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Above Knee / Below Knee Amputation Surgery

Home Above Knee / Below Knee Amputation Surgery

Above Knee / Below Knee Amputation Surgery

Leg Amputation Surgery: Causes, Types, Recovery & Prevention

Leg amputation is a life-saving surgical procedure performed when a limb is severely damaged, infected, or has lost its blood supply beyond recovery. While the thought of amputation can be overwhelming, modern vascular surgery and rehabilitation techniques help patients regain mobility and improve their quality of life.

At Hyderabad Vascular Center, our goal is always to save the limb whenever possible. However, in certain advanced conditions, amputation becomes the safest option to protect the patient's overall health and prevent life-threatening complications.

What Is Leg Amputation?


Leg amputation is the surgical removal of a part of the lower limb due to severe disease, injury, infection, or poor blood circulation. The procedure may involve removing a toe, foot, lower leg, or entire leg depending on the extent of tissue damage.

Amputation is usually considered only when all other limb-saving treatments have failed or are unlikely to succeed.

Common Causes of Leg Amputation


1. Peripheral Artery Disease (PAD)


Peripheral Artery Disease occurs when arteries supplying blood to the legs become narrowed or blocked. Reduced blood flow can lead to:

  • Severe leg pain
  • Non-healing wounds
  • Gangrene
  • Tissue death

In advanced stages, amputation may be necessary if blood circulation cannot be restored.

2. Diabetic Foot Complications

People with diabetes are at higher risk of:

  • Foot ulcers
  • Nerve damage (Neuropathy)
  • Severe infections
  • Poor wound healing

Untreated diabetic foot infections can spread rapidly and threaten life, making amputation necessary in some cases.

3. Gangrene

Gangrene develops when body tissue dies due to lack of blood supply or severe infection. Blackened skin, foul-smelling wounds, and severe pain are common warning signs.

4. Severe Trauma or Accidents

Road traffic accidents, crush injuries, and industrial trauma can severely damage bones, muscles, nerves, and blood vessels, requiring emergency amputation.

5. Chronic Kidney Disease

Patients with chronic kidney disease often have poor circulation and diabetes, increasing the risk of severe foot infections and limb loss.

6. Cancer Affecting the Limb

Rarely, bone or soft tissue cancers affecting the leg may require amputation to prevent disease spread.

Types of Leg Amputation Surgery

Below Knee Amputation (BKA)

A Below Knee Amputation removes the lower part of the leg while preserving the knee joint.

Benefits:
  • Better mobility
  • Easier rehabilitation
  • More efficient prosthetic use
  • Lower energy expenditure during walking

Whenever medically possible, vascular surgeons prefer Below Knee Amputation over Above Knee Amputation.

Above Knee Amputation (AKA)

An Above Knee Amputation involves removing the leg above the knee joint.

This procedure may be required when:

  • Blood supply is severely compromised
  • Infection extends above the knee
  • Trauma causes extensive tissue destruction

Although rehabilitation may take longer, modern prosthetic technology helps many patients return to active lifestyles.

Partial Foot or Toe Amputation

For diabetic patients, early treatment may allow removal of only infected toes or a small portion of the foot, preventing major limb loss.

Warning Signs That May Lead to Amputation

Seek immediate vascular consultation if you experience:

  • Persistent foot ulcers
  • Black or discolored toes
  • Severe leg pain at rest
  • Non-healing wounds
  • Swelling with infection
  • Foul-smelling foot wounds
  • Sudden loss of sensation in the foot
  • Cold or pale feet

How Is Leg Amputation Decided?

Before recommending amputation, a vascular surgeon performs a comprehensive evaluation including:

  • Clinical examination
  • Doppler Ultrasound
  • CT Angiography
  • Blood Investigations
  • Wound Assessment
  • Infection Evaluation

The goal is to determine whether blood flow can be restored through angioplasty, stenting, bypass surgery, or endovascular procedures.

What Happens Before Surgery?

Patients usually undergo:

  • Blood Tests
  • Chest X-Ray
  • ECG
  • Echocardiography
  • Vascular Imaging Studies

Recovery After Leg Amputation

Immediate Postoperative Care

  • Pain Management
  • Infection Prevention
  • Wound Monitoring
  • Physical Therapy Initiation

Rehabilitation

  • Muscle Strengthening
  • Balance Training
  • Mobility Improvement
  • Prosthetic Preparation

Prosthetic Fitting

Most patients can be fitted with an artificial limb once healing is complete. Modern prosthetic limbs allow patients to walk independently, climb stairs, return to work, and participate in daily activities.

Life After Amputation

Many patients fear they will lose independence after surgery. However, with proper rehabilitation:

  • Mobility can be restored
  • Daily activities can continue
  • Emotional well-being improves
  • Quality of life can significantly increase

Can Leg Amputation Be Prevented?

For Diabetic Patients

  • Check feet daily
  • Wear protective footwear
  • Control blood sugar levels
  • Treat wounds immediately
  • Schedule regular foot examinations

For PAD Patients

  • Stop smoking
  • Control cholesterol
  • Maintain healthy blood pressure
  • Exercise regularly
  • Follow prescribed medications

For Everyone

  • Seek medical attention for non-healing wounds
  • Never ignore blackened toes or foot ulcers
  • Consult a vascular surgeon early

Why Choose Hyderabad Vascular Center?

