Lower-limb amputation is a surgical procedure performed to remove a limb that has been damaged due to
Transfemoral (above-knee) amputation comprises approximately 27% of all lower-limb amputations. Amputation can happen to anyone in any age group, but its prevalence is highest among people aged 65 years and older.
Transfemoral (above knee) amputation is a surgical procedure performed to remove the lower limb at or above the knee joint when that limb has been severely damaged via trauma, disease, or congenital defect.
Most transfemoral amputations are performed due to peripheral vascular disease (a complication of diabetes), or severe disease of the circulation in the lower limb. Poor circulation limits healing and immune responses to injury. Foot or leg ulcers may develop and not heal. They may become infected, and the infection may spread to the bone and become severe enough to be life-threatening.
Amputation is performed to remove the diseased tissue and prevent further spread of infection. Transfemoral amputations are performed when the blood flow is inadequate in the lower leg or infection is so severe it prohibits a lower-level (below the knee) surgery.
If a transfemoral surgery is necessary, it is usually performed by a vascular or orthopedic surgeon.
The diseased or severely injured part of the limb will be removed, keeping as much of the healthy tissue and bone as possible. The surgeon shapes the remaining limb to allow the best use of a prosthetic leg after recovery.
The need for transfemoral amputation is caused by conditions including:
Prior to transfemoral surgery, we may:
Immediately After Surgery
You should expect to stay in the hospital for approximately 5 to 14 days following your surgery. Your wound will be bandaged, and you may also have a drain at the surgery site (this is to drain excess fluids including blood).
Post amputation physical therapy will begin soon after surgery when your condition is stable and the doctor clears you for rehabilitation. In the hospital, the hospital physical therapist will review your medical and surgical history, and visit you at your bedside.
Your first 2 to 3 days of hospital physiotherapy treatment may include:
When you are medically stable, the physiotherapist will help you learn to move about in a wheelchair, and stand and walk with an assistive device like a walker.
Prevention of Contractures
A contracture is the development of soft-tissue tightness that limits joint motion. Contractures happens when muscles and soft tissues become permanently shortened and stiffened from lack of movement for a period of time.
For example, if a person with a transfemoral amputation sits in the same position for long periods of time, the hip muscles may adapt to the new position and become stiff. Lying in bed with a pillow between (or under) your legs may cause a contracture with the leg positioned too far out to the side, if this position is repeated over sustained periods of time.
Contractures can become permanent if not addressed following surgery, throughout recovery, and after rehabilitation is completed. Contractures can make it difficult to wear your prosthesis and will make standing or walking more difficult, increasing the need for an assistive device, such as a walker.
Our senior physiotherapists will help you maintain normal posture and range of motion at your hip and will show you how to position your limb to avoid development of a contracture, and teach you stretching and positioning exercises to maintain normal range of motion.
Compression to Address Swelling
It is normal to experience postoperative swelling.
We will help you maintain compression on your residual limb to protect it, reduce and control swelling, and help it heal.
Compression can be accomplished by:
These methods also help shape the limb to prepare it for fitting the prosthetic leg.
In some cases, a rigid dressing or a plaster cast may be used instead of elastic bandages. An immediate postoperative prosthesis made with plaster or plastic may be applied. The method chosen depends on each person's unique condition. We will help monitor the fit of these devices and instruct you in their use.
Your physical therapist will help with pain management in a variety of ways, including:
We will work with the prosthetist to prescribe the most suitable prosthesis for your life situation and activity goals. An above-knee prosthesis includes a
You will receive a temporary prosthesis at first while your residual limb continues to heal and shrink/shape over several months of healing. The prosthesis will be modified to fit as needed over this time.
Increasing independent function
After you move from acute care to rehabilitation, you will learn to function more independently. We will help you master wheelchair mobility and walking with an assistive device, such as crutches or a walker.
We will also teach you the skills you need for successful use of your new prosthetic limb. You will learn how to care for your residual limb with skin checks and hygiene, and continue contracture prevention with exercise and positioning.
Learning prosthesis use and care
We will teach you how to put your new prosthesis on and take it off, and how to manage a good fit with the socket type you receive. We will help you to gradually build up tolerance for wearing your prosthesis for increasingly longer times, while protecting the skin integrity of your residual limb.
You will continue to use a wheelchair for getting around, even after you get your permanent prosthesis, for the times when you are not wearing the limb.
Prosthetic training is a process that can last up to a full year.
You will begin when the physician clears you for weight-bearing on the prosthesis. Our senior physical therapists will help you learn to
Most likely you will begin walking using parallel bars, then progress to a walker, and later, as you get stronger, you may progress to using a cane before walking independently without any assistance.
You will also need to continue strengthening and stretching exercises to achieve your fullest potential for a return to many of the activities you performed before your amputation.