Amputation, transtibial (BK)

• Below knee amputation

• V49.75 Below knee amputation status

• Z89.519 Acquired absence of unspecified leg below 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 distal to the tibial plateau

Essentials of Diagnosis

• A surgeon makes diagnosis after surgery.
• A transtibial amputation is an amputation of the lower limb between the ankle and the knee where the knee joint is retained.
  • The superior tibiofibular joint is preserved, however the tibia and the fibula are no longer joined distally.
• A transtibial amputation is made between the area of the tibial plateau and the junction of the middle and lower third of the tibia.
  • Amputations distal to the lower third of the leg are avoided because of a lack of soft tissue to pad the distal end of the residual limb.
• An amputation that preserves the femur and the patella is called a knee disarticulation.
• An amputation at the level of the talocrural joint that leaves the distal end of tibia and fibula in tact is called an ankle disarticulation.

General Considerations2,3

• Loss of a limb below 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 postacute 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 to 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.
• Promoting 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 ...