Levels
| Level | Features |
|---|---|
| Transtibial | Preferred level when viable. Long posterior myocutaneous flap (Burgess). Bevel the anterior tibia and cut the fibula shorter |
| Knee disarticulation | End bearing stump with a long lever. Useful in children as the distal femoral physis is preserved |
| Transfemoral | Adductor myodesis to the femur (Gottschalk) keeps the femur adducted |
Indications
- Peripheral vascular disease and diabetes cause most lower limb amputations in Australia
- Unreconstructable trauma
- Tumour
- Infection and failed limb salvage
Principles
- Energy cost of walking rises the more proximal the level
- Preserve as much length as healthy tissue allows
- Cut nerves sharply under tension so they retract
- Avoid flexion contracture, which hinders prosthetic fitting
- Transtibial bone cut about 12 to 15 cm below the knee joint line
- Myodesis or myoplasty stabilises muscles and improves control
- Rigid dressing reduces oedema and prevents knee flexion contracture
- Knee disarticulation avoids terminal overgrowth in children
Rehabilitation
- Early mobilisation and stump shaping with compression
- Prosthetic fitting at about 6 to 8 weeks once the wound has healed
- Energy cost of walking rises by about 25% with a unilateral transtibial and about 65% with a transfemoral amputation
- Phantom sensation is almost universal and phantom pain is common
Related Pages
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.