Knee disarticulation and transfemoral amputations general principles, pitfalls, and operative techniques

Knee disarticulation and transfemoral amputations are challenging procedures that require precise decision making and strict adherence to surgical principles in order to minimize long term morbidity. Additionally, selection of the proper amputation level is needed to optimize the patient's ability to recover lower extremity function. While the indications for transfemoral amputation and knee disarticulation are similar, individual patients vary greatly on their pre-amputation functional status, and this must be taken into account during the pre-operative planning stage. Assessment and management of the soft tissue envelope is the most critical factor in the surgical decision making process during limb reconstruction. Furthermore, proper management ofthe residual bone and muscle ends, and neurovascular structures are important to maximize patient outcome. This review will highlight the indications for knee disarticulation and transfemoral amputation, as well as the guidelines that should be utilized for amputation level selection. Important pertinent surgical techniques, pearls, pitfalls, and the common advantages and disadvantages of these two amputations will be discussed.