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Below-the-Knee Amputation

(Amputation, Below-the-Knee; BKA)

by Patricia Griffin Kellicker, BSN

Definition

A below-the-knee amputation (BKA) is the surgical removal of the leg below the knee.

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    TOP

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

Factors that may increase your risk of complications include:

  • Poor blood flow
  • Diabetes
  • Obesity
  • 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

What to Expect    TOP

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.
  • Talk to your doctor about any medications, herbs, or supplements you are taking.
  • Ask your doctor about devices you will need after the surgery, such as an artificial limb, walker, crutches, and/or wheelchair.

You may need to stop taking some medications up to one week before the procedure. Medications that may need to be stopped may include:

  • Anti-inflammatory drugs
  • Blood thinners
  • Antiplatelets

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:

Description of Procedure

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.

How Long Will It Take?

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

How Much Will It Hurt?

Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

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.

At Home

When you return home, take these steps:

  • Follow your doctor’s instructions on cleaning the incision site.
  • Ask your doctor when it is safe to shower, bathe, or soak in water.
  • Continue with your physical therapist’s exercise program.

Adjusting to an amputation may be difficult and can lead to depression. Consider talking to a therapist or psychologist.

Call Your Doctor    TOP

Call your doctor if any of these occur:

  • Increased swelling in the residual limb
  • Poorly fitting prosthesis
  • Pain that can't be controlled with the medication you've been 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 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 medical help 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
http://www.hc-sc.gc.ca

References:

Amputation. John Hopkins Medicine website. Available at:
...(Click grey area to select URL)
Accessed December 3, 2013.
Amputation. Society for Vascular Surgery website. Available at:
...(Click grey area to select URL)
Updated February 2011. Accessed December 3, 2013.
Amputation procedure. John Hopkins Medicine website. Available at:
...(Click grey area to select URL)
Accessed December 3, 2013.
Management of critical limb ischemia. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 2, 2013. Accessed December 3, 2013.
Professional Guide to Diseases . 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.
Last reviewed December 2013 by Michael Woods, MD
Last Updated: 12/3/2013