Where limb salvage efforts failed, in the form of non-union, infection, instability, or pain, a patient may consider above knee amputation. This may also be the treatment of choice for medically comorbid patients.
This procedure can be extremely complicated in patients who have undergone multiple surgeries on the limb, particularly if the patient has a revision total knee, distal femur stem in place. Consideration must be given to removal of a potentially ingrown device, and avoidance of intraoperative fracture of the femur. In addition, neovascularization can make blood loss difficult to control, and the length of the shortened extremity can preclude the use of a tourniquet. In this setting, use of intraoperative intravascular balloon tamponade of the external iliac artery may be considered.
Outcome of above knee amputations can be quite variable. Events technique including adductor myodesis and targeted muscle innervation can be employed to improve outcome. Many elderly patients do not utilize a prosthesis and become dependent as a result of this intervention. Younger patients with less medical comorbidities are more likely to benefit from prosthetic fitting and training.
Future consideration of osseous integration prosthesis may dictate the type of above knee amputation performed.