An above knee amputation is done when the blood supply, infection or injury does not allow healing below the knee. It heals more reliably at that level, and the trade is that walking with a prosthesis takes considerably more effort.
An above knee amputation removes the leg through the thigh when a below knee level will not heal or is not safe. It heals more dependably because the blood supply in the thigh is better, but walking with a prosthesis requires roughly double the energy of normal walking, so not every patient becomes a walker. The stump is shaped with muscle secured to bone to give control of the prosthesis.
Choosing a level is a balance between healing and function. Below the knee gives much better walking but needs enough blood supply in the calf to heal. When that is not present, or when infection or injury extends above the knee, an above knee amputation is the level that will heal, and a stump that heals is the foundation of everything else.
The functional cost is real and should be stated plainly. Without a knee, the prosthetic limb must be controlled entirely from the hip, and the energy required to walk is roughly double normal. For a fit younger person that is very achievable. For an older patient with heart or lung disease it may not be, and for them the realistic goals become comfortable sitting, safe transfers and a wheelchair rather than walking. Being honest about that at the outset is kinder than implying otherwise.
The operation aims for a stump that works. Muscle is secured to bone under tension, which keeps the thigh strong and stops the muscle sliding uselessly over the bone end. The femur is cut and bevelled so no edge presses through. Nerves, particularly the sciatic, are handled carefully because a neuroma there is painful and difficult.
Keeping the hip from drawing up into a flexed, abducted position is the aftercare priority. That contracture develops quickly and makes prosthetic fitting far harder.
The realistic goal is agreed beforehand: walking with a prosthesis for some, comfortable seating and transfers for others.
Blood supply and the extent of infection are assessed. The knee is preserved if there is any realistic prospect of healing below it.
Equal front and back flaps are usually marked, placing the scar away from the end of the stump where the socket presses.
The bone is cut at a level that leaves a good lever arm for the prosthesis, and the edges are bevelled smooth.
The thigh muscles are secured to the bone under tension, which maintains strength and gives active control of the prosthesis.
The sciatic nerve is drawn down, its accompanying vessel tied, and it is divided cleanly so it retracts away from the pressure area.
Skin closed without tension over the muscle padding, with a drain and a compressive dressing.
Pain control including for phantom sensation. The hip is kept straight and not propped on pillows. Sitting out of bed and transfer practice begin early.
Wound heals, drain removed. Compression shapes the stump. Physiotherapy for hip extension, core and upper body strength.
Prosthetic assessment, where walking is a realistic goal. Casting and fitting follow. For others, wheelchair and seating are optimised.
Gait training is demanding and progressive. The stump shrinks and the socket is refitted more than once.
The stump heals more reliably than a below knee one, and pain and infection are resolved. Walking is the variable part: younger, fitter patients frequently walk well with a prosthesis, while many older patients with cardiac or respiratory disease find the energy cost too high and do better with a wheelchair and good seating. Neither outcome is a failure, but conflating them sets people up for disappointment. Hip contracture is the commonest avoidable obstacle to fitting a limb.
Most of these patients have advanced vascular disease or major trauma, and mortality at this level is genuinely higher than for lower amputations.
Hip position in the first weeks decides whether a prosthesis can be fitted at all.
Many do, particularly younger and fitter patients. Walking above knee takes roughly double the energy of normal walking, and for some older patients with heart or lung disease a wheelchair with good seating gives more independence.
The knee is preserved wherever there is a realistic prospect of healing below it, precisely because it matters so much for walking. The level is dictated by blood supply and infection.
It encourages the hip to tighten into a bent position, and that contracture is one of the main reasons a prosthesis cannot be fitted later.
It cannot, which is why the discussion beforehand is thorough and why a second opinion is welcomed rather than resented when there is time for one.
Securing the muscle properly to the bone is what gives a stump that can control a prosthesis rather than one that simply exists. Setting a realistic rehabilitation goal before the operation matters just as much.
Amputation and rehabilitation are commonly covered by health insurance and by government schemes including PM JAY. Above knee prostheses cost more than below knee ones and vary widely by type; that is planned separately with the prosthetist. A written estimate covers the surgery and admission.
The honest answers, including the ones people find hard to hear.
Ask your question →Because a below knee stump needs enough blood supply in the calf to heal, and where that is absent it breaks down and needs revising anyway. If infection or damage extends above the knee, the choice is made for us. The knee is preserved whenever it realistically can be.
Some patients walk well with an above knee prosthesis, particularly if younger and otherwise fit. It takes roughly double the energy of normal walking, so for some older patients with heart or lung disease the honest goal is comfortable transfers and a wheelchair. That is discussed before surgery.
To stop the hip tightening into a bent position. That contracture develops within a few weeks, feels comfortable at the time, and is one of the commonest reasons a prosthesis cannot be fitted afterwards.
Usually eight to twelve weeks where walking is the goal, once the wound is sound and the stump has begun to settle. The socket will need refitting several times during the first year as the stump shrinks.
Yes, more so than a lower amputation, mainly because the patients needing it usually have advanced vascular disease, diabetes or major injury. The risks are discussed frankly, including with family, before the decision is made.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
