Benjamin C Taylor1, Attila Poka1, Sanjay Mehta1, Bruce G French1. 1. Department of Orthopedic Surgery, Grant Medical Center, 285 East State Street, Suite 500, Columbus, OH 43215. E-mail address for B.C. Taylor: drbentaylor@gmail.com.
Abstract
INTRODUCTION: The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues. STEP 1 PREOPERATIVE PLANNING: As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure. STEP 2 FLAP DESIGN: Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure. STEP 3 SOFT-TISSUE DISSECTION: Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain. STEP 4 DISTAL FEMORAL AND PATELLAR CUTS: Use a high-speed saw to transect the femur and patella. STEP 5 POSTERIOR DISSECTION: Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures. STEP 6 PATELLOFEMORAL ARTHRODESIS: Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture. STEP 7 SOFT-TISSUE CLOSURE: Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion. STEP 8 POSTOPERATIVE MANAGEMENT: Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes. RESULTS: The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues. STEP 1 PREOPERATIVE PLANNING: As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure. STEP 2 FLAP DESIGN: Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure. STEP 3 SOFT-TISSUE DISSECTION: Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain. STEP 4 DISTAL FEMORAL AND PATELLAR CUTS: Use a high-speed saw to transect the femur and patella. STEP 5 POSTERIOR DISSECTION: Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures. STEP 6 PATELLOFEMORAL ARTHRODESIS: Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture. STEP 7 SOFT-TISSUE CLOSURE: Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion. STEP 8 POSTOPERATIVE MANAGEMENT: Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes. RESULTS: The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.