Through-the-knee amputation: an improved technique.

Through-the-knee amputation (TKA) is an excellent lower extremity treatment for the ischemic extremity when revascularization is not feasible and a prosthesis is not practical. Over the past 8 years 185 major amputations have been performed at our hospital of which 63 were of the TKA type. In 61 of these an improved technique was used that resulted in nonischemic, strong, and aesthetic stumps with 100 per cent primary healing. Our technique consists of removing the distal 2 cm of the femoral head with the two condyles and allowing the patella to ankylose to the new distal femoral end. In comparison with the other major amputations the TKA with this technique had significant advantages over the above-knee amputation and often was found to be superior to the below-knee amputation especially when rehabilitative ambulation with a prosthesis was not possible.