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Dewi M, Gwilym BL, Coxon AH, Carradice D, Bosanquet DC. Surgical Techniques for Performing a Through-Knee Amputation: A Systematic Review and Development of an Operative Descriptive System. Ann Vasc Surg 2023; 93:428-436. [PMID: 36708765 DOI: 10.1016/j.avsg.2022.12.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Through-knee amputation (TKA) carries potential biomechanical advantages over above knee amputation (AKA) in patients unsuitable for a below-knee amputation. However, concerns regarding prosthetic fit, cosmesis and wound healing have tempered enthusiasm for the operation. Furthermore, there are many described surgical techniques for performing a TKA. This frustrates attempts to compare past and future comparative data, limiting the opportunity to identify which procedure is associated with the best patient centered outcomes. The aim of this systematic review is to identify all the recognized operative TKA techniques described in the literature and to develop a clear descriptive system to support future research in this area. METHODS A systematic review was performed, searching the OVID, PubMed, and Cochrane Library databases, according to Cochrane and PRISMA guidelines. Papers of any design were included if they described an operative technique for a TKA. Key operative descriptions were captured and used to design a classification system for surgical techniques. RESULTS A total of 906 papers were identified, of which 28 are included. The most important distinctions in operative technique were the level of division of the femur (disarticulation without bone division, transcondylar amputation, with or without shaving of the medial, lateral, and posterior condyles and supracondylar amputation), management of the patella (kept whole, partially preserved, completely removed), use of a muscular gastrocnaemius flap, and skin incisions. A 4-component classification system was developed to be able to describe TKA operative techniques. A suggested shorthand nomenclature uses the first letter of each component (FPMS; Femur, Patella, Muscular flap, Skin incision), followed by a number, to describe the operation. Patient outcomes were poorly reported, and therefore outcomes for different types of TKA are not addressed in this review. CONCLUSIONS A novel descriptive system for describing different techniques for performing a TKA has been developed. This classification system will help in reporting, comparing, and interpreting past and future studies of patients undergoing TKA.
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Affiliation(s)
- M Dewi
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Newport, UK; Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK.
| | - B L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Newport, UK
| | - A H Coxon
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - D Carradice
- Hull York Medical School, Hull, UK; Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - D C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Newport, UK; Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
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Fard B, Persoon S, Jutte PC, Daemen JWHC, Lamprou DAA, Hoope WT, Prinsen EC, Houdijk H, Olsman J, Holling T, De Wever HPPR, Schrier E, Donders N, Rietman JS, Geertzen JHB. Amputation and prosthetics of the lower extremity: The 2020 Dutch evidence-based multidisciplinary guideline. Prosthet Orthot Int 2023; 47:69-80. [PMID: 36112468 DOI: 10.1097/pxr.0000000000000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lower-limb amputations are rare but debilitating events in the lives of affected persons. Treatment of persons with amputation inherently involves many different health care professions at different stages leading to and after an amputation. There are prevailing clinical questions within the work field related to different facets of care including peri/postoperative aspects, prosthetic components, rehabilitation treatment, and health care processes. OBJECTIVES To provide an up-to-date multidisciplinary evidence-based guideline for health care professionals involved in the treatment of persons with lower-limb amputation in the Netherlands. METHODS Identification of key questions in a focus group, systematic review of the evidence (up to March 2019, using Embase and MEDLINE databases), and weighing considerations, culminating in clinical recommendations. RESULTS Twelve key questions were formulated. Recommendations of two key questions were upheld in line with the previous 2012 guideline. Ten systematic literature searches were performed, leading to the inclusion of 59 studies. CONCLUSION A summary of evidence-based conclusions, considerations, and recommendations of the 2020 guideline is presented.
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Affiliation(s)
- Behrouz Fard
- Roessingh Center for Rehabilitation, Enschede, The Netherlands
| | - Saskia Persoon
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Paul C Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Erik C Prinsen
- Roessingh Research and Development, Enschede, The Netherlands
| | - Han Houdijk
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Ernst Schrier
- University Medical Center Groningen, Groningen, The Netherlands
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Edwards JB, Wooster MD, Tran T, Armstrong PA, Moudgill N, Shames ML, Brooks JD. Factors Associated With Unplanned Reoperation After Above-Knee Amputation. JAMA Surg 2019; 154:461-462. [PMID: 30725076 DOI: 10.1001/jamasurg.2018.5074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Mathew D Wooster
- Department of Vascular Surgery, University of South Florida, Tampa.,Department of Vascular Surgery, Medical University of South Carolina, Charleston
| | - Thanh Tran
- Department of Vascular Surgery, University of South Florida, Tampa
| | - Paul A Armstrong
- Department of Vascular Surgery, University of South Florida, Tampa.,Department of Vascular Surgery, James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Neil Moudgill
- Department of Vascular Surgery, University of South Florida, Tampa.,Department of Vascular Surgery, James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Murray L Shames
- Department of Vascular Surgery, University of South Florida, Tampa
| | - James D Brooks
- Department of Vascular Surgery, University of South Florida, Tampa.,Department of Vascular Surgery, James A. Haley Veterans' Affairs Hospital, Tampa, Florida
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Murakami T, Murray K. Outcomes of knee disarticulation and the influence of surgical techniques in dysvascular patients: A systematic review. Prosthet Orthot Int 2016; 40:423-35. [PMID: 25820640 DOI: 10.1177/0309364615574163] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/09/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dysvascularity is the main cause of lower limb amputations in Scotland, and there is an insignificant proportion (1.7%) of knee disarticulations, despite the benefits of amputation. OBJECTIVES The outcomes of knee disarticulation and its associated surgical techniques will be evaluated based on healing, reamputations, functional outcomes, prosthetic ambulation and gait biomechanics to determine whether a greater rate of knee disarticulations can be justified among dysvascular patients. STUDY DESIGN Systematic review. METHODS Key electronic databases were searched for the relevant literature based on a pre-specified eligibility criterion. RESULTS The 17 articles included in this review were appraised for their quality, and key findings are extracted. CONCLUSION Healing rates are favourable, but there is a need for appropriate amputation level selection to prevent reamputations. Knee disarticulation patients have better maintenance of independent living status than transfemoral patients, but overall prosthetic ambulation rates are inconsistent. In terms of gait biomechanics of knee disarticulation, there are some positive indications, but the evidence is insubstantial. A stronger body of evidence is required in this subject field, and recommendations are made for future research - Scottish Intercollegiate Guidelines Network Grade of Recommendation: C. CLINICAL RELEVANCE This review aims to inform the multidisciplinary teams involved in the rehabilitation of dysvascular amputees about evidence-based outcomes following knee disarticulation. This knowledge will be beneficial when formulating treatment pathways for this vulnerable population group.
