of the knee joint distally from the KD socket. This results in lengthening of the thigh and subsequent shortening of the shank. The objective of this study was to assess the cosmetic effect of the knee joint in a KD prosthesis by determining the extent of the lengthening of the thigh and the shortening of the shank. This lengthening and shortening were measured through an experimental setup using laser techniques. These measurements were made of 18 knee joints used in KD prostheses. Lengthening of the thigh varied between 23 and 92 mm, and shortening of the shank varied between 3 and 50 mm. The polycentric knees Medi KH6 and Medi KHF1 showed the least lengthening of the thigh, and the polycentric knees Teh Lin Prosthetic & Orthotic Co. Ltd Graph-Lite and Medi KP5 showed the least shortening of the shank.

show abstract

Advantages of the Knee Disarticulation Over Amputations Through the Thigh

Cited by 22 publications

References 0 publications

Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

Are Gait Parameters for Through-knee Amputees Different From Matched Transfemoral Amputees?

Cosmetic effect of knee joint in a knee disarticulation prosthesis

Contact Info

Product

Resources

About