Above knee amputation

PURPOSE OF THE STUDY: To evaluate the clinical results and safety of fungal periprosthetic joint Infections (fPJIs) using two-stage treatment protocol. MATERIAL AND METHODS: 8 patients with fPJIs (3 hips and 5 knees) using two-stage revision were reviewed retrospectively and followed up at least 2 years. The preoperative demographic data, two-stage treatment protocol, results of microbiology and histologic workup and postoperative follow-up results (reimplantation success rate and infection free time) were recorded...

OBJECTIVES: Decision making regarding level of lower extremity amputation is sometimes challenging. Selecting an appropriate anatomic level for major amputation requires consideration of tradeoffs between postoperative function and risk of wound complications that may require additional operations, including debridement and/or conversion to above-knee amputation (AKA). We evaluated the utility of common, non-invasive diagnostic tests used in clinical practice to predict need for reoperations among patients undergoing primary, elective below knee-amputations (BKA) by vascular surgeons...

IMPORTANCE: Patients with kidney failure have an increased risk of diabetes-related foot complications. The benefit of regular foot and ankle care in this at-risk population is unknown. OBJECTIVE: To investigate foot and ankle care by podiatrists and the outcomes of diabetic foot ulcers (DFUs) in patients with kidney failure. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included Medicare beneficiaries with type 2 diabetes receiving dialysis who had a new DFU diagnosis...

The aim of this study is to gain insight in the cardiorespiratory fitness of persons with lower limb amputation (LLA) during rehabilitation, and in potential factors influencing their cardiorespiratory fitness. We performed a retrospective cohort study using data from cardiopulmonary exercise tests. Included participants were adults with LLA. Main outcome was cardiorespiratory fitness expressed as O2 peak (ml/min/kg) and was directly determined using breath-by-breath gas analysis. O2 peak was compared to reference values for able-bodied controls...

Introduction Failure of infrainguinal bypass grafts remains a major problem tackled by vascular surgeons despite a meticulous surgical technique. All infrainguinal bypasses should go under routine surveillance to pick the grafts at risk for the prevention of graft failure. Objectives The aim was to find out if we were adhering to the European Society of Vascular Surgery (ESVS) guidelines in the management of chronic limb-threatening ischaemia (CLTI) patients, including postoperative follow-up and to monitor whether the patients were having postoperative duplex surveillance scans to pick any graft at risk...

INTRODUCTION: Patients with above-knee amputations (AKA) are normally treated with the traditional socket-mounted prosthesis (SMP), which is associated with a high incidence of problems. Osseointegration has been proposed as a promising option for avoiding many common SMP drawbacks. Several concerns have arisen regarding amputee osseointegration, however, mainly with respect to infection. We report on the safety of a single-stage osseointegration protocol using an antibiotic-loaded hydrogel to coat the intramedullary implant...

OBJECTIVE: Staged surgery with open guillotine amputation (OGA) prior to a definitive major lower extremity amputation (LEA) has been shown to be effective for sepsis control and improving wound healing. Studies have evaluated postoperative complications including infection, return to the operating room for re-amputation, and amputation failure following OGA. However, the role of timing to close OGA for predictive outcomes remains poorly understood. We aim to assess outcomes of major LEA related to the time of OGA closure...

Lower limb trauma often results in mangled extremities, and in some cases, complete amputation may be necessary. However, limiting the extent of amputation and preserving the major knee joint are crucial to enhance mobility and overall functionality. By providing painless soft tissue coverage on the stump, early prosthesis use and the initiation of physiotherapy become more feasible. Soft tissue transfers hold the potential to benefit patients in two essential aspects: first, resolving soft tissue deficiencies without causing bone shortening, and second, preparing the stump to enhance overall functionality...

BACKGROUND: The incidence of phantom limb pain in patients with Charcot neuroarthropathy who undergo major amputation is not well described. The purpose of this study was to determine whether patients with Charcot neuroarthropathy and diabetes who underwent either a below-knee amputation (BKA) or above-knee amputation (AKA) had an increased rate of phantom limb pain compared with those with a diagnosis of diabetes alone. METHODS: Using international classification of disease (ICD) and common procedural terminology (CPT) codes, the TriNetX research database identified 10 239 patients who underwent BKA and 6122 who underwent AKA between 2012 and 2022...

This case study examines the total physiotherapy care of a 50-year-old male patient, who had a right-sided displaced distal tibia and fibula fracture, a talus fracture due to a road traffic accident, and an above-knee amputation due to a serious infection. Enhancing muscle strength, reducing pain from phantom limbs, avoiding problems, maintaining range of motion, increasing endurance, and promoting functional independence in the postoperative period were the main goals of the patient's rehabilitation. The recovery plan included an intensive four-week program of physiotherapy care...

