Name of the Procedure:

Knee Disarticulation (or Through Knee)
Technical Term: Knee disarticulation with molded socket, single axis knee, pylon, SACH foot, endoskeletal system
HCPCS Code: L5312

Summary

A knee disarticulation, also known as through-knee amputation, involves the surgical removal of the leg at the knee joint. Following the amputation, a prosthesis consisting of a molded socket, single axis knee, pylon, and SACH (solid ankle cushion heel) foot is fitted. This prosthetic system offers enhanced mobility and stability for individuals who have undergone a knee disarticulation.

Purpose

Medical Conditions: This procedure is primarily indicated for individuals with severe trauma, tumors, infections, or chronic conditions that affect the leg below the knee, making limb preservation impossible. Goals/Outcomes: The primary goals are to alleviate pain, remove diseased or damaged tissue, and provide the patient with improved mobility and independence through the use of a prosthetic limb.

Indications

Symptoms/Conditions:

• Severe trauma to the lower limb
• Malignant tumors in the lower leg
• Unmanageable infections (e.g., osteomyelitis)
• Chronic limb ischemia (lack of blood flow) Patient Criteria:
• Non-viable lower limb with no potential for recovery or repair
• Adequate overall health to undergo surgery and rehabilitation
• Psychological readiness to adapt to prosthetic use

Preparation

Pre-procedure Instructions:

• Fasting 6-8 hours prior to surgery
• Adjustment of any medication as advised by the surgeon
• Pre-operative evaluation including medical history, physical examination, and consent Diagnostic Tests:
• Blood tests
• Imaging studies (e.g., X-rays, MRI) to assess the extent of the condition
• Cardiovascular assessment if necessary

Procedure Description

1. Anesthesia: The procedure begins with the administration of general or regional anesthesia.
2. Incision and Disarticulation: The surgeon makes an incision around the knee joint, carefully disarticulates the knee, and removes the lower limb.
3. Muscle and Skin Management: Muscles and tendons are stitched to shape the stump, and the skin is closed using sutures or staples.
4. Prosthetic Fitting: A molded socket is created to fit the residual limb. This is attached to a single axis knee, pylon, and SACH foot, forming the endoskeletal system.

Tools/Equipment:

• Surgical instruments for amputation (scalpel, clamps, etc.)
• Prosthetic components (molded socket, single axis knee, pylon, SACH foot)

Duration

The surgical procedure typically takes about 2-3 hours, followed by prosthetic fitting which can span several days to weeks.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon: Performs the amputation
• Anesthesiologist: Manages anesthesia
• Nursing Staff: Assists during surgery and post-operative care
• Prosthetist: Designs and fits the prosthetic limb
• Physical Therapist: Assists in rehabilitation and training for prosthetic use

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Blood clots (deep vein thrombosis)
• Pain and discomfort Rare Risks:
• Poor wound healing
• Prosthetic fitting issues
• Phantom limb pain Management:
• Antibiotics for infections
• Pain management strategies
• Rehabilitation and adjustment for prosthetic fitting

Benefits

Expected Benefits:

• Alleviation of pain and discomfort from a diseased or damaged limb
• Improved mobility with the use of a prosthetic limb
• Greater independence and quality of life Realization: Benefits are typically realized within a few weeks to months after surgery, with ongoing improvements as the patient adapts to prosthetic use.

Recovery

Post-procedure Care:

• Regular wound inspection and care
• Pain management with prescribed medications
• Physical therapy to strengthen the residual limb and adapt to the prosthetic Recovery Time:
• Initial recovery from surgery: 2-4 weeks
• Full adaptation to prosthetic limb: Several months Restrictions/Follow-up:
• Limited physical activity until the wound heals
• Regular follow-up appointments with the surgeon and prosthetist

Alternatives

Other Options:

• Below-knee amputation (when possible)
• Advancements in limb preservation techniques Pros and Cons:
• Below-knee amputation generally allows greater mobility but is not always feasible.
• Limb preservation techniques can avoid amputation but may not always be successful and can prolong suffering if the condition is severe.

Patient Experience

During the Procedure: The patient will be under anesthesia and will not feel pain during the surgery. After the Procedure: Post-operative pain is managed with medications. The patient might experience swelling and discomfort initially. Phantom limb sensations are common but can be managed with therapy and medication. Pain Management: Analgesics are prescribed to manage pain, and physical therapy is recommended to promote healing and adaptation to prosthetic use.