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Above/Below the Knee Amputees

Author / Coordinator:  
Amputation: Knee
March 2007

Above-Knee Amputees

Amputations are caused by accidents, disease and congenital disorders. Approximately 74% are due to peripheral vascular disease (poor circulation of the blood) and cancer; 23% are due to accidents, and 3% are due to a problem found at birth.

The accidents most likely to result in amputation are traffic accidents, followed by farm and industrial accidents.

Amputations in the case of disease are performed as a lifesaving measure. The diseases that cause the most amputations are peripheral vascular disease (poor circulation of the blood) and cancer.

A congenital disorder or defect of a limb present at birth is not an amputation, but rather a lack of development of part or all of a limb. A person born with a limb deficiency usually can be helped by use of an artificial limb.

Sometimes amputation of part of a deformed limb or other surgery may be desirable before the application of an artificial limb.

There are more than 1.5 amputees per 1,000 people in the United States and Canada, and therefore more than 380,000 amputees in the U.S. at the present time. Above-knee (trans-femoral) amputees form the second largest group of amputees.

Surgeons preserve as much length in thigh amputations as is medically feasible because longer stumps provide better control over the prosthesis. Experienced surgeons avoid leaving unnecessary skin and muscle. Disarticulation at the knee preserves the entire thigh, and, in addition, permits "end-bearing,” or the ability of the stump to carry a substantial portion of the body weight over the end.

Below-Knee Amputees

Amputations are caused by:
· Accidents
· Disease
· Congenital Disorders

The accidents most likely to result in amputation are traffic accidents, followed by farm and industrial accidents.

Amputations in the case of disease are performed as a lifesaving measure. The diseases that cause the most amputations are peripheral vascular disease (poor circulation of the blood) and cancer

Congenital disorders or defective limbs present at birth are not amputations, but rather are a lack of part or all of a limb. A person with a limb deficiency can usually be helped by use of an artificial limb. Sometimes amputation of part of a deformed limb or some other type of surgery may be desirable before the application of an artificial limb.

The distribution of amputations by cause is shown below:
There are slightly more than 1.5 amputees per 1000 persons in the United States and Canada. Therefore, the present total in the United States is approximately 380,000. There are more "below-knee" (trans-tibial) amputees than any other type as can be seen from the chart below.

Surgeons preserve the knee joint whenever it is practical to do so and will fashion the stump at the lowest practical level. Very short stumps make fitting extremely difficult and very long below-knee stumps are prone to circulation problems.

The Syme’s amputation, which is essentially removal of the foot at the ankle, usually results in a stump that will bear a substantial part of the body weight over the end.

Distribution Site of Amputations
Arm-Shoulder- 1.0%
Arm- Above the elbow – 2.0%
Arm- Elbow – 0.2
Arm- Below elbow- 4.4%
Arm- Wrist -0.7%
Arm- Hand- 2.0%
Leg- Upper thigh – 32.5%
Leg- Knee- 0.7%
Leg- Below Knee- 55.2%
Leg-Ankle – 2.4

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