Surgical treatment of your amputation stump or primary amputation may be required for a nonfunctional or painful extremity . Your rehabilitation doctor will assess, in consultation with the prosthetist and the surgeon, whether you are eligible for this treatment. Especially upper or lower leg or arm amputation with or without osseointegration system with complaints that do not respond sufficiently to conservative treatments, resulting in limited quality of life due to pain or other complaints, can be a good indication for surgical treatment.
Usually after a serious accident or infections with often various operations, an arm or leg can be so mutilated that an amputation is the best solution as the last option. Because there are few surgeons who specifically focus on arm and leg amputations and reconstructive surgery such as osseointegration is still little known, amputation is not often recommended. Many people with such a functional or painful arm or leg are also insufficiently aware of the possibilities after an amputation. Primary amputations in the AOFE Clinics can be performed by a highly experienced and dedicated team of specialists at every level in close consultation with rehabilitation physician and prosthetist.
Over time, the amputation stump can change in such a way that fit in the socket becomes an increasing problem. Not only does the bone quality deteriorate, but the soft tissues also become more vulnerable, making exostoses more sensitive and the stump less resistant to the frictional forces caused by the socket. Despite various adjustments to the socket by your prosthetist, you will tolerate the prosthesis less well and take off the socket as soon as you get the opportunity (after a working day). In that case, it may be useful to request a second opinion at our clinic and have our experienced amputation team assess your situation. Of course you may be a suitable candidate for an osseointegration treatment, but in some cases a relatively simple surgical treatment can make a huge profit, so that you are more mobile with your conventional socket prosthesis.
The fibula no longer has any function after a below knee amputation and can become increasingly painful in the prosthetic socket due to fragile skin. The prosthetist often has to adjust the socket and provide extra padding to make walking possible. By surgically shortening the fibula, this problem can be solved with a relatively simple operation, whether or not in combination with TMR.
This stump revision means that a bone bridge is made between the tibia and fibula provided it has sufficient length. The aim of this method is to make the stump more (end) loading and to improve rotational stability, so that you benefit more from the conventional socket prosthesis. This procedure does not exclude future osseointegration surgery.
Shortening after knee disarticulation
In some cases, amputation through the knee (disarticulation) is a better option than above the knee (transfemoral) amputation. This is mainly due to the extra length of the stump, which gives more stability in the socket, but also because this stump (in contrast to transfemoral) can in principle be subject to end-loading. The major disadvantage of a knee disarticulation however is the fact that wearing a prosthetic leg with a built-in knee joint means that this knee is at a lower level. Depending on the installation height, this can be 12 to 15 cm. The quality of walking does not have to be disadvantaged as a result, but sitting is inconvenient, especially with problems in public transport or in cinema and theater. Of course, this can be an excellent indication for osseointegration, but it is also possible to perform a stump revision with shortening of the thigh and preserving the final load capacity and condyle block. Here, a segment of bone of 12-15 cm between hip and knee is removed, followed by fixation by pin or plate with screws. This procedure does not exclude future osseointegration surgery.