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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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Surgical Technique for Targeted Muscle Reinnervation in Knee Disarticulation Amputation for Nonambulatory Patients. Plast Reconstr Surg Glob Open 2023; 11:e4801. [PMID: 36798722 PMCID: PMC9925100 DOI: 10.1097/gox.0000000000004801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/14/2022] [Indexed: 02/15/2023]
Abstract
Chronic neuropathic pain following major limb amputation has historically been difficult to treat. In patients undergoing lower extremity amputation, "preemptive" targeted muscle reinnervation (TMR) nerve transfers may be performed concurrently with the amputation to help mitigate the risk of chronic neuropathic postoperative pain. Despite clinical studies demonstrating efficacy of TMR in lower extremity amputations, few procedural descriptions have been written, and none have been written regarding performing TMR at the knee disarticulation (KD) level of amputation. Although uncommonly utilized, the KD amputation has clear functional benefits over other levels of amputation for nonambulatory patients. As nonambulatory patients are also subject to the occurrence of chronic neuropathic postamputation pain, it stands to reason that the addition of TMR to KD surgery could be an improvement to standard techniques. In this report, we provide a technical description for concurrent TMR with KD and describe the rationale for its use.
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Furrer PR, Zimmermann SM, Böni T, Waibel FWA. Endoscopic Treatment of Stump Infection of the Residual Synovial Cavity After Through-the-Knee Amputation: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00031. [PMID: 36574429 DOI: 10.2106/jbjs.cc.22.00313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/23/2022] [Indexed: 12/28/2022]
Abstract
CASE We report the case of a 35-year-old patient who presented with a septic residual synovial cavity infection 8 weeks after a through-the-knee amputation because of a parosteal sarcoma. An endoscopic evacuation of the turbid fluid and synovial debridement through parapatellar portals as in a standard knee arthroscopy was performed, in conjunction with appropriate antibiotic therapy. One year postoperatively, there were no signs of residual infection. CONCLUSION Endoscopic treatment of a septic stump infection of the residual synovial cavity after through-the-knee amputation is feasible. In our case, this approach resulted in rapid wound healing and early prosthesis mobility.
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Affiliation(s)
- Pascal R Furrer
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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4
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Huang YJ, Assi PE, Drolet BC, Al Kassis S, Bastas G, Chaker S, Manzanera Esteve IV, Perdikis G, Thayer WP. A Systematic Review and Meta-analysis on the Incidence of Patients With Lower-Limb Amputations Who Developed Symptomatic Neuromata in the Residual Limb. Ann Plast Surg 2022; 88:574-580. [PMID: 34270470 DOI: 10.1097/sap.0000000000002946] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromata developed after major extremity amputation can cause pain, limit the use of prosthetics, and negatively affect the quality of life. The frequency of postamputation neuroma varies widely. The objective of this study was to determine the incidence of patients who developed symptomatic neuromata after lower-limb amputation through a systematic review and meta-analysis. METHODS A systematic review of the literature was performed on 4 major databases. Studies that reported the incidence of symptomatic neuroma in lower-limb amputees were included. A meta-analysis was performed to calculate the pooled incidence of neuromata. RESULTS Thirteen studies consisting of 1329 patients were included in this meta-analysis. The reported incidence of patients who developed symptomatic neuromata ranged between 4% and 49%. The median duration of follow-up was 8.6 years (interquartile range, 2.0-17.4 years). The pooled percentage (95% confidence interval [CI]) of lower-limb amputees who developed symptomatic neuromata was 19% (12%-29%). In studies with a duration of follow-up at least 3 years, the pooled percentage (95% CI) of lower-limb amputees who developed symptomatic neuromata was 30% (22%-40%). In studies with a follow-up period of fewer than 3 years, the pooled percentage (95% CI) of neuroma incidence was 3% (2%-6%). CONCLUSIONS In summary, the overall incidence of patients who developed symptomatic neuromata was 19% or approximately 1 in 5 lower-limb amputees. Symptomatic neuromata are more commonly diagnosed when the follow-up period is longer than 3 years. These findings suggest that neuroma after amputation might be underestimated in studies with a short duration of follow-up.
