The Journal of Bone and Joint Surgery, Vol 70, Issue 5 746-750, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Selection of patients for through-the-knee amputation
MS Pinzur, DG Smith, DJ Daluga and H Osterman
STAMP (Special Team for Amputations, Mobility, Prosthetics/Orthotics) Center, Hines Veterans Administration Hospital, Maywood, Illinois.
Forty-six adult patients had a through-the-knee amputation (disarticulation
of the knee) in a four-year period. Thirty-four of the patients had
peripheral vascular insufficiency and were judged to lack the potential for
using a prosthesis functionally, although the evaluation indicated that
they had the potential for healing of the wound at the below-the-knee level
of amputation. At a minimum follow-up of one year, the amputation wound had
healed in thirty of these patients, and no joint contracture had developed.
Two patients died in the first postoperative month, and two had failure to
heal and needed revision to an above-the-knee amputation. The remaining
twelve patients who had a through-the-knee amputation were judged to be
potentially able to use a prosthesis functionally, but they did not have
the capacity for wound-healing at the below-the-knee level. Therefore, in
these patients, a through-the-knee amputation was performed as an
alternative to an above-the-knee amputation. The amputation wound healed in
eight of these patients, but four (33 per cent) had failure to heal and
needed subsequent revision to an above-the-knee amputation. All twelve
patients were able to use a prosthesis. The through-the-knee amputation
provides good muscular balance and has a low risk for the late development
of joint contracture. The residual limb (stump) provides an excellent
surface area for sitting balance and a lever-arm for transfer. In a patient
who has the potential to use a prosthesis functionally, the residual limb
allows direct load-transfer (end weight-bearing).(ABSTRACT TRUNCATED AT 250
WORDS)
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