At Hyderabad Vascular Center, we specialize in:

  • Peripheral Artery Disease Treatment
  • Diabetic Foot Care
  • Limb Salvage Procedures
  • Endovascular Interventions
  • Advanced Vascular Surgery
  • Comprehensive Rehabilitation Support

Our primary goal is always limb preservation. When amputation becomes unavoidable, we ensure patients receive compassionate care, advanced surgical treatment, and complete rehabilitation support.

Your vascular surgeon has probably recommended this operation for one of the following reasons:

The blood supply to your foot is very poor, because the arteries of the leg have become very narrow or are completely blocked. This condition is quite serious, because the foot cannot survive and will make you feel very unwell. You may have developed severe pain in your foot waking you at night or even ulcers and black areas in the toes, foot or lower leg. Your physicians have come to the conclusion that your leg circulation is not possible to be improved and so an amputation is necessary.

Your are a diabetic or suffer from chronic renal failure, and you have have developed a very serious infection in a large area of the toes, foot or even the lower leg. This condition will make you feel very unwell and will threaten your life. In many cases such an infection cannot be managed with antibiotics alone and an amputation is necessary.

You will usually be admitted to the hospital one or two days before surgery so that there is enough time for the necessary investigations (blood tests, chest x-ray, electrocardiography, echocardiography etc) to be done. In many cases, a special x-ray of your arteries (arteriography) will have usually been performed to see whether there was any way to improve the leg circulation.

Your physician will generally require that 2 units of blood are available for you. In Greece, you need to personally liaise with the Blood Bank of your hospital in order that blood is secured for you.

The physician will have probably asked you to discontinue for a few days (if you take) any anticoagulant, like Warfarin or Sintrom, or antiplatelet drugs like Clopidogrel (Iscover, Plavix) or Aspirin, in order to reduce the risk for bleeding during the operation.

When you are admitted, it will be quite useful to bring with you all medications you are on. Your medical history will be recorded. Later, your vascular surgeon and the anaesthetist who will put you to sleep will visit. They will explain certain aspects of the procedure and of the immediate postoperative care. If you have any questions regarding the operation, you may ask the doctors then. You will be asked to sign a form confirming that you understand why the procedure needs to be performed, the risks of the procedure and that you agree to the surgery.

The first part of any operation is the administration of anaesthesia. Your operation will be performed either under general anaesthesia (injection of the anaesthetic through an IV in your arm, which will put you to sleep within a few seconds) or under regional anaesthesia (insertion of an epidural catheter in your back to provide pain relief during and after the operation). Occasionally combined anaestesia may be administered. A urinary catheter will be placed in your bladder to monitor your urine output.

The amputation stump will be closed with either Nylon stitches or metal clips and will be bandaged. The sutures will usually be removed 15-20 days after the operation.

Following the operation you will return to your normal ward and you will be given all your fluids by a drip until you are able to eat and drink. The nursing and medical staff will try to keep you free of pain and will explain you the way. It is common to experience pain that feels to be a part of the leg that has been removed (phantom limb pain), but this can be helped with medication and rapidly disappears. Certain pain-killers (opioids) favour constipation and you may need some laxative (syrup, suppositories, enema), while drinking plenty of fluids will help.

The various catheters will gradually be removed and you will become more mobile until you are fit enough to go home. You will be visited by the physiotherapist who will help you with with your mobility, and even with your breathing (if you are thought a high risk for chest infection).

Initially you will be shown exercises in bed and then you will be encouraged to transfer from your bed to a chair. As your wound heals, the physiotherapist will start you walking with help and you will be taught how to use a wheelchair. As your rehabilitation progresses, an appointment will be made at the limb fitting centre to start you walking on a temporary artificial limb (“prosthesis”) and eventually you will have an artificial limb tailored to your needs.

Some alterations may be necessary at your home, especially in the bathroom and the stairs, before you are discharged. Following discharge you will need to continue physiotherapy to become independent with your artificial limb or wheelchair. You will be able to walk again provided you have the motivation and fitness to do so.

Driving may be possible with an amputation, either with an automatic car or with some special modifications. You will probably need some help to bathe at first. You may also need handles or a hoist to get in and out of the bath safely.

As with any operation there is a small risk of a heart attack or stroke or even of dying. Chest infections can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy.

Because of the relatively poor blood supply at the level of the amputation, wound healing can sometimes be slow and occasionally it is necessary to perform another amputation higher up in the leg if the wound does not heal.

If the wound becomes infected, appropriate antibiotic treatment will be given, while more rarely a new operation may be required.

You may continue to feel aches and twinges in the wound for several months. If you experience symptoms of phantom limb, as mentioned above, you may be helped with appropriate medication.

Studies have found that amputees who engage in regular physical exercise feel better about themselves than those who are more sedentary. Also, people who recover from an amputation are more likely to have greater job satisfaction, possibly because of changes in their attitudes regarding life goals

  • You can learn how to adapt to having an artificial limb, including getting regular exercise, with the help of physiotherapy
  • Do not put on weight, because mobilising with the artificial limb will be more difficult
  • Quit smoking completely. If you continue, you may cause further damage to your arteries and increase the risk of having a heart attack or a stroke and of losing your remaining leg
  • Eat plenty of fruit and vegetables to prevent constipation
  • Control your blood pressure, blood cholesterol and diabetes. Take your medication regularly
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