Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Amputation, Above-the-Knee

(Transfemoral Amputation)
by Michelle Badash, MS
Definition

An above-the-knee amputation (AKA) is the surgical removal of the leg above the knee.

Reasons for Procedure

An amputation is usually done for one of the following reasons:

  • Congenital disorder (eg, a limb that has not formed properly)
  • Poor blood flow cannot be corrected, resulting in tissue loss or extreme pain
  • Severe infection
  • Trauma or injury
  • Tumor
Possible Complications

If an above-the-knee amputation has been recommended, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Blood clots
  • Decreased range of motion in the hip joint
  • Infection
  • Non-healing of the amputation site resulting in the need for a higher level of amputation
  • Phantom limb sensation —feeling that the amputated limb is still there
  • Phantom pain—feeling pain in amputated limb area
  • Reaction to anesthesia
  • Swelling of the stump
  • Wound breakdown

Some factors that increase the risk for complications include: Be sure to discuss these risks with your doctor before surgery.

  • Blood clotting disorders
  • Diabetes
  • Heart disease
  • Infection
  • Poor blood flow
  • Prolonged immobilization
  • Smoking or lung disease
What to Expect
Prior to Procedure

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

At your appointment before your surgery:

  • Questions you should ask your doctor—These include the kind of rehabilitation you will need after surgery and how long your recovery will be.
  • Your doctor may ask questions—These include the kind of help you have at home and whether you would like to talk to a therapist about the loss of your limb.
  • Your doctor may examine your leg—Pulse, skin temperature, skin appearance, and sensitivity to touch will be tested.

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

  • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • Aspirin or other anti-inflammatory drugs

As this is major surgery that will create many life changes, many people find it helpful to receive counseling to help cope with these changes.

You may see a physical therapist who will explain your rehabilitation after surgery.

You will be asked to fast for 8-12 hours before your surgery. Ask your doctor if you should take regular medicines with a sip of water before your surgery.

Anesthesia

You may be given:

Description of the Procedure

Once you are asleep and no longer feel pain, a breathing tube will be placed if you have general anesthesia. The doctor will make an incision 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 so that a stump is formed to cushion the bone. Nerves are divided and placed so they do not cause pain. The skin is closed over the muscles, forming the stump. Drains may be inserted into the stump to drain blood for the first few days after surgery. A dressing and compression stocking will be placed over the stump.

Immediately After Procedure

You will be taken to a recovery room. There, you will be monitored for any negative reactions. If all is well, your breathing tube will be removed while you are there. You will then be transferred to your hospital room to begin your recovery.

How Long Will It Take?

The length of time for this procedure will vary. The length will depend on your overall condition.

How Much Will It Hurt?

During surgery, you will not feel pain. After surgery, you will be given pain medicine in the hospital and a prescription for pain medicine to take at home. You may feel phantom pain. This is a feeling of pain in the amputated portion of the limb which is no longer present. If you do, tell your doctor so it can be treated.

Average Hospital Stay

The length of your hospital stay will be determined by your recovery progress and your overall health. In general, the stay may be from five days to two weeks.

Post-procedure Care
At the Hospital

While you are recovering at the hospital:

  • You may be taught how to change your dressing.
  • You may use a wheelchair for mobility at first.
  • You will be asked to move your stump often. This will help stimulate circulation and help prevent stiffening of the hip joint.
  • You will begin physical therapy as soon as possible. Therapy often begins within 48 hours of surgery.
  • You will receive antibiotics to prevent infection.
At Home

Initially, the stump will be swollen. It will take some weeks for the stump to shrink. Depending on your age, physical strength, and condition, you may be then fitted with a prosthesis. Recovery requires a long-term treatment plan of physical therapy. You will be able to walk with a prosthesis.

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

  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Change your bandages as instructed, replacing them with sterile bandages provided by the hospital.
  • Get some help from family and/or friends as you recover.
  • Inspect the stump often.
  • You will need to continue physical therapy to build your strength, maintain range of motion, and learn how to walk with a prosthesis.

Be sure to follow your doctor's instructions .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs: In case of an emergency, call for medical help right away.

  • Cough, shortness of breath, or chest pain
  • Depression
  • Increased stump swelling
  • Joint pain, fatigue, stiffness, rash, or other new symptoms
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency or frequency of urination, or blood in the urine
  • Poorly fitting prosthesis
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Signs of infection, including fever and chills

Last reviewed: December 2011 by John C. Keel, MD.

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