Functional outcome after redo below-knee amputation.

Abstract

Nonhealing below-knee amputation (BKA) necessitates redo BKA or conversion to above-knee amputation (AKA). Outcomes after redo BKA remain poorly defined. We hypothesized that in selected patients redo BKA results in favorable functional outcomes. Patients undergoing redo BKA at a single institution during 4 years were reviewed. A concurrent cohort proceeding directly to ipsilateral AKA served as comparative controls. Of 138 BKAs, 23 (17%) failed to heal primarily. Baseline demographics and medical comorbidities were similar between groups. Clinicians selected 14 for redo BKA and 9 for ipsilateral AKA. Eight (57%) of those undergoing redo BKA had a history of minor stump trauma and 13 (93%) had a palpable popliteal pulse, compared with no trauma (P = 0.007) and 4 (44%, P = 0.018) palpable popliteal pulses in the AKA group. Functionally, 86% of redo-BKA patients returned home, all eventually healed, and 86% walked, whereas none in the AKA group walked. In selected patients, redo BKA yields excellent functional outcomes. A history of minor stump trauma and a palpable popliteal pulse favor redo BKA compared with conversion to AKA.