Amputation, transfemoral (AK)

• Above-knee amputation

• V49.76 Above-knee amputation status

• Z89.619 Acquired absence of unspecified leg above knee

• 4J: Impaired motor function, muscle performance, range of motion, gait, locomotion, and balance associated with amputation

Description

• 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 Diagnosis2

• 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.

General Considerations2-4

• 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 society.
• Emotional support and education must infiltrate postoperative rehabilitation beginning on postoperative day one 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 ranges from 5 to 14 days, and the post-acute hospital stay could range from 2 to 8 weeks.
  • This period includes surgery recovery, wound healing, early rehabilitation, and determination of prosthetic readiness.
• The immediate recovery stage begins with the healing of the wound and could extend up to 6 months.
  • This stage ends with stabilization of limb volume after accommodating to prosthetic use with ambulation.
• The last stage of recovery is widely variable. During this time, limb volumes continue to stabilize but are no longer rapidly changing.
  • Prosthetic adjustments can be made as the limb continues to stabilize.
  • When the prosthesis is worn full time for a period of at least 6 months and the limb volume has stabilized to a point that socket fit remains relatively consistent for at least 2 to 3 weeks, a definitive prosthesis may be indicated.
  • Higher-level functional training and social reintegration mark the end of this stage.
• Promotion of independence can start as early as postoperative day one with quadriceps and gluteus medius and maximus strengthening of the contralateral limb.
• Exercises that promote muscle control of the residual limb depend on the patient’s pain tolerance, the surgical procedure, and the healing response. Clear communication among the care team is warranted.
• Trunk stability will assist ...