Through-knee amputation

Abstract

SUMMARYForty-three through-knee disarticulation amputations in 41 patients are reviewed. I n 11 patients the procedure was entirely palliative, and 8 of these died within I month of operation. Of the 30 patients for whom a prosthesis was planned, only 2 died within this period. Ten patients were measured for a walking pylon preoperatively. The value of premeasurement is demonstrated by the speed of rehabilitation which was achieved by this group. The time scale of rehabilitation was much longer in those patients who were measured for their prostheses postoperatively. However, other adverse factors were present in this group, and their importance is discussed. Despite these factors, a very high rate of ultimate rehabilitation was obtained. Healing was obtained in 83 per cent of the entire series. The results indicate that the through-knee amputation is excellent for the elderly patient with atherosclerotic gangrene of the foot. The importance of an active programme of walking training in this advanced age-group is particularly stressed.

Through-knee amputation in patients with peripheral arterial disease: A review of 50 cases

“…4,5,11,[20][21][22][23][24] Most of the other series, however, included patients who did not have peripheral vascular disease but had wounds related to infectious com- plications of diabetes mellitus. All the patients in our series had vascular disease with leg wounds or ischemia that precluded even a short BKA.…”

“…17 The technique used for each of those series used a long anterior flap to close the wound over the bulbous femoral condyles. [18][19][20] The publication of several subsequent studies in the European surgical literature. which showed favorable outcomes of TKAmp in patients with PAD has prompted a resurrection of the procedure, particularly in Great Britain.…”

Amputation for vascular disease

“…To obtain primary healing of an amputation: The higher the amputation, the better are the chances of healing and the less the risk of failure to heal, forcing revision of the amputation to a higher level. Aboveknee and Gritti-Stokes amputations heal better than through-or below-knee amputations (Warren and Kihn, 1968;Weale, 1969;Green et al, 1972;Newcombe and Marcuson, 1972). This is to be expected as ischaemia is always more severe distally, and transection of the limb through its proximal part means that healing is more likely in an area of relatively greater vascularity.…”

“…The average life expectancy after losing a limb for ischaemia in Australia is less than 3 years (Little, 1973), and we have no reason to believe that it is any greater in the United Kingdom (Harris et al, 1974). The mortality of patients with an aboveor below-knee amputation is much higher than that of elective aorto-iliac reconstruction (Martin et al, 1967;Brodie, 1970;Devas, 1971;Green et al, 1972;Newcombe and Marcuson, 1972;Browse, 1973;Taylor, 1973). It is a depressing subject and perhaps often glossed over by the surgeon, which may partly explain why it is so hard to obtain concrete facts in quantity from the literature.…”

“…The through-knee amputation has fallen from favour after a rather promising resurrection (Howard et al, 1969) because of its poor healing rate, but its rejection may be premature. The British literature on which its condemnation is based consisted of three small series containing 117 limbs in all and each representing the 'learning curve' of the surgeons involved Green et al, 1972;Newcombe and Marcuson, 1972). There were a low mortality and an encouraging ease of rehabilitation of the elderly but a distressingly high incidence of skin necrosis.…”