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Below-the-Knee Amputation

Authors:
  • Cynthia M. Johnson, MA
Publication Type:

Procedure

Below-the-Knee Amputation

(Amputation, Below-the-Knee; BKA)

Definition

A below-the-knee amputation (BKA) is the surgical removal of the leg below the knee.

Reasons for Procedure

An amputation may be done for:

  • Poor blood flow that cannot be fixed
  • Severe infection
  • Trauma or injury
  • Tumors
  • Problems at birth, such as a limb that has not formed properly

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Excessive bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Infection
  • Blood clots
  • Skin breakdown and swelling of the remaining limb
  • Poor healing that may result in more amputation
  • Feeling pain in the amputated limb or feeling that it is still there

Things that may raise the risk of problems are:

  • Smoking
  • Drinking excess alcohol
  • Chronic diseases, such as diabetes or obesity

What to Expect

Problems to Look Out For

Call the doctor if you are not getting better or you have:

  • Signs of infection, such as fever or chills
  • Redness, swelling, increased pain at the wound
  • Increased bleeding or other leakage from the wound
  • Pain that you cannot control with medicine
  • Nausea or vomiting that is severe or that lasts a long time
  • Feelings of depression
  • Cough, shortness of breath, or chest pain
  • New or unexpected symptoms

If you think you have an emergency, call for medical help right away.

Prior to Procedure

The surgical team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Arranging for a ride to and from surgery
  • Tests that will need to be done before surgery, such as images

Prior to Procedure

The surgical team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Arranging for a ride to and from surgery
  • Tests that will need to be done before surgery, such as images

Anesthesia

The doctor may give:

Description of Procedure

A cut will be made in the skin below the knee. The muscles will be divided and the blood vessels clamped. A special saw is used to cut through the bone. The muscles are then sewn and shaped. It will form a stump that will cushion the bone. Nerves are divided and placed so they do not cause pain. The skin is closed over the muscles. Drains may be inserted into the stump. It will allow blood and fluids to drain from the area in the first few days after surgery. A bandage and compression stocking will be placed over the stump.

Below-the-Knee Amputation.

A cut is made below the knee.

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How Long Will It Take?

It may take many hours. It depends on the reason for the surgery.

Will It Hurt?

Pain and swelling are common in the first month. Medicine and home care can manage pain.

Average Hospital Stay

The usual length of stay is 5 to 14 days. If you have any problems, you may need to stay longer.

Post-procedure Care

At the Hospital

Right after the procedure, the staff may:

  • Give you pain medicine
  • Give you medicine to prevent blood clots
  • Raise the leg to ease swelling
  • Apply ice to the area

Physical therapy will be started soon after surgery. The care team will teach you how to use any assistive devices.

Preventing Infection

During your stay, staff will take steps to lower your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your wounds covered

You can also lower your chance of infection by:

  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Not letting others touch your wounds

At Home

It will take 1 to 2 months for the remaining limb to heal. Physical activity will be limited during this time. You may need to ask for help with daily activities and delay your return to work. You will need to learn new ways to do daily tasks. This may take up to a year.

RESOURCES:

CANADIAN RESOURCES:

CANADIAN RESOURCES:

References

  • Amputation. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/physical_medicine_and_rehabilitation/amputation_85,P01141.
  • Amputation. Society for Vascular Surgery website. Available at: https://vascular.org/patient-resources/vascular-treatments/amputation. Accessed September 28, 2020.
  • Management of acute and critical limb ischemia. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/management-of-acute-and-critical-limb-ischemia.

Contributors

  • Warren A. Bodine, DO, CAQSM
Last Updated:
2023-03-01

(C) Copyright 2023 EBSCO Information Services

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.