Carl R. Darnall Army Medical Center - Health Library

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
  • Congenital disorders, such as a limb that has not formed properly

Possible Complications  ^

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Skin breakdown at the residual limb
  • Infection
  • Poor healing of the amputation site that may require a higher level amputation
  • Swelling of the residual limb
  • Decreased range of motion in the hip joint
  • Phantom limb sensation —feeling that the amputated limb is still there
  • Phantom pain —feeling pain in amputated limb area
  • Bleeding
  • Blood clots
  • Reaction to anesthesia

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:

What to Expect  ^

Prior to Procedure

Your doctor may do any of the following before your procedure:

  • Physical exam
  • Blood tests
  • Imaging tests, such as x-rays or scans
  • Have you donate blood in case you need a transfusion
  • Prescribe antibiotics to prevent infection

Before surgery, you will need to:

  • Arrange for a ride home.
  • Arrange for help at home while you recover.
  • Talk to your doctor about any medications, herbs, or supplements you are taking.
  • Ask your doctor about devices you will need after the surgery like an artificial limb, walker, crutches, and/or wheelchair.

Talk to the doctor about the medications you are taking. You may need to stop taking some medications up to 1 week before the procedure.

Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

Anesthesia

You may be given one of the following:

Description of the Procedure

An incision will be made in the skin above the knee. Next, 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, to complete the stump. 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?

Several hours, depending on your health and the reason for the surgery.

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. There will be pain and discomfort after the procedure. It can be managed with medications.

Average Hospital Stay

The usual length of stay is 5-14 days. It is possible that you may have to stay longer if complications arise. You may also go to a rehabilitation hospital to help you recover.

Post-procedure Care

At the Hospital

Right after the procedure, you will be in a recovery room. Your blood pressure, pulse, and breathing will be monitored. Treatment during recovery may also include:

  • Pain medications
  • Antibiotics to prevent infection
  • Medication to prevent blood clots

Physical therapy often starts within 24 hours after your surgery. Devices will help you walk.

Preventing Infection

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision

At Home

When you return home, you will continue with physical therapy and exercise. You will be instructed on how to care for the wound. Medications may be prescribed to manage pain.

Adjusting to an amputation may be difficult. Some may have depression. Consider talking to a therapist or psychologist.

Call Your Doctor  ^

Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:

  • Increased swelling in the residual limb
  • Poorly fitting prosthesis
  • Pain that cannot be controlled with the medications you were given
  • Signs of infection, such as fever or chills
  • Increasing redness, swelling, increasing pain, excess bleeding, or discharge from the incision site
  • Persistent nausea or vomiting
  • New or increased symptoms of depression
  • New cough, shortness of breath, or chest pain
  • Joint pain, fatigue, stiffness, rash, or other new symptoms

If you think you have an emergency, call for emergency medical services 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_medicine_and_rehabilitation/amputation_85,P01141. Accessed November 10, 2017.

Amputation. Society for Vascular Surgery website. Available at: https://vascular.org/patient-resources/vascular-treatments/amputation. Accessed November 10, 2017.

Amputation procedure. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/amputation_procedure_92,P08292. Accessed November 10, 2017.

Management of acute and critical limb ischemia. EBSCO DynaMed Plus website. Available at::http://www.dynamed.com/topics/dmp~AN~T901128/Management-of-acute-and-critical-limb-ischemia. Updated September 8, 2017. Accessed November 10, 2017.

Last reviewed June 2018 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM  Last Updated: 6/12/2018