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CONDITION/DISORDER SYNONYM
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  • Above-knee amputation

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ICD-9-CM CODE
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  • V49.76 Above-knee amputation status

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ICD-10-CM CODE
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  • Z89.619 Acquired absence of unspecified leg above knee

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PREFERRED PRACTICE PATTERN
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  • 4J: Impaired Motor Function, Muscle Performance, Range of Motion, Gait, Locomotion, and Balance Associated With Amputation

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PATIENT PRESENTATION

A 22-year-old male with a right above the knee amputation presents in a manual wheelchair with his prosthetic leg in his lap. He notes that he picked up his prosthesis from his prosthetist earlier that day and is eager to see if the adjustments made to the socket will improve his gait mechanics. When you assessed him last week you found that he was not achieving full hip extension at terminal stance on the right and that he was circumducting on the right in the swing period of gait. You discovered that he has an 8-degree hip flexion contracture on the right and a 4/5 strength of the right adductor magnus. His gluteus medius strength is 3/5 on the right and 4/5 on the left.

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KEY FEATURES
++ Description
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  • Result of ultimate loss of tissue perfusion from the surrounding circulation at any level proximal to the femoral condyles.

  • A transfemoral amputation is an amputation of the lower limb between the knee and the hip.

++ Essentials of Diagnosis1
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  • A surgeon makes diagnosis after surgery.

  • A transfemoral amputation is made between the femur at the level of the greater trochanter and proximal to the level of the femoral condyles.

  • Efforts are made to preserve the attachment of the adductor magnus at the medial distal third of the femur to maintain the normal biomechanical alignment of the femur.

  • An amputation at the level proximal to the greater trochanter of the femur is called a hip disarticulation.

  • The amputation of the entire lower extremity (LE) and half of the ipsilateral pelvis is called a hemipelvectomy.

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FIGURE 1-1

Silesian band suspension of a transfemoral prosthesis. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics, 4th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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++ General Considerations13
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  • Loss of a limb above the knee results in widespread impairments in body structure and function as well as significant activity limitations and participation restrictions that will ultimately affect the individual’s participation in family and home life as well as reintegration into the society.

  • Emotional support and education must infiltrate postoperative rehabilitation beginning on postoperative day 1 to assist the individual with repossessing life roles.

  • The total recovery period is consistently 12 to 18 months and includes activity recovery, reintegration, prosthetic training, and prosthetic management.

  • The acute hospital stay ...

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