Above-the-Knee Amputation

(Transfemoral Amputation)
  • Definition

    An above-the-knee amputation (AKA) is the surgical removal of the leg above the knee.
    Above-the-Knee Amputation
    cropped leg
    Copyright © Nucleus Medical Media, Inc.
  • Reasons for Procedure

    An amputation above the knee may be done because of:
    • Poor blood flow that cannot be fixed
    • Severe infection
    • Trauma or injury
    • Tumors
    • Congenital disorders, such as a limb that has not formed properly
  • Possible Complications

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • Skin breakdown at the residual limb
    • Infection
    • Poor healing of the amputation site that may require a higher level amputation
    • Swelling of the residual limb
    • Decreased range of motion in the hip joint
    • Phantom limb sensation —feeling that the amputated limb is still there
    • Phantom pain —feeling pain in amputated limb area
    • Bleeding
    • Blood clots
    • Reaction to anesthesia
    Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
  • What to Expect

    Prior to Procedure
    Your doctor may do the following before your procedure:
    • Physical exam
    • Blood tests
    • Imaging tests, such as x-rays or scans
    • Have you donate blood in case you need a transfusion
    • Prescribe antibiotics to prevent infection
    Before surgery, you will need to:
    • Arrange for a ride home.
    • Arrange for help at home while you recover.
    • Talk to your doctor about any medications, herbs, or supplements you are taking.
    • Ask your doctor about devices you will need after the surgery like an artificial limb, walker , crutches , and/or wheelchair .
    You may need to stop taking some medications up to one week before the procedure. Medications that may need to be stopped may include:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelets
    Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
    Anesthesia
    You may be given:
    Description of the Procedure
    The doctor will make an incision in the skin above the knee. Next, the muscles will be divided and the blood vessels clamped. A special saw is used to cut through the bone. The muscles are then sewn and shaped so that a stump is formed to cushion the bone. Nerves are divided and placed so they do not cause pain. The skin is closed over the muscles, forming the stump. Drains may be inserted into the stump to drain blood for the first few days after surgery. A dressing and compression stocking will be placed over the stump.
    How Long Will It Take?
    Several hours, depending on your health and the reason for the surgery
    How Much Will It Hurt?
    Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
    Average Hospital Stay
    The usual length of stay is 5-14 days. It is possible that you may have to stay longer if complications arise. You may also go to a rehabilitation hospital to help you recover.
    Post-procedure Care
    At the Hospital
    Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
    • Pain medications
    • Antibiotics to prevent infection
    • Medication to prevent blood clots
    Physical therapy often starts within 24 hours after your surgery. During this time you may need devices to help you walk.
    Preventing Infection
    During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
    • Washing their hands
    • Wearing gloves or masks
    • Keeping your incisions covered
    There are also steps you can take to reduce your chance of infection, such as:
    • Washing your hands often and reminding your healthcare providers to do the same
    • Reminding your healthcare providers to wear gloves or masks
    • Not allowing others to touch your incision
    At Home
    When you return home, take these steps:
    • Follow your doctor’s instructions on cleaning the incision site.
    • Ask your doctor when it is safe to shower, bathe, or soak in water.
    • Continue with your physical therapist’s exercise program.
    Adjusting to an amputation may be difficult and can lead to depression . Consider talking to a therapist or psychologist.
  • Call Your Doctor

    Call your doctor if any of these occur:
    • Increased swelling in the residual limb
    • Poorly fitting prosthesis
    • Pain that can't be controlled with the medications you've been given
    • Signs of infection, such as fever or chills
    • Increasing redness, swelling, increasing pain, excess bleeding, or discharge from the incision site
    • Persistent nausea or vomiting
    • Increased symptoms of depression
    • New cough , shortness of breath, or chest pain
    • Joint pain, fatigue, stiffness, rash, or other new symptoms
    If you think you have an emergency, call for medical help right away.
  • RESOURCES

    American Diabetes Association http://www.diabetes.org

    Amputee Coalition of America http://www.amputee-coalition.org

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Amputation. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/physical%5Fmedicine%5Fand%5Frehabilitation/amputation%5F85,P01141. Accessed December 3, 2013.

    Amputation. Society for Vascular Surgery website. Available at: http://www.vascularweb.org/vascularhealth/Pages/amputation.aspx. Updated February 2011. Accessed December 3, 2013.

    Amputation procedure. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/cardiovascular/amputation%5Fprocedure%5F92,P08292. Accessed December 3, 2013.

    Management of critical limb ischemia. EBSCO DynaMed website. Available at:: http://www.ebscohost.com/dynamed. Updated October 2, 2013. Accessed December 3, 2013.

    Professional Guide to Diseases. 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.

    Revision Information

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