Below knee amputation (transtibial amputation) is an operation to remove the leg below the knee, preserving the knee joint. This allows better prosthetic function than above-knee amputation.
An incision is made around the upper calf. A long posterior muscle flap is created for stump padding. The tibia and fibula are cut, and the posterior flap is brought forward to cover the bone ends. The skin is closed. The knee joint is preserved. The operation takes one to one and a half hours.
Below knee amputation is performed when the tumour is confined to the lower leg and the knee can be preserved. Preserving the knee provides much better functional outcomes than above-knee amputation.
Limb salvage surgery. Rotationplasty in selected cases.
MDT discussion. Prosthetic team involvement. Pre-operative physiotherapy and psychological support.
Preservation of the knee joint allows excellent prosthetic function. Most below-knee amputees walk well and many return to running, cycling, and sport with appropriate prosthetics.
Expected.
Particularly with prior chemotherapy.
Swelling management with compression is essential.
May require revision.
Loss of full knee extension if not maintained with exercises.
Painful nerve endings.
Rarely needed if the stump fails.
General or spinal anaesthesia with regional block.
Hospital stay five to seven days. Stump compression and shaping. Prosthetic fitting at six to eight weeks. Gait training. Most patients walk independently within two to three months.
Prosthetic reviews. Oncology surveillance. Psychological support.
The knee joint provides enormous functional advantage for prosthetic walking. Below-knee amputees use approximately 40% more energy to walk than normal, compared to 60-100% more for above-knee amputees.