ADVANTAGES OF THE KNEE DISARTICULATION OVER AMPUTATIONS THROUGH THE THIGH

¹ Orthopaedic Service, Walter Reed Army Hospital, Washington, D. C.

Whenever an adequate below-the-knee stump cannot be obtained, a knee disarticulation is the next procedure of choice. The operative procedure is quick, safe, and causes less shock than amputations through the thigh. The circulation in the thigh is preserved, to supply skin flaps which are accustomed to pressure.

Because muscle and bone are not transected, the spread of infection is minimized and the stump heals rapidly. When the patellar tendon has been fixed distally, patellar pain and swelling have not been significant problems. The largest surface available in the lower extremity is provided for weight-bearing. The stump is firm and insensitive. There is less atrophy of the muscles in the stump than after amputations at a higher level and, because of this, earlier fitting of a prosthesis is possible. The shape of the stump provides greater balance and stability without rotation than that of stumps in higher amputations. The patient can walk with an excellent gait almost immediately.

The prosthesis for such stumps is easy to construct and to fit, requires fewer adjustments, and is superior to prostheses for higher levels of amputation through the thigh.

Without a prosthesis the patient can kneel in work or play, bearing weight on the end of the stump in much the same way as the Symes amputee can on his longer stump.

Knee disarticulation as a definitive procedure deserves the consideration of all orthopaedic surgeons.

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