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. 2021 Dec 14;12(12):CD013839.
doi: 10.1002/14651858.CD013839.pub2.

Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations

Hayley Crane  1 , Gemma Boam  1 , Daniel Carradice  1 , Natalie Vanicek  2 , Maureen Twiddy  3 , George E Smith  1
Affiliations

Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations

Hayley Crane et al. Cochrane Database Syst Rev. .

Abstract

Background: Diabetes and vascular disease are the leading causes of lower limb amputation. Currently, 463 million adults are living with diabetes, and 202 million with peripheral vascular disease, worldwide. When a lower limb amputation is considered, preservation of the knee in a below-knee amputation allows for superior functional recovery when compared with amputation at a higher level. When a below-knee amputation is not feasible, the most common alternative performed is an above-knee amputation. Another possible option, which is less commonly performed, is a through-knee amputation which may offer some potential functional benefits over an above-knee amputation.

Objectives: To assess the effects of through-knee amputation compared to above-knee amputation on clinical and rehabilitation outcomes and complication rates for all patients undergoing vascular and non-vascular major lower limb amputation.

Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases; the World Health Organization International Clinical Trials Registry Platform; and the ClinicalTrials.gov trials register to 17 February 2021. We undertook reference checking, citation searching, and contact with study authors to identify additional studies.

Selection criteria: Published and unpublished randomised controlled trials (RCTs) comparing through-knee amputation and above-knee amputation were eligible for inclusion in this study. Primary outcomes were uncomplicated primary wound healing and prosthetic limb fitting. Secondary outcomes included time taken to achieve independent mobility with a prosthesis, health-related quality of life, walking speed, pain, and 30-day survival.

Data collection and analysis: Two review authors independently reviewed all records identified by the search. Data collection and extraction were planned in line with recommendations outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to assess the certainty of evidence using the GRADE approach.

Main results: We did not identify RCTs that met the inclusion criteria for this review.

Authors' conclusions: No RCTs have been conducted to determine comparative clinical or rehabilitation outcomes of through-knee amputation and above-knee amputation, or complication rates. It is unknown whether either of these approaches offers improved outcomes for patients. RCTs are needed to guide practice and to ensure the best outcomes for this patient group.

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Conflict of interest statement

HC: has declared that her institution received a research bursary of £2000 from the British Association of Chartered Physiotherapists in Amputee Rehabilitation (BACPAR). This was solely for participant costs for qualitative interviews conducted with through‐knee and above‐knee amputees for her PhD.

GB: has declared that her institution received £1000 from Help for Health solely to cover the costs of participant incentives and their travel costs when completing data collection for her PhD.

DC: has received consultancy fees from Medtronic related to venous treatment policy, and travel expenses from All Party Parliamentary Group on Vascular Disease, NICE, MHRA, to provide expert advice.

NV: has received payment for Editorial board membership (Associate Editor) for Journal of Sports Sciences. She is Chief Investigator on a study funded by the National Institute for Health Research (PB‐PG‐0816‐20029). This study is conducted to assess the feasibility of conducting an RCT about the effectiveness and cost‐effectiveness of a novel prosthesis for older patients with vascular‐related below‐the‐knee amputations and multi‐morbidities. It is not relevant to this review.

MT: none known.

GES: has in the past received consulting fees from BSN Medical for consulting on NICE technology appraisal application, speakers fees from BSN Medical and Bayer with regard to presenting research related to their products. GES reports that in the past, his institution has received unconditional funding from Diomed/Angiodynamics. This was used to help fund a research nurse to assist with objective assessments in the context of randomised controlled trials.

Figures

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Figure 1: PRISMA flow diagram.
See this image and copyright information in PMC

Update of

References

References to studies excluded from this review

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NCT04120558 {published data only}
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References to other published versions of this review

Crane 2021
    1. Crane H, Boam G, Carradice D, Vanicek N, Twiddy M, Smith GE. Through‐knee versus above‐knee amputation for vascular and non‐vascular major lower limb amputations. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No: CD013839. [DOI: 10.1002/14651858.CD013839] - DOI - PMC - PubMed

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