A review of through-knee amputation

Abstract

Objectives: Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a through-knee amputation approach. This article seeks to (1) determine the number of through-knee amputation performed compared with other major lower limb amputations in England over the past decade; (2) identify the theoretical concepts behind through-knee amputation surgical approaches and their potential effect on functional and clinical outcomes and (3) provide a platform for discussion and research on through-knee amputation and surgical outcomes.

Methods: National Health Service Hospital Episodes Statistics were used to obtain recent numbers of major lower limb amputations in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on through-knee amputation surgery.

Results: In the past decade, 4.6% of major lower limb amputations in England were through-knee amputations. Twenty-six articles presenting through-knee amputation surgical techniques met our criteria. These articles detailed three through-knee amputation surgical techniques: the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur.

Conclusions: Through-knee amputation has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional and biomechanical outcomes of through-knee amputation frequently fail to distinguish between the three distinct and differing approaches, making direct comparisons difficult. Future studies that compare through-knee amputation approaches to one another and to other amputation levels are needed.

Keywords: Amputee; Gritti-Stokes; Mazet; knee disarticulation; surgical technique.

Figure 1.

Schematic of the residual limb after through-knee amputation following different techniques. (a) Classical approach: the patella is preserved, and the patellar tendon is attached to the cruciate ligaments. (b) Mazet technique: the femoral condyles are shaved, the patella is removed and the quadriceps tendon is attached to the cruciate ligaments. (c) Gritti-Stokes technique: the femur is divided transversally, and the patella is attached at the distal cut end of the femur.

Figure A1.

Number of articles presenting through-knee amputation (TKA) surgical techniques or modifications per decade. Articles not in English or French are included in this total (n = 10) but were not included in the subsequent review. Articles before 1940 were identified through reference screening of identified studies techniques to be included in the review.