Orb # 10 fitting is what thread

Knee disarticulation and transgenic amputation

Summary

Operation objective

Disarticulation in the knee joint or transcondylar thigh amputation with preservation of all thigh muscles and free active hip joint mobility in all 3 levels. The stumps are accordingly efficient, fully axially loadable and can be provided with excellent prosthetic restorations. The pear-shaped stump gives the prosthesis shaft a torsionally stable, firm hold.

Indications

A more peripheral amputation, e.g. B. ultra-short in the lower leg is excluded. Important alternative to thigh amputation. Possible for any etiology, with the exception of rapidly progressive arterial occlusive diseases such as thrombangiitis obliterans (M. Buerger-Winiwarter). After an infected and loosened total knee prosthesis despite multiple revision operations.

Contraindications

With the possibility of preserving the knee joint.

Surgical technique

Disarticulation: Severing the skin, subcutaneous tissue and joint capsule with synovial skin, cruciate and collateral ligaments and the vascular-nerve cord between the femoral condyles.

The menisci and the articular cartilage are left in place and serve as cushioning when the stump is fully axially loaded. Osteophytes are to be removed. The anchoring of tendon stumps analogous to myoplastic stump covering on the lower and upper thighs is expressly waived. The patella is left in its anatomical place and held by the retinacula. The amputee can actively move them up and down by 1–2 cm and feels this is pleasant.

Tension-free closure of the skin flaps. Where possible, place the scar outside the stress zone.

Transcondylar (transgenicular) amputation indicated by the femoral condyles only if too few soft tissues are available for disarticulation.

Alternatives: Techniques according to Gritti, according to Klaes-Eigler, shortening osteotomy of the femur, overturning plastic according to Sauerbruch.

Follow-up

Pad blunt over the condyles and on the patella due to the risk of pressure ulcers. After the wound has healed (3–6 weeks) prosthesis fitting and walking training, depending on the level of activity.

Results

The advantages of knee disarticulation are particularly evident in disabled sports, but the proportion of knee disarticulations in leg amputations is less than 5%. Meaningful statistical information is therefore not available.

Abstract

Objective

A knee disarticulation or a through-knee stump is superior compared to a transfemoral stump. The thigh muscles are all preserved, and the muscle balance remains undisturbed. The range of motion of the hip joint is not limited. The bulbous shape of the stump allows full weight bearing at the stump end and can easily be fitted with a prosthesis. An amputee with a bilateral knee disarticulation is able to walk “barefoot”.

Indications

A more distal amputation level, e.g., an ultra-short transtibial amputation, is not possible. Important alternative to transfemoral amputations. Possible for any etiology except for Buerger-Winiwarter’s disease. New indications are infected and loosened total knee replacements.

Contraindications

Preservation of the knee joint is possible.

Surgical technique

Knee disarticulation is a very atraumatic procedure, compared to transfemoral amputations. Neither bones nor muscles have to be severed, just skin, ligaments, vessels, and nerves. Even the meniscal cartilages may be left in place to act as axial shock absorbers. The cartilage of the femur is not resected, but only beveled in case of osteoarthritis. There are no tendon attachments or myoplastic procedures necessary. The patella remains in place and is held in position only by the retinacula. Skin closure must be performed without the slightest tension, and if possible not in the weight-bearing area.

Transcondylar amputations across the femoral condyles are only indicated when there are not sufficient soft tissues for wound closure of a knee disarticulation.

Alternatives as the techniques of Gritti, Klaes, and Eigler, the shortening of the femur and the Sauerbruch’s rotation plasty [14] are presented and discussed.

Postoperative management

The risk of decubital ulcers is rather high. Correct bandaging of the stump is, therefore, particularly important. Prosthetic fitting is possible 3-6 weeks after surgery. The type of prosthesis depends on the amputee’s activity level.

Results

The superior performance of amputees with knee disarticulations in sports prove the superiority of that amputation level compared to transfemoral amputees. However, because less than 5% of amputations are knee disarticulations, statements about statistical significance cannot be made. On the other hand, one should do everything to preserve an ultra-short transtibial stump.

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Conflict of interest

The corresponding author declares that there is no conflict of interest.

Author information

Affiliations

  1. -, Langwisstr. 14, CH-8126, Zumikon near Zurich, Switzerland

    Prof. em. Dr. R. Baumgartner

Corresponding author

Correspondence to Prof. em. Dr. R. Baumgartner.

additional information

1985–1996 the author was director of the Clinic and Polyclinic for Technical Orthopedics and Rehabilitation, Westfälische Wilhelms-Universität Münster.

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Cite this article

Baumgartner, R. Knee Disarticulation and Transgenicular Amputation. Opera Orthop Traumatol23, 289-295 (2011). https://doi.org/10.1007/s00064-011-0041-y

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keywords

  • Knee joint
  • Knee disarticulation
  • Transcondylar amputation
  • Transgenic amputation
  • Plastic overturning after Sauerbruch

Keywords

  • Knee joint
  • Knee disarticulation
  • Transcondylar amputation
  • Transgenicular amputation
  • Sauerbruch’s rotation plasty