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Affiliation(s)
| | | | | | | | - Gerasimos Bastas
- Department of Physical Medicine and Rehabilitation, Vanderbilt University
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Crane H, Boam G, Carradice D, Vanicek N, Twiddy M, Smith GE. Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations. Cochrane Database Syst Rev 2021; 12:CD013839. [PMID: 34904714 PMCID: PMC8669807 DOI: 10.1002/14651858.cd013839.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diabetes and vascular disease are the leading causes of lower limb amputation. Currently, 463 million adults are living with diabetes, and 202 million with peripheral vascular disease, worldwide. When a lower limb amputation is considered, preservation of the knee in a below-knee amputation allows for superior functional recovery when compared with amputation at a higher level. When a below-knee amputation is not feasible, the most common alternative performed is an above-knee amputation. Another possible option, which is less commonly performed, is a through-knee amputation which may offer some potential functional benefits over an above-knee amputation. OBJECTIVES To assess the effects of through-knee amputation compared to above-knee amputation on clinical and rehabilitation outcomes and complication rates for all patients undergoing vascular and non-vascular major lower limb amputation. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases; the World Health Organization International Clinical Trials Registry Platform; and the ClinicalTrials.gov trials register to 17 February 2021. We undertook reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA Published and unpublished randomised controlled trials (RCTs) comparing through-knee amputation and above-knee amputation were eligible for inclusion in this study. Primary outcomes were uncomplicated primary wound healing and prosthetic limb fitting. Secondary outcomes included time taken to achieve independent mobility with a prosthesis, health-related quality of life, walking speed, pain, and 30-day survival. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed all records identified by the search. Data collection and extraction were planned in line with recommendations outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to assess the certainty of evidence using the GRADE approach. MAIN RESULTS We did not identify RCTs that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS No RCTs have been conducted to determine comparative clinical or rehabilitation outcomes of through-knee amputation and above-knee amputation, or complication rates. It is unknown whether either of these approaches offers improved outcomes for patients. RCTs are needed to guide practice and to ensure the best outcomes for this patient group.
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Affiliation(s)
- Hayley Crane
- Academic Vascular Surgical Unit, Hull York Medical School, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Gemma Boam
- Academic Vascular Surgical Unit, Hull York Medical School, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Daniel Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Natalie Vanicek
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
| | | | - George E Smith
- Academic Vascular Surgical Unit, Hull York Medical School, Hull University Teaching Hospitals NHS Trust, Hull, UK
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Panhelleux B, Shalhoub J, Silverman AK, McGregor AH. A review of through-knee amputation. Vascular 2021; 30:1149-1159. [PMID: 34844469 DOI: 10.1177/17085381211045183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a through-knee amputation approach. This article seeks to (1) determine the number of through-knee amputation performed compared with other major lower limb amputations in England over the past decade; (2) identify the theoretical concepts behind through-knee amputation surgical approaches and their potential effect on functional and clinical outcomes and (3) provide a platform for discussion and research on through-knee amputation and surgical outcomes. METHODS National Health Service Hospital Episodes Statistics were used to obtain recent numbers of major lower limb amputations in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on through-knee amputation surgery. RESULTS In the past decade, 4.6% of major lower limb amputations in England were through-knee amputations. Twenty-six articles presenting through-knee amputation surgical techniques met our criteria. These articles detailed three through-knee amputation surgical techniques: the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur. CONCLUSIONS Through-knee amputation has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional and biomechanical outcomes of through-knee amputation frequently fail to distinguish between the three distinct and differing approaches, making direct comparisons difficult. Future studies that compare through-knee amputation approaches to one another and to other amputation levels are needed.
