Below-the-Knee Amputation

(Amputation, Below-the-Knee; BKA)
  • Definition

    A below-the-knee amputation (BKA) is the surgical removal of the leg below the knee.
  • Reasons for Procedure

    An amputation below the knee may be done because of:
    • Poor blood flow that cannot be fixed
    • Tumors
    • Trauma or injury
    • Severe infection
  • Possible Complications

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • Poor healing of the amputation site that may require a higher level amputation
    • Skin breakdown at the residual limb
    • Infection
    • Decreased range of motion in the hip or knee
    • Phantom sensation —feeling that the amputated limb is still there
    • Phantom pain —feeling pain in the amputation area
    • Stump swelling
    • Bleeding
    • Reaction to anesthesia
    • Heart attack
    • Blood clots
    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, such as 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 either:
    Description of Procedure
    The doctor will make a cut in the skin below the knee. The muscles will be separated and blood vessels clamped. A special saw will be used to cut through the bone. The muscles will be sewn and shaped so that a stump is formed to cushion the bone. Nerves will be separated and placed so that they do not cause pain. Blood vessels will be tied off. The skin will be closed over the muscles, forming the stump. Drains may be inserted into the stump to drain blood for the first few days. A dressing and compression stocking will be placed over the stump.
    Below-the-Knee Amputation
    IMAGE
    A cut is made below the knee.
    Copyright © Nucleus Medical Media, Inc.
    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 medication 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 or persistent 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: https://dynamed.ebscohost.com/about/about-us. 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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