Amputation, Above-the-Knee
(Transfemoral Amputation)
Definition
An above-the-knee amputation (AKA) is the surgical removal of the leg from above the knee.
Above-the-Knee Amputation
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Parts of the Body Involved
The parts of the body that are involved in this procedure include the thigh, knee, calf, ankle, and foot, as well as surrounding muscles, veins, and tissue.
Reasons for Procedure
An amputation is usually done for one of the following reasons:
- Inadequate blood flow to the tissue of the leg
- Severe infection in the leg
- Severe trauma or irreparable injury
- Removal of malignant tumors
- Congenital disorder (eg, a limb that has not formed properly)
Conditions which might require an above-the-knee amputation include peripheral vascular disease , severe injury, tumors, or infection.
What to Expect
Prior to Procedure
If the surgery is planned (versus as a result of an accident) your doctor will explain the procedure to you in detail prior to the surgery. Your doctor will also discuss with you whether you are a candidate for using a prosthesis after the surgery. If you will not be using a prosthesis, your doctor will discuss what method you will use for mobility.
As this is major surgery that will create many life changes, many people find it helpful to receive counseling to help cope with these changes.
Anesthesia
You will be given general anesthesia or spinal anesthesia prior to the surgery.
Description of the Procedure
After you have been given anesthesia, and the leg has been prepared for surgery, your doctor will make a transverse incision above your knee, and locate the main artery and the veins. The muscles are cut, and the arteries and veins tied off, leaving access to the femur (the thigh bone). Using a special saw, the femur is then cut. The muscles are sutured over the bone, and then covered by the remaining flaps of skin. These skin flaps are sutured together to form the end of the stump produced by the amputation.
After Procedure
After the surgery, you will be given pain medication and antibiotics to prevent infection. Your limb will be dressed in either elastic bandages or a plaster-of-paris cast to prevent edema (swelling).
How Long Will It Take?
The length of time for this procedure will vary, depending on the condition of the patient.
Will It Hurt?
As you will be under anesthesia, you will not feel pain during the surgery. However, you will experience pain during the postoperative period and recovery process. Your doctor will prescribe medication to alleviate the pain.
Possible Complications
Some of the most common types of complications from this surgery include:
- Infection
- Wound breakdown
- Swelling of the stump
- Hip joint flexion contracture
- Pain
- Phantom limb sensation (a feeling that the amputated limb is still present)
- Deep vein thrombosis (clots in the leg veins)
Average Hospital Stay
The length of your hospital stay will be determined by your recovery progress and your overall health. In general, the stay may be from two days to two weeks.
Postoperative Care
They will ask you to move your stump frequently to help stimulate circulation, and you will begin physical therapy as soon as possible—usually within 48 hours after surgery. Initially, the stump will be swollen, and it will take several weeks for the stump to shrink.
Prosthesis
Depending on your age, physical strength, and condition, you may be fitted with a prosthesis after the stump has shrunk. If you do receive a prosthesis, you will undergo a long-term treatment plan of physical therapy to build strength and mobility.
Care of the Stump
It is very important to keep the stump clean, dry, and free from infection at all times. If fitted with a prosthesis, you should remove it before going to sleep. Inspect and wash the stump with mild soap and warm water every night, then dry thoroughly and apply talcum powder. (If the stump is too dry, apply a lanolin-based cream.) If the skin on the stump is abraded or there is any weeping of the tissues, do not use the prosthesis until the skin has healed. The stump sock should be changed daily, and the inside of the socket may be cleaned with mild soap.
After the surgery, you will continue to have regular check-ups with your doctor every 3-6 months for the next two years.
Outcome
Depending upon circulation in the remaining thigh, the stump will heal after an adequate recovery period from surgery. You may use either a wheelchair or prosthesis for mobility. If you are fitted for a prosthesis, and participate in physical therapy and rehabilitation, you will be able to walk with the prosthesis.
RESOURCES:
American Academy of Orthopedic Surgeons
http://orthoinfo.aaos.org
Amputee Coalition of America
http://www.amputee-coalition.org/index.html
National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov
CANADIAN RESOURCES:
Amputee Coalition of America
http://www.amputee.ca
The War Amps
http://www.waramps.ca
References:
Amputations of the lower extremity. Available at: http://www.emedicine.com/orthoped/topic9.htm . Accessed September 21, 2005.
Leg amputation. Merck Manual of Geriatrics . Chapter 29, Rehabilitation for Specific Problems. Merck website. Available at: http://www.merck.com/mrkshared/mmg/sec3/ch29/ch29e.jsp . Accessed September 21, 2005.
Last reviewed January 2008 by Ronald Nath, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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