Below-the-Knee Amputation
(Amputation, Below-the-Knee; BKA)
Reasons for Procedure ^
An amputation below the knee may be done because of:
- Poor blood flow that cannot be fixed
- Tumors
- Trauma or injury
- Severe infection
Possible Complications ^
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Poor healing of the amputation site that may require a higher level amputation
- Skin breakdown at the residual limb
- 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
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 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.
- Ask your doctor about devices you will need after the surgery, such as an artificial limb, walker , crutches, and/or wheelchair.
Talk to your doctor about any medications, herbs, or supplements 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 either:
- General anesthesia —you will be asleep through the surgery
- Spinal anesthesia —you will be numbed from the waist down
- Regional anesthesia —used to block pain in the lower legs, but you will not be asleep
Description of Procedure
A cut will be made 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.
A cut is made below the knee.
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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. Pain and discomfort after the procedure 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 where your blood pressure, pulse, and breathing will be monitored. 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. During this time you may need devices to 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 residual limb. Medications may be prescribed to manage pain.
Adjusting to an amputation may be difficult and can lead to 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 medication 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
- Increased symptoms of depression
- New or persistent 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
Amputee Coalition of America
http://www.amputee-coalition.org
CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca
Health Canada
https://www.canada.ca
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. Johns 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 November 2017 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM Last Updated: 12/20/2014
