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Friday, September 19, 2014
Is Above or Below the Knee Amputation Better?
Which is better, above or below the knee amputation?
Amputation below the knee is far preferable to amputation through or above the knee. This is true even for a person who wouldn't be doing much - or any - walking after amputation, since having an intact knee joint significantly improves mobility in the bed.
An above-knee amputee must expend considerably greater effort to walk with a prosthesis compared to a below-knee amputee walking with a prosthesis. And, despite the considerable advances which have been made in prosthetic componentry for above-knee amputees - particularly with the availability of microprocessor-controlled knee units - there really is no substitute for the structure and function of an intact knee joint.
Exceptions to the usual preference to keep the knee joint intact would include:
- if a below-knee amputation would result in too short of a residual limb to allow proper use of a below-knee prosthesis;
- if scarring or hypersensitivity of a below-knee residual limb would make use of a below-knee prosthesis unlikely;
- if there is severe arthritis or internal derangement of the knee which would be expected to result in excessive pain with weight-bearing on that knee; or
- if there is a significant knee flexion contracture - meaning the knee is unable to be straightened past a certain point - such that the advantages of a below-knee prosthetic socket couldn't be utilized.
The specifics of each patient's unique situation should be discussed with each patient by his/her physicians, to determine what is best for them.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University