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Above-the-Knee Amputation

(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 AKA may be done because of problems in the foot or lower leg such as:
  • Poor blood flow that cannot be fixed
  • Severe infection
  • Trauma or injury
  • Tumors
  • Problems at birth, such as a limb that has not formed properly

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:
  • Excess bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Infection
  • Blood clots
  • Skin breakdown and swelling of the remaining limb
  • Poor healing that may result in further amputation
  • Feeling pain in the amputated limb or feeling that it is still there
Things that may raise the risk of problems are:

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:
  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Whether you need a ride to and from surgery
  • Tests that will need to be done before surgery, such as images

Anesthesia

The doctor may give:

Description of the Procedure

An incision will be made in the skin above the knee. 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. It will form a stump that will cushion the bone. Nerves are divided and placed so they do not cause pain. The skin is closed over the muscles. Drains may be inserted into the stump. It will allow blood and fluids to drain from the area in the first few days after surgery. A dressing and compression stocking will be placed over the stump.

How Long Will It Take?

It may take many hours. It depends on the reason for the surgery.

How Much Will It Hurt?

Pain and swelling are common in the first month. Medicine and home care can manage pain.

Average Hospital Stay

The usual length of stay is 5 to 14 days. If you have any problems, you may need to stay longer.

Post-procedure Care

At the Hospital
Right after the procedure, the staff may:
  • Give you pain medicine
  • Give you medicine to prevent blood clots
  • Raise the leg to ease swelling
  • Apply ice to the area
Physical therapy will be started soon after surgery. The care team will teach you how to use any assistive devices.
Preventing Infection
During your stay, staff will take steps to lower your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
You can also lower your chance of infection by:
  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Not letting others touch your incisions
At Home
It will take 1 to 2 months for the remaining limb to heal. Physical activity will be limited during recovery. You may need to ask for help with daily activities and delay return to work. You will need to learn new ways to do daily tasks. This may take up to a year.

Call Your Doctor

Call the doctor if you are not getting better or you have:
  • Increasing redness, swelling, pain, excess bleeding, or discharge
  • Pain that you cannot control with medicine
  • Signs of infection, such as fever or chills
  • Nausea or vomiting
  • Feelings of depression
  • Cough, shortness of breath, or chest pain
  • New or unexpected symptoms
If you think you have an emergency, call for medical help right away.

RESOURCES

American Diabetes Association
http://www.diabetes.org
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Diabetes Association
http://www.diabetes.ca
The Canadian Orthopaedic Association
http://www.coa-aco.org

References

Amputation. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/physical%5Fmedicine%5Fand%5Frehabilitation/amputation%5F85,P01141. Accessed September 28, 2020.
Amputation. Society for Vascular Surgery website. Available at: https://vascular.org/patient-resources/vascular-treatments/amputation. Accessed September 28, 2020.
Management of acute and critical limb ischemia. EBSCO DynaMed website. Available at:: https://www.dynamed.com/management/management-of-acute-and-critical-limb-ischemia . Accessed September 28, 2020.
Rooke TW, Hirsch AT, et al. 2011 American College of Cardiology Foundation/American Heart Association Focused Update of the Guideline for the Management of patients with peripheral artery disease (Updating the 2005 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 Nov 1;124(18):2020-2045.

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