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

Morse, Bryan C.; Cull, David L.; Kalbaugh, Corey A.; Cass, Anna L.; Taylor, Spence M.

doi:10.1016/j.jvs.2008.04.018

Cited by 34 publications

(43 citation statements)

References 24 publications

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“…The only procedure with a significant change was through-knee amputation, but this accounted for only 2·8 per cent of all major amputations undertaken. The greater ease of fitting modern prostheses to through-knee compared with above-knee amputation stumps is a likely factor in this change of practice 18,19 . The geographical variation in incidence seen in the GLEAS paper was still present and significant but less pronounced.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological study of lower limb amputation in England between 2003 and 2008

Moxey

Hofman

Hinchliffe

et al. 2010

British Journal of Surgery

164

138

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Section: Discussionmentioning

confidence: 99%

Epidemiological study of lower limb amputation in England between 2003 and 2008

Moxey

Hofman

Hinchliffe

et al. 2010

British Journal of Surgery

164

138

View full text Add to dashboard Cite

show abstract

“…Rehabilitation clinicians undoubtedly need to take into account other factors for which we did not have data, such as wound healing,25 time to healing,26 onset of additional adverse outcomes,27 and biopsychosocial and environmental factors 28, 29. Each patient's specific characteristics and the facility structural characteristics will help with the decision of when the patient receives inpatient rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Late Specialized Rehabilitation Among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

Kurichi

Xie

Kwong

et al. 2011

American Journal of Physical Medicine &Amp; Rehabilitation

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Objective To determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Design Data were obtained from 8 administrative databases for 2,453 patients who underwent lower extremity amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazards ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from the surgical hospitalization. Results There were 2,304 patients who received only immediate postoperative services, while 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared to the Southeast region, and had their surgeries in CARF accredited facilities were all more likely to receive late services. The hazards ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt, however, after 3 months, those who received early specialized rehabilitation were significantly less likely to receive late services. Conclusion The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding CARF accredited units.

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“…Yet despite these proven benefits, the KD is frequently overlooked as a surgical option with concerns for a bulky distal stump, prosthetic knee that is distal to the contralateral normal leg, or healing complications from longer soft tissue flaps. The Mazet technique has previously addressed concerns of a bulky stump by shaving the femoral condyles and excising the patella to make a conical distal amputation [9]. For a patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a better counterbalance, and eliminates the potential for knee flexion contracture with subsequent distal stump skin breakdown.…”

Section: Introductionmentioning

confidence: 99%

Through Knee Amputation: Technique Modifications and Surgical Outcomes

et al. 2014

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BackgroundKnee disarticulations (KD) are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center.MethodsA retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A.) between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified.ResultsBetween 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%), arterial thrombosis (35%), and trauma (9%). Postoperative complications included superficial cellulitis (13%), soft tissue infection (4%), and flap ischemia (4%) necessitating one case of surgical debridement (4%) and four trans-femoral amputations (9%). 9 (22%) patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01.ConclusionsKnee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

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

Cited by 34 publications

References 24 publications

Epidemiological study of lower limb amputation in England between 2003 and 2008

Epidemiological study of lower limb amputation in England between 2003 and 2008

Factors Associated with Late Specialized Rehabilitation Among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

Through Knee Amputation: Technique Modifications and Surgical Outcomes

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