Your Health - Amputation, Above-the-Knee

Amputation, Above-the-Knee

(Transfemoral Amputation)

by Michelle Badash, MS

Definition

An above-the-knee amputation (AKA) is the surgical removal of the leg above the knee.

Above-the-Knee Amputation

Reasons for Procedure

An amputation is usually done for one of the following reasons:

Poor blood flow that 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 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 surgeon 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 all after your surgery.

At your appointment before your surgery:

Your doctor may examine your leg—check pulse, skin temperature, skin appearance, and sensitivity to touch will be tested.
Questions your doctor may ask you—this includes what 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—this includes what 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:

Spinal anesthesia (commonly used)—you will be numbed from the waist down
General anesthesia—you will be asleep through the surgery
Regional anesthesia (uncommon)—will numb your leg and the area surrounding it (IV sedation will also be used)

Description of the Procedure

Once you are asleep and no longer feeling any pain, a breathing tube will be placed if you have general anesthesia. The surgeon will make an incision in the skin above the knee. Next the muscles are divided and 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 cushioning the bone. Nerves are divided and placed so they don’t cause pain. The skin is then 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

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 can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
Pain that you can't control with the medications you've been given
Poor 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 911.

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.

Last reviewed November 2009 by Robert E. Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.