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Affiliation(s)
- Brieuc Panhelleux
- Department of Surgery and Cancer, 4615Imperial College London, London, UK
| | - Joseph Shalhoub
- Department of Surgery and Cancer, 4615Imperial College London, London, UK.,Imperial Vascular Unit, 4615Imperial College Healthcare NHS Trust, London, UK
| | - Anne K Silverman
- Department of Mechanical Engineering, 3557Colorado School of Mines Golden, CO, USA
| | - Alison H McGregor
- Department of Surgery and Cancer, 4615Imperial College London, London, UK
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List EB, Krijgh DD, Martin E, Coert JH. Prevalence of residual limb pain and symptomatic neuromas after lower extremity amputation: a systematic review and meta-analysis. Pain 2021; 162:1906-1913. [PMID: 33470746 DOI: 10.1097/j.pain.0000000000002202] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/11/2021] [Indexed: 01/11/2023]
Abstract
ABSTRACT Residual limb pain (RLP) is associated with (partial) extremity amputations and is defined as pain felt in the remaining part of the amputated limb. A common cause of RLP is neuroma formation after nerve transections. Neuromas can be very painful and severely debilitating pathologies, preventing prosthetic use, reducing quality of life, and requiring medication. Residual limb pain and symptomatic neuromas are often not properly recognized by physicians explaining the varying prevalence in the literature. This systematic review and meta-analysis aim to provide a comprehensive overview of published literature on the prevalence of RLP and symptomatic neuroma after lower extremity amputation. Studies reporting the prevalence of RLP and symptomatic neuroma pain in patients who have had a lower extremity amputation published between 2000 and 2020 were identified in PubMed and Embase. Random-effects meta-analyses of proportions were performed to quantify the prevalence of RLP and symptomatic neuroma. Subgroups were identified and analysed. For RLP, the pooled prevalence was 59% (95% CI: 51-67). For symptomatic neuromas, the pooled prevalence was 15% (95% CI: 7-28). Residual limb pain subgroup analysis showed statistically significant higher prevalence in patients aged >50 years, follow-up >2 years, and in studies using a self-administered questionnaire for data collection. The prevalence of RLP and symptomatic neuroma in patients who have had a lower extremity amputation is 59% and 15%, respectively. Knowledge of their high prevalence may result in better awareness among physicians, in turn providing timely and adequate management.
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Affiliation(s)
- Emile B List
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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8
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Aerden LK, Wuite S, Houthoofd S, Matricali GA. Reviving the debate: Articular cartilage preservation during disarticulation at the lower limb? A systematic review. Foot Ankle Surg 2021; 27:246-251. [PMID: 33388250 DOI: 10.1016/j.fas.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/25/2020] [Accepted: 12/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The need for preservation(P) or removal(R) of articular cartilage during disarticulations remains unanswered. METHODS Medline database was used to conduct a systematic review regarding all types of minor disarticulations and some types of major disarticulations in patients with diabetes mellitus, peripheral arterial disease or trauma related disarticulations. Fisher-exact statistical test was used to perform calculations for the entire group as for subgroups. RESULTS A total of 444 disarticulations at the Chopart joint, ankle and knee were included (P = 255 vs. R = 189). There was no difference in wound healing, functionality and mortality. Reamputation rate was lower in the P-group (9.4% vs. 16.9%). Infection rate was not significantly different. Differences in reamputations (R = 10.6% vs. P = 1.0%) and infections (R = 4.4% vs. P = 22.6%) were only present for the ankle subgroup. CONCLUSIONS There is no difference in wound healing, functionality and mortality between the preservation and removal of articular cartilage in the lower limb.
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Affiliation(s)
- Laurens K Aerden
- Departement of Orthopeadic Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Sander Wuite
- Departement of Orthopeadic Surgery, University Hospitals Leuven, Leuven, Belgium; Multidisciplinary Diabetic Footclinic, University Hospitals Leuven, Leuven, Belgium; Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium.
| | - Sabrina Houthoofd
- Multidisciplinary Diabetic Footclinic, University Hospitals Leuven, Leuven, Belgium; Departement of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Giovanni A Matricali
- Departement of Orthopeadic Surgery, University Hospitals Leuven, Leuven, Belgium; Multidisciplinary Diabetic Footclinic, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Heverlee, Belgium; Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium.
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Felder JM, Skladman R. Translating Technique into Outcomes in Amputation Surgeries. MISSOURI MEDICINE 2021; 118:141-146. [PMID: 33840857 PMCID: PMC8029626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The department of surgery at Washington University is putting increased emphasis on outcomes for amputees. This multidisciplinary effort begins with choosing the correct surgery and incorporating the latest technical advances in amputation surgery.
