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.

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

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

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

Factors that may increase your risk of complications include:

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

Discuss these risks with your doctor before surgery.

What to Expect
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:

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

You should ask your doctor questions like:

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

Before surgery, you may:

  • 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)
  • 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.
  • See a physical therapist who will explain rehabilitation after surgery.
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 (needle) in your hand or arm. Regional anesthesia will numb your leg and the surrounding area. You may also receive IV sedation.

Description of Procedure

Once you are asleep and no longer feeling pain, a breathing tube will be placed if you have 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.

Immediately After Procedure

You will be taken to the recovery room for observation. If all is well, 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?

During surgery, you will not feel pain. After surgery, you will be given pain medicine. 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
  • 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 taught how to change your dressing.
  • You will receive antibiotics to prevent infection.

While in the hospital, you may be asked to move your stump often. This will allow 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:

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

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

  • Cough , shortness of breath, or chest pain
  • Depression
  • Joint pain, fatigue, stiffness, rash, or other new symptoms
  • 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
  • Pain that is not controlled with pain medicines given
  • Poorly fitting prosthesis
  • Redness, swelling, increasing pain, a lot of bleeding, or discharge from the incision site
  • Signs of infection, like fever or chills
  • Stump swelling

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

Last reviewed: September 2011 by Marcin Chwistek, MD.

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