BACKGROUND: The COVID-19 pandemic has affected the healthcare systems worldwide since the dawn of 2020. In March 2020, the United Kingdom government announced the first national lockdown which severely disturbed all NHS healthcare elective services. Our aim is to assess the long-term impact of COVID-19 related disruption of NHS elective services on emergency major lower limb amputations. METHOD: Patients' data for emergency major lower limb amputations (MLLA) for critical limb-threatening ischemia and diabetic foot infections performed at Aberdeen Royal Infirmary was collected through Trakcare® and divided into the control pre-pandemic group (April 2018 to March 2020) and the pandemic group (April 2020 to March 2022)...

BACKGROUND: Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) can result in bone and soft-tissue loss, leg length discrepancies, and dysfunctional extensor mechanisms. While above-knee amputation (AKA) is an established salvage treatment, modular knee arthrodesis (MKA) is a viable option that provides rigid stability and maintains leg length even in patients with severe bone and soft-tissue loss. We sought to report the outcomes of patients with an MKA as the definitive treatment...

The earliest stages of osteosarcomas are primitive mesenchymal cells. It generally occurs close to the long bones' metaphysis and typically affects the long bones, such as the arm and leg. This case report underscores the pivotal role of physiotherapy in the rehabilitation of a 14-year-old male diagnosed with osteosarcoma, who underwent above-knee amputation. The structured six-week rehabilitation program, encompassing passive, active-assisted, and active exercises for the affected limb, alongside strength training for unaffected joints, produced notable gains in the pain rating scale and the lower-extremity functional scale in just 15 days...

AIM: To present the short- and long-term outcomes of lower extremity bypass (LEB) surgery in patients with critical limb-threatening ischaemia (CLTI), comparing diabetic (DM) and non-diabetic (non-DM) patients. METHODS: Retrospective analysis of anonymised data from a nationwide health insurance company (AOK). Data from 22,633 patients (DM: n = 7266; non-DM: n = 15,367; men: n = 14,523; women: n = 8110; mean patient age: 72.5 years), who underwent LEB from 2010 to 2015, were analysed...

INTRODUCTION: Malignant triton tumor (MTT) is a rare and aggressive subtype of malignant peripheral nerve sheath tumor consisting of a neurogenic tumor with rhabdomyoblastic differentiation. Only 170 cases have been reported to date, two-thirds occurring in young patients with neurofibromatosis type 1 and the remaining third presenting as a sporadic tumor. CASE PRESENTATION: We present the case of a 49-year-old man with a sporadic grade 2 MTT of the lower limb which had had a previous tibial fracture...

BACKGROUND: In transtibial limb loss, computer simulations suggest that the maintenance of muscle strength between pre- and post-limb loss can maintain the pre-limb loss metabolic cost. These results are consistent with comparable costs found experimentally in select cases of high functioning military service members with transtibial limb loss. It is unlikely that similar results would be found with transfemoral limb loss, although the theoretical limits are not known. Here we performed optimal control simulations of walking with and without an above-knee prosthesis to determine if transfemoral limb loss per se increases the metabolic cost of walking...

BACKGROUND: Above and below knee amputation (AKA, BKA) are treatments of last resort for peripheral arterial disease (PAD). The aim was to examine amputation rates, AKA:BKA ratios, previous revascularization and minor amputation, lengths of stay in hospital, mortality following amputation, and regional variation in people with and without diabetes in England. METHODS: The study used population-based ecological and cohort study designs, 31 672 census areas, hospital admissions from 2006 to 2018 and Poisson, logistic and Cox regression...

BACKGROUND: The aims of this study were: i) to assess fragility indices (FI) of individual randomized controlled trials (RCT) that compared paclitaxel-based drug-coated balloons (DCB) or drug-eluting stents (DES) versus standard endovascular devices, and ii) to meta-analyze mid-term and long-term safety and efficacy outcomes from available RCT data while also estimating the FI of pooled results. METHODS: This systematic review has been registered in the PROSPERO public database (CRD42022304326 https://www...

BACKGROUND: Enhanced recovery after surgery (ERAS) pathways lead to improve perioperative outcomes for patients with vascular related amputations, however long-term data and functional outcomes are lacking. This study evaluated patients treated by the Lower Extremity Amputation Pathway (LEAP) and identified predictors of ambulation. METHODS: A retrospective review of LEAP patients who underwent major amputation from 2016 to 2022 for WIfI Stage V disease was performed...

INTRODUCTION AND IMPORTANCE: Adamantinoma is a rare primary low-grade malignant bone tumor with a median age of 20 to 30 years with a specific predilection to the lower 2/3rd shaft of the tibia. We present an unusual presentation of a giant adamantinoma with synchronous involvement of almost entire lengths of the tibia and fibula and extensive to the skin in a geriatric man. CASE PRESENTATION: An elderly male patient in their late 50s presented to us with a grossly deformed left leg with a fungating mass over the left leg for 5 years...