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Affiliation(s)
- Tsurayuki Murakami
- Department of Biomedical Engineering, National Centre for Prosthetics and Orthotics, University of Strathclyde, Glasgow, UK
| | - Kevin Murray
- Department of Biomedical Engineering, National Centre for Prosthetics and Orthotics, University of Strathclyde, Glasgow, UK
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Hawkins AT, Henry AJ, Crandell DM, Nguyen LL. A systematic review of functional and quality of life assessment after major lower extremity amputation. Ann Vasc Surg 2013; 28:763-80. [PMID: 24495325 DOI: 10.1016/j.avsg.2013.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/17/2013] [Accepted: 07/18/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND When judging the success or failure of major lower extremity (MLE) amputation, the assessment of appropriate functional and quality of life (QOL) outcomes is paramount. The heterogeneity of the scales and tests in the current literature is confusing and makes it difficult to compare results. We provide a primer for outcome assessment after amputation and assess the need for the additional development of novel instruments. METHODS MEDLINE, EMBASE, and Google Scholar were searched for all studies using functional and QOL instruments after MLE amputation. Assessment instruments were divided into functional and QOL categories. Within each category, they were subdivided into global and amputation-specific instruments. An overall assessment of instrument quality was obtained. RESULTS The initial search revealed 746 potential studies. After a review of abstracts, 102 were selected for full review, and 40 studies were then included in this review. From the studies, 21 different assessment instruments were used 63 times. There were 14 (67%) functional measures and 7 (33%) QOL measures identified. Five (36%) of the functional instruments and 3 (43%) of the QOL measures were specific for MLE amputees. Sixteen instruments were used >1 time, but only 5 instruments were used >3 times. An additional 5 instruments were included that were deemed important by expert opinion. The 26 assessment instruments were rated. Fourteen of the best-rated instruments were then described. CONCLUSIONS The heterogeneity of instruments used to measure both functional and QOL outcomes make it difficult to compare MLE amputation outcome studies. Future researchers should seek to use high-quality instruments. Clinical and research societies should endorse the best validated instruments for future use in order to strengthen overall research in the field.
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Affiliation(s)
- Alexander T Hawkins
- Center for Surgery and Public Health, Boston, Massachusetts; Brigham & Women's Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | | | - David M Crandell
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Louis L Nguyen
- Center for Surgery and Public Health, Boston, Massachusetts; Brigham & Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Bell JC, Wolf EJ, Schnall BL, Tis JE, Tis LL, Potter BK. Transfemoral amputations: the effect of residual limb length and orientation on gait analysis outcome measures. J Bone Joint Surg Am 2013; 95:408-14. [PMID: 23467863 DOI: 10.2106/jbjs.k.01446] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The level of function achieved following a transfemoral amputation is believed to be affected by surgical attachment of the remaining musculature, resulting orientation of the femur, residual limb length, and eventual prosthetic fit. METHODS Twenty-six subjects underwent gait analysis testing in the current preferred prosthesis more than twenty-four months postamputation. The femoral length and orientation angles of each subject were measured from standing postoperative radiographic scanograms. The subjects were separated into groups for analysis on the basis of the femoral shaft angles and the residual limb length ratios. Gait analysis was performed to collect kinematic and temporospatial parameters. RESULTS A good correlation was observed between residual femoral length and trunk with regard to forward lean (r = -0.683) and lateral flexion (r = -0.628). A good correlation was also observed between residual femoral length and pelvic motion with regard to pelvic tilt (r = -0.691) and obliquity (r = -0.398). A moderate correlation was observed with speed (r = 0.550), indicating that subjects with shorter residual limbs experienced a greater excursion in the torso and pelvis, while walking at a slower self-selected pace. A significant correlation (r = 0.721, p < 0.001) was observed between the femoral shaft abduction angle and the residual femoral length; the shorter the residual limb, the more abducted it was. CONCLUSIONS The length of the residual femur substantially influences temporospatial and kinematic gait outcomes following transfemoral amputation, and appears to be more important than femoral orientation with regard to these parameters.
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Affiliation(s)
- Johanna C Bell
- Center for Performance & Clinical Research, Walter Reed National Military Medical Center, Bethesda, MD 20889-5600, USA.
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Fleury AM, Salih SA, Peel NM. Rehabilitation of the older vascular amputee: A review of the literature. Geriatr Gerontol Int 2012; 13:264-73. [DOI: 10.1111/ggi.12016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - Salih A Salih
- Centre for Research in Geriatric Medicine; The University of Queensland; Brisbane; Queensland; Australia
| | - Nancye M Peel
- Centre for Research in Geriatric Medicine; The University of Queensland; Brisbane; Queensland; Australia
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