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  • Amputation, Above-the-Knee

    (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 is usually done for one of the following reasons:
    • Poor blood flow cannot be corrected, resulting in tissue loss or extreme pain
    • Severe infection
    • Trauma or injury
    • Tumor
    • Congenital disorder (eg, a limb that has not formed properly)

    Possible Complications

    If an above-the-knee amputation has been recommended, your doctor will review a list of possible complications, which may include:
    • Wound breakdown
    • Infection
    • Non-healing of the amputation site resulting in the need for a higher level of amputation
    • Swelling of the stump
    • Decreased range of motion in the hip joint
    • Phantom pain—feeling pain in amputated limb area
    • Phantom limb sensation —feeling that the amputated limb is still there
    • Bleeding
    • Blood clots
    • Reaction to anesthesia
    Some factors that increase the risk for complications include:
    • Poor blood flow
    • Diabetes
    • Infection
    • Prolonged immobilization
    • Heart disease
    • Smoking or lung disease
    • Blood clotting disorders
    Be sure to discuss these risks with your doctor before surgery.

    What to Expect

    Prior to Procedure

    If your surgery is planned, your doctor will review the surgery and what to expect afterwards. Your doctor will also talk to you about how you are going to move after surgery. You may need a prosthesis (artificial limb), crutches, wheelchair, or a combination of these after surgery.
    At your appointment before your surgery:
    • Your doctor may examine your leg—Pulse, skin temperature, skin appearance, and sensitivity to touch will be tested.
    • Your doctor may ask questions—These include the kind of help you have at home and whether you would like to talk to a therapist about the loss of your limb.
    • Questions you should ask your doctor—These include the kind of rehabilitation you will need after surgery and how long your recovery will be.
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    As this is major surgery that will create many life changes, many people find it helpful to receive counseling to help cope with these changes.
    You may see a physical therapist who will explain your rehabilitation after surgery.
    You will be asked to fast for 8-12 hours before your surgery. Ask your doctor if you should take regular medicines with a sip of water before your surgery.

    Anesthesia

    You may be given:

    Description of the Procedure

    Once you are asleep and no longer feel pain, a breathing tube will be placed if you have general anesthesia. 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.

    Immediately After Procedure

    You will be taken to a recovery room. There, you will be monitored for any negative reactions. If all is well, your breathing tube will be removed while you are there. You will then be transferred to your hospital room to begin your recovery.

    How Long Will It Take?

    The length of time for this procedure will vary. The length will depend on your overall condition.

    How Much Will It Hurt?

    During surgery, you will not feel pain. After surgery, you will be given pain medicine in the hospital and a prescription for pain medicine to take at home. You may feel phantom pain. This is a feeling of pain in the amputated portion of the limb which is no longer present. If you do, tell your doctor so it can be treated.

    Average Hospital Stay

    The length of your hospital stay will be determined by your recovery progress and your overall health. In general, the stay may be from five days to two weeks.

    Post-procedure Care

    At the Hospital
    While you are recovering at the hospital:
    • You will be asked to move your stump often. This will help stimulate circulation and help prevent stiffening of the hip joint.
    • You will begin physical therapy as soon as possible. Therapy often begins within 48 hours of surgery.
    • You may use a wheelchair for mobility at first.
    • You may be taught how to change your dressing.
    • You will receive antibiotics to prevent infection.
    At Home
    Initially, the stump will be swollen. It will take some weeks for the stump to shrink. Depending on your age, physical strength, and condition, you may be then fitted with a prosthesis. Recovery requires a long-term treatment plan of physical therapy. You will be able to walk with a prosthesis.
    When you return home, do the following to help ensure a smooth recovery:
    • Get some help from family and/or friends as you recover.
    • Change your bandages as instructed, replacing them with sterile bandages provided by the hospital.
    • You will need to continue physical therapy to build your strength, maintain range of motion, and learn how to walk with a prosthesis.
    • Inspect the stump often.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    Be sure to follow your doctor's instructions .

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Increased stump swelling
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Pain that you cannot control with the medicines you have been given
    • Poorly fitting prosthesis
    • Pain, burning, urgency or frequency of urination, or blood in the urine
    • Cough, shortness of breath, or chest pain
    • Depression
    • Joint pain, fatigue, stiffness, rash, or other new symptoms
    In case of an emergency, call for medical help right away.

    RESOURCES

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

    National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/

    CANADIAN RESOURCES

    Amputee Coalition of America http://www.amputee.ca/

    The War Amps http://www.waramps.ca/

    References

    Amputation. Vascular Web website. Available at: http://www.vascularweb.org/patients/NorthPoint/Amputation.html . Accessed July 21, 2009.

    Leg amputation. Merck website. Available at: http://www.merck.com/mrkshared/mmg/sec3/ch29/ch29e.jsp . Accessed September 21, 2005.

    Revision Information

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