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Below-the-Knee Amputation

(Amputation, Below-the-Knee; BKA)

by Patricia Griffin Kellicker, BSN

Definition

This is the surgical removal of the leg below the knee.

Reasons for Procedure

Possible Complications    TOP

Your doctor will review the possible complications. These may include:

  • Poor healing of the amputation site that may require a higher level amputation
  • Skin breakdown at the stump
  • Infection
  • Decreased range of motion in the hip or knee
  • Phantom sensation —feeling that the amputated limb is still there
  • Phantom pain —feeling pain in the amputation area
  • Stump swelling
  • Bleeding
  • Reaction to anesthesia
  • Heart attack
  • Blood clots

Factors that may increase your risk of complications include:

  • Poor blood flow
  • Diabetes
  • Infection or open leg/foot ulcers
  • Not being able to move for a long time
  • Heart disease
  • Smoking or lung disease
  • Increased age
  • History of clotting or bleeding disorders

Talk to your doctor about these risks before surgery.

What to Expect    TOP

Prior to Procedure

If your surgery is planned, your doctor will review the surgery and what to expect. He will talk to you about how you are going to move after surgery. You may need a prosthesis (artificial limb), walker, crutches, wheelchair, or a combination of these.

At your appointment before your surgery, your doctor may:

  • Examine your leg (check pulses, skin temperature, skin appearance, and sensitivity to touch)
  • Ask you questions like:
    • What kind of help do you have at home?
    • Would you like to talk to a therapist about the amputation?

You should ask your doctor questions like:

  • What kind of rehabilitation will I need?
  • How long will my recovery be?

Before surgery, you may:

  • See a physical therapist who will explain rehabilitation after surgery.
  • Be asked not to eat or drink for 8-12 hours before your surgery—Ask your doctor if you should take regular medicines with a sip of water before surgery.
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the surgery. Medicines stopped may include:
    • Anti-inflammatory drugs (eg, aspirin)
    • Blood thinners like clopidogrel (Plavix) or warfarin (Coumadin)

Anesthesia

General anesthesia or regional anesthesia will be used. General anesthesia will block pain and keep you asleep during surgery. It is given through an IV. Regional anesthesia will numb your leg and the surrounding area. You may also receive IV sedation.

Description of Procedure

After you are asleep and no longer feeling pain, a breathing tube will be placed in a patient having general anesthesia. The doctor will make a cut in the skin below the knee. The muscles will be separated and blood vessels clamped. A special saw will be used to cut through the bone. The muscles will be sewn and shaped so that a stump is formed to cushion the bone. Nerves will be separated and placed so that they do not cause pain. Blood vessels will be tied off. The skin will be closed over the muscles, forming the stump. Drains may be inserted into the stump to drain blood for the first few days. A dressing and compression stocking will be placed over the stump.

Below-the-Knee Amputation

FC00009_105433_1.jpg
A cut is made below the knee.
Copyright © Nucleus Medical Media, Inc.

Immediately After Procedure

You will be taken to the recovery room for observation. Your breathing tube will be removed. You will be transferred to your hospital room for recovery.

How Long Will It Take?

Several hours (depending on your health and the reason for the surgery)

How Much Will It Hurt?

You will not feel pain during surgery. You will be given pain medicine after surgery. You may feel phantom pain. If you do, tell your doctor.

Average Hospital Stay

5-14 days (Your doctor may choose to keep you longer if complications occur.)

Post-procedure Care

At the Hospital

  • You will receive antibiotics to prevent infection.
  • You may be taught how to change your dressing.
  • Physical therapy will begin in the hospital. Your therapist will show you how to stretch your hip and leg muscles to maintain range of motion. You will learn how to get in and out of bed and how to put weight on your leg. You may be taught how to use crutches, a walker, or a wheelchair until you can be fitted with a prosthesis.

You may be asked to move your stump often while you are in the hospital. This will allow for circulation and prevent contractures (stiffening causing loss of joint movement).

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Get help from family and friends.
  • Change your bandages. Replace them with sterile bandages.
  • You will need to continue physical therapy. It will help you build strength and maintain range of motion. You will also learn how use a prosthesis.
  • Take care of your stump and prosthesis.
  • Many people feel depressed after this type of surgery. Consider talking to a therapist or psychologist.
  • Check with your doctor about which medicines to take at home.
  • Ask your doctor when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor's instructions.

Call Your Doctor    TOP

After you leave the hospital, call your doctor if any of the following occurs:

  • Stump swelling
  • Poorly fitting prosthesis
  • Pain that is not controlled with pain medicines that you have been given
  • Signs of infection, like fever or chills
  • Redness, swelling, increasing pain, a lot of bleeding, or discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medicines you were given, or which continue for more than two days after leaving the hospital
  • Depression
  • Cough, shortness of breath, or chest pain
  • Joint pain, fatigue, stiffness, rash, or other new symptoms

In case of an emergency, call for medical help right away.

RESOURCES:

American Diabetes Association
http://www.diabetes.org
American Orthopaedic Foot and Ankle Society
http://www.aofas.org
Amputee Coalition of America
http://www.amputee-coalition.org

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca/
Health Canada
http://www.hc-sc.gc.ca

References:

Amputation. Society for Vascular Surgery website. Available at: http://www.vascularweb.org/vascularhealth/Pages/amputation.aspx . Updated September 2011. Accessed November 12, 2012.
Amputation, above-the-knee. EBSCO Health Library. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 21, 2011. Accessed November 12, 2012.
Professional Guide to Diseases . 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.
Last reviewed November 2012 by Marcin Chwistek, MD
Last Updated: 11/12/2012