Through-knee amputation in peripheral vascular disease

Abstract

T hrough-knee amputation accounts for just 2.8% of annual amputations in England. Traditionally it is viewed as an operation with poor outcomes, and its use limited. We present a case series and review of articles published on through knee amputation.The literature review covers the 17 papers identified on through-knee amputation in peripheral vascular disease. The results are summarised and discussed, with favourable outcomes in terms of perioperative mortality and primary healing demonstrated in the majority of papers.In the case series, 14 patients who underwent through knee amputation were retrospectively reviewed. Perioperative mortality was 7%. Primary healing was achieved in 79% of cases. Functional outcomes were excellent, with predicted functional activity achieved in 81% of survivors, with 34% ambulating regularly.In conclusion, through-knee amputation should be considered as an alternative to transfemoral amputation, as perioperative mortality, healing rates and functional outcomes appear excellent, both in this series and the majority of others published. Br J Diabetes Vasc Dis 2012;12:26-32

Outcomes of knee disarticulation and the influence of surgical techniques in dysvascular patients

“…There were no controlled trials found (level 1), with 11 observational studies (level 2) 8,34,38,42,45,47–52 and 6 non-analytical studies (level 3). 5,15,26,43,44,46 Seven studies had a high risk of bias (−), 5,8,34,42,43,46,52 eight studies had a low risk of bias (+) 15,26,38,44,45,47,49–51 and only one study had a very low risk of bias (++). 48 Most of the studies were retrospective with only four prospective studies, 8,47,48,51 and it was due to the retrospective nature that a higher quality grading (++) could not be given in four other studies.…”

“…Nine studies used clinical judgments to determine the appropriate amputation level, 5,15,26,42–46,51 none of the studies utilised physiological tests and three studies did not indicate the method of assessment. 34,50,52 The number of identified variables/confounders that affect wound healing ranged from 0 to 5 among the studies, but only one study analysed how the variables influenced the results.…”

“…38,48 The last two studies used custom surveys to measure independent living with no comparison to other amputation levels. 26,44…”

“…Three studies used mobility scales, 45,49,52 and six studies did not do so, 15,26,38,43,44,46 out of which two were surveys. 26,44 Three studies involved a prosthetist in the research team, 38,43,44 while others did not.…”

“…Three studies used mobility scales, 45,49,52 and six studies did not do so, 15,26,38,43,44,46 out of which two were surveys. 26,44 Three studies involved a prosthetist in the research team, 38,43,44 while others did not. 15,26,45,46,49,52 The number of identified variables/confounders that affect prosthetic ambulation ranged from 0 to 5 among the studies; however, only two studies analysed how these variables influenced the results.…”