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Is the Effort to Preserve the Knee Joint Justified?

John J. Castronuovo, Jr, MD; Leland M. Deane, MD; Ralph A. Deterling, Jr, MD; Thomas F. O'Donnell, Jr, MD; David M. O'Toole, MD; Allan D. Callow, MD

Arch Surg. 1980;115(10):1184-1187.

Abstract
• The records of 50 patients (31 men and 19 women, ranging in age from 49 to 89 years) undergoing definitive below-knee amputation for ischemia from May 1971 to May 1979 were reviewed. Forty-three (86%) had ulceration or necrosis involving the foot or toes. Seven had rest pain without tissue loss. Overall healing rate was 86%. Seven patients (14%) failed to heal and required reamputation above the knee; the functional status of the remaining 43 patients was graded preoperatively and at the time of late follow-up (mean, 3.4 years). Twenty-five of 35 (71%) unilateral below-knee amputees could walk with a prosthesis; ten could not. Seventeen patients (34%) either required an additional, higher amputation or did not use the knee joint to increase mobility. The patient with marginal circulation and marked preoperative functional limitations may have the above-knee level as the chosen site for amputation.

(Arch Surg 115:1184-1187, 1980)

Author Affiliations
From the Departments of Surgery (Drs Castronuovo, Deane, Deterling, O'Donnell, and Callow) and Rehabilitation Medicine (Dr O'Toole), New England Medical Center Hospital, Tufts University School of Medicine, Boston.

Footnotes
Accepted for publication June 19, 1980.

Read before the sixth annual meeting of the New England Society for Vascular Surgery, Waterville Valley, NH, Sept 27, 1979.

Reprint requests to Department of Surgery, New England Medical Center Hospital, 171 Harrison Ave, Boston, MA 02111 (Dr Deterling).

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