Amputations, especially those above the knee, are caused by accidents, disease and congenital disorders. Approximately 74% of above the knee amputations are due to peripheral vascular disease and cancer while 23% are due to accidents. Any amputations done because of disease are usually performed as a life-saving measure. However, there are those researchers and physicians who advocate above the knee amputations for individuals who suffer from spinal cord injuries and have a severe degree of spasticity which is not able to be controlled and negatively affects the individuals ability to be independent or causes pain.
The elderly are also at risk for an above the knee amputation following a total knee replacements. Despite the current modern surgical techniques it is very difficult to salvage a failed total knee replacement. In situations when other options have been exhausted these individuals become candidates for an above the knee amputation.
Another reason for an above the knee amputation is a congenital disorder or defect of the leg that is present at birth. A person born with a limb deficiency can usually be helped with use of an artificial limb. There are times when amputation of the deformed limb may be desirable before the application of an artificial limb to make the leg better able to accept the application of the prosthetic.
There are more than 1.5 per 1000 people in the United States and Canada who experience in amputation in their lifetime. This equates to more than 380,000 individuals in the United States alone. Of these, and above the knee (trans femoral) form the second largest group.
The definition of an above the knee amputation is the removal of a leg from any portion above the knee. At this time surgeons will try to retain as much of the thigh and muscle as possible because it makes abetter stump and application of the prosthetic.
Once the decision for an amputation has been made, surgeon will discuss with the individual options available for the surgical incision and the ultimate results. The individual and their family will be advised of the postsurgical period, as well as the recommendations for rehabilitation.
Almost every individual who experiences an amputation will be deppressed immediately after the surgery. The only exception to this may be individuals who were suffering intense pain in the legs just prior to the amputation. With assistance from counselors, nursing staff as well as support from the family many individuals will replace this with a will to resume an active lifestyle.
The physician will either use a soft ordinary cotton bandaging technique but more often will use a harder, rigid plaster of Paris dressing to protect the stump as well as to begin the molding in preparation for a prosthetic. It is important that patients do not do anything to encourage muscle tightening or contractures of that leg such as resting the stump on a crutch handle, placing a pillow under the hip or placing a pillow between the thighs.
One of the early challenges facing the amputee and treatment team is the swelling which occurs in the amputated area because of accumulating fluids. This fluid accumulation will sometimes make fitting the prosthesis very difficult but the physicians and nurses will recommend certain measures to reduce the amount of edema such as using a rigid dressing control it. Once the rigid dressing is removed the individual can go to using elastic bandages to decrease the swelling and allow them to use their prosthetic.
The stump should be kept bandaged at all times but changed every four to six hours. If the individual experiences throbbing it should be changed immediately. Swelling happens rapidly and when it is left on the bandage can create sores from constriction. Some physicians would prefer to use the elastic “shrinker” socks instead of elastic bandages to decrease the chance of swelling. What ever is being used it should be removed at least three times a day and the stump massage vigorously for 10 to 15 minutes.
The more quickly a prosthetic can be fitted after surgery the better it is for both the individual, his rehabilitation and the development of the stump. The socket of the first prosthetic will be preparatory and made either of plaster of Paris or a plastic material. Although a variety of shoes can be worn with artificial limb the patient should consult with the prosthetist (manufacturer of the prosthetic) because heel height is a major factor.
Individuals who experience an above the knee amputation have a very good chance of reintegrating back into their previous lifestyle as long as their pre-amputation ability to perform skills was high. In other words, those individuals who are over the age of 70 or have significant peripheral vascular disease, cardiovascular disease or stroke or who never were able to climb stairs will probably not be able to go back to living independently. However, those individuals who were walking before the amputation and had no difficulty with their mobility will most likely be able to resume their previous lifestyle without a problem.
Orthotics and Prosthetics Information:http://health.net.au/health-living/
United States Department of Veterans Affairs: http://health.net.au/health-living/
Journal of Bone Joint Surgery: http://health.net.au/health-living/