{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:54:59Z","timestamp":1790420099636,"version":"4.1.0"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T00:00:00Z","timestamp":1651708800000},"content-version":"vor","delay-in-days":2803,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:p>Background Knee disarticulations (KD) are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center.<\/jats:p><jats:p>Methods A retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A.) between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified.<\/jats:p><jats:p>Results Between 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%), arterial thrombosis (35%), and trauma (9%). Postoperative complications included superficial cellulitis (13%), soft tissue infection (4%), and flap ischemia (4%) necessitating one case of surgical debridement (4%) and four trans-femoral amputations (9%). 9 (22%) patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P&lt;0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P&lt;0.01.<\/jats:p><jats:p>Conclusions Knee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.<\/jats:p>","DOI":"10.5999\/aps.2014.41.5.562","type":"journal-article","created":{"date-parts":[[2014,9,19]],"date-time":"2014-09-19T10:38:36Z","timestamp":1411123116000},"page":"562-570","source":"Crossref","is-referenced-by-count":28,"title":["Through Knee Amputation: Technique Modifications and Surgical Outcomes"],"prefix":"10.1055","volume":"41","author":[{"given":"Frank P","family":"Albino","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Seidel","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles G","family":"Crone","sequence":"additional","affiliation":[{"name":"Nascott\/Hanger Clinic, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E","family":"Attinger","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,5,5]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1682\/JRRD.2008.07.0085","article-title":"Pain and pain-related interference in adults with lower-limb amputation: comparison of knee-disarticulation, transtibial, and transfemoral surgical sites","volume":"46","author":"J Behr","year":"2009","journal-title":"J Rehabil Res Dev"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.ijsu.2006.06.027","article-title":"Survival rates in dysvascular lower limb amputees","volume":"4","author":"J Kulkarni","year":"2006","journal-title":"Int J Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"593","DOI":"10.2340\/16501977-0393","article-title":"Predicting walking ability following lower limb amputation: a systematic review of the literature","volume":"41","author":"K Sansam","year":"2009","journal-title":"J Rehabil Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1682\/JRRD.2007.09.0151","article-title":"Prosthesis use in persons with lower- and upper-limb amputation","volume":"45","author":"KA Raichle","year":"2008","journal-title":"J Rehabil Res Dev"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"358","DOI":"10.5435\/00124635-199811000-00004","article-title":"Lower-limb deficiencies and amputations in children","volume":"6","author":"JI Krajbich","year":"1998","journal-title":"J Am Acad Orthop Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1080\/03093640802557020","article-title":"Knee disarticulation: survival, wound healing and ambulation. A historic cohort study","volume":"33","author":"K Ten Duis","year":"2009","journal-title":"Prosthet Orthot Int"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.3928\/0147-7447-19920901-07","article-title":"Energy demands for walking in dysvascular amputees as related to the level of amputation","volume":"15","author":"MS Pinzur","year":"1992","journal-title":"Orthopedics"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3109\/03093649409164389","article-title":"Energy expenditure of trans-tibial amputees during ambulation at self-selected pace","volume":"18","author":"RS Gailey","year":"1994","journal-title":"Prosthet Orthot Int"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.jvs.2008.04.018","article-title":"Through-knee amputation in patients with peripheral arterial disease: a review of 50 cases","volume":"48","author":"BC Morse","year":"2008","journal-title":"J Vasc Surg"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"12169","DOI":"10.3402\/dfa.v3i0.12169","article-title":"Incidence of re-amputation following partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy: a systematic review","volume":"3","author":"SL Borkosky","year":"2012","journal-title":"Diabet Foot Ankle"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1002\/dmrr.2236","article-title":"Amputation and ambulation in diabetic patients: function is the goal","volume":"28","author":"CE Attinger","year":"2012","journal-title":"Diabetes Metab Res Rev"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jdiacomp.2011.02.001","article-title":"The importance of limb preservation in the diabetic population","volume":"25","author":"KK Evans","year":"2011","journal-title":"J Diabetes Complications"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jvs.2005.04.015","article-title":"Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients","volume":"42","author":"SM Taylor","year":"2005","journal-title":"J Vasc Surg"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/0741-5214(88)90106-1","article-title":"One-stage versus two-stage amputation for wet gangrene of the lower extremity: a randomized study","volume":"8","author":"DF Fisher Jr","year":"1988","journal-title":"J Vasc Surg"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1177\/000313480206800514","article-title":"Through-the-knee amputation: an improved technique","volume":"68","author":"N Nellis","year":"2002","journal-title":"Am Surg"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.5999\/aps.2014.41.5.562.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,16]],"date-time":"2023-07-16T17:17:09Z","timestamp":1689527829000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.5999\/aps.2014.41.5.562"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,9]]},"references-count":15,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2022,5,5]]},"published-print":{"date-parts":[[2014,9]]}},"URL":"https:\/\/doi.org\/10.5999\/aps.2014.41.5.562","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,9]]}}}