Above knee amputation (transfemoral amputation) is an operation to remove the leg above the knee. In orthopaedic oncology, it is performed when a bone or soft tissue tumour cannot be safely removed with limb salvage surgery.
An incision is made around the thigh at the planned level. The muscles, blood vessels, and nerves are divided and the bone is cut. Muscle flaps are shaped to create a well-padded, conical stump suitable for prosthetic fitting. The skin is closed and a compressive dressing is applied. The operation takes one and a half to two hours.
Amputation is recommended when a tumour involves critical neurovascular structures making limb salvage unsafe, when the resulting limb would be non-functional, when infection has destroyed a previous reconstruction, or when the patient prefers a definitive solution.
Limb salvage surgery (wide excision with reconstruction) is the primary alternative. Radiotherapy may be considered in some cases.
Multidisciplinary team discussion. Pre-operative meeting with the prosthetics team. Psychological support. Pre-operative physiotherapy to strengthen the upper body.
Definitive removal of the tumour. A well-fashioned stump allows prosthetic fitting and return to walking. Many patients achieve excellent functional outcomes with modern prosthetics.
Feeling that the amputated limb is still present. Very common and usually manageable.
Pain perceived in the missing limb. Occurs in approximately 50-80% of amputees.
Particularly in patients who have received radiotherapy or chemotherapy.
Grief, anxiety, and depression are common and need support.
Wound infection requiring antibiotics.
Painful nerve ending in the stump.
The stump may need surgical revision for bony prominence, soft tissue problems, or prosthetic fitting issues.
DVT in the remaining leg.
Severe depression or adjustment disorder.
General or spinal anaesthesia with epidural for post-operative pain management.
Hospital stay five to ten days. Early stump compression and shaping. Prosthetic fitting at six to eight weeks once the stump has healed and matured. Intensive gait training with a prosthetic limb. Psychological support throughout. Most patients are walking with a prosthesis within three to six months.
Regular prosthetic reviews. Oncology surveillance. Psychological support as needed.
Most patients begin walking with a prosthesis within three to six months. Modern prosthetics are highly functional and many amputees return to work, sport, and driving.
Phantom pain typically improves over time. Various treatments are available including medication, mirror therapy, and neurostimulation. Support from the pain team is important.