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
- Anesthesia: The procedure begins with the administration of general or regional anesthesia.
- Incision and Disarticulation: The surgeon makes an incision around the knee joint, carefully disarticulates the knee, and removes the lower limb.
- Muscle and Skin Management: Muscles and tendons are stitched to shape the stump, and the skin is closed using sutures or staples.
- 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.