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Affiliation(s)
- John M Felder
- Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri
| | - Rachel Skladman
- Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri
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Crane H, Boam G, Carradice D, Vanicek N, Twiddy M, Smith GE. Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations. Hippokratia 2021. [DOI: 10.1002/14651858.cd013839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hayley Crane
- Academic Vascular Surgical Unit, Hull York Medical School; Hull University Teaching Hospitals NHS Trust; Hull UK
| | - Gemma Boam
- Academic Vascular Surgical Unit, Hull York Medical School; Hull University Teaching Hospitals NHS Trust; Hull UK
| | - Daniel Carradice
- Academic Vascular Surgical Unit, Hull York Medical School; Hull University Teaching Hospitals NHS Trust; Hull UK
| | - Natalie Vanicek
- Department of Sport, Health & Exercise Science; University of Hull; Hull UK
| | | | - George E Smith
- Academic Vascular Surgical Unit, Hull York Medical School; Hull University Teaching Hospitals NHS Trust; Hull UK
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11
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Wound Complications and Reoperations after Transtibial Amputation of the Leg. Ann Vasc Surg 2020; 69:292-297. [PMID: 32474142 DOI: 10.1016/j.avsg.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Transtibial amputations (TTAs) of the leg have been associated with high rates of wound complications. We assessed outcomes of TTAs to determine if bundled interventions implemented at our hospital had an impact on lowering wound complications, including surgical site infections. METHODS We assessed the impact of a surgical site infection prevention bundle (negative-pressure wound therapy, minimizing the use of staples, and a decontamination protocol for methicillin-resistant Staphylococcus aureus) on 90-day wound complications. The year of implementation of the prevention bundle was excluded, and the pre-eras and posteras were defined as the four-year period before and after implementation. The study sample consisted of a single-center cohort, with TTA cases identified using operating room scheduling software. RESULTS A total of 182 TTAs were performed: 110 in the pre-era and 72 in the postera. The wound complication rate decreased from 22 to 17% despite fewer two-stage operations, less imaging to identify peripheral artery disease, and an increased proportion of patients with end-stage renal disease. Wound complications and revision to a higher level of amputation were more associated with indication (especially no-option peripheral artery disease with ischemic rest pains) than with any particular aspect of surgical technique. The use of drains was associated with reoperations but not higher level revision. CONCLUSIONS Higher rates of wound complications and revision to a higher level of amputations should be expected among patients with no-option peripheral artery disease with ischemic rest pains undergoing TTAs. Drains should be avoided.
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Lazic I, Knebel C, Consalvo S, Rechl H, von Eisenhart-Rothe R, Lenze U. [Amputations around the knee]. DER ORTHOPADE 2020; 49:461-470. [PMID: 32266433 DOI: 10.1007/s00132-020-03906-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An amputation around, through or below the knee joint constitutes a "huge" change in a patient's life. In Orthopaedics, amputations are most frequently performed in cases with musculoskeletal tumours or failed total knee arthroplasty. A multidisciplinary team approach (surgeon, anaesthetist, pain specialists, orthotist, psychologist etc.) and patient-specific treatment regime from the outset as well as a meticulous surgical technique are of the outmost importance. Nowadays, prosthetic legs can be fitted for nearly any amputation level. The functional outcome of amputations below the knee is usually superior to amputations above or through the knee joint. Postoperative stump conditioning is paramount and the final prosthetic leg should not be fitted earlier than 4-6 months postoperatively. Problems with wound healing, muscle contractures and phantom limb pain represent common complications which might adversely affect patient outcomes.
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Affiliation(s)
- Igor Lazic
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Carolin Knebel
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Sarah Consalvo
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Hans Rechl
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Rüdiger von Eisenhart-Rothe
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Ulrich Lenze
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Eid-Arimoku L, Brooks M. Through-knee amputation: mediolateral fasciocutaneous flaps with the addition of a protective gastrocnemius layer. Ann R Coll Surg Engl 2019; 102:162-163. [PMID: 31532224 DOI: 10.1308/rcsann.2019.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- L Eid-Arimoku
- Vascular Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Brooks
- Vascular Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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14
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Lim S, Javorski MJ, Halandras PM, Aulivola B, Crisostomo PR. Through-knee amputation is a feasible alternative to above-knee amputation. J Vasc Surg 2018; 68:197-203. [DOI: 10.1016/j.jvs.2017.11.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/24/2017] [Indexed: 11/25/2022]
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Ozawa S, Mans C. Stifle Disarticulation as a Pelvic Limb Amputation Technique in a Cockatiel (Nymphicus hollandicus) and a Northern Cardinal (Cardinalis cardinalis). J Avian Med Surg 2017; 31:33-38. [DOI: 10.1647/2015-138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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