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Amputation - Above Knee

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Overview


Q. What is it?

There is not enough blood getting down your leg to keep it alive. The lack of blood causes severe pain and allows serious infection to take hold. If left untreated, the leg will eventually get necrotic (will become dead) and become life threatening. The only choice is to remove the damaged part. This must be done high enough up the leg to an area that has a good blood supply to get proper healing of the stump. In your case it means an amputation through the thigh.

Types of amputation include : -


  1. leg
    • amputation of digits
    • partial foot amputation (Chopart, Lisfranc, Ray)
    • ankle disarticulation (Syme,[1] Pyrogoff)
    • below-knee amputation (transtibial e.g. Burgess, Kingsley Robinson)
    • knee-bearing amputation (knee disarticulation, e.g. Gritti or Gritti-Stokes)
    • above knee amputation (transfemoral)
    • Van-ness rotation/rotationplasty (Foot being turned around and reattached to allow the ankle joint to be used as a knee.)
    • hip disarticulation
    • hemipelvectomy/hindquarter amputation
  2. arm
    • amputation of digits
    • metacarpal amputation
    • wrist disarticulation
    • forearm amputation (transradial)
    • elbow disarticulation
    • above-elbow amputation (transhumeral)
    • shoulder disarticulation and forequarter amputation
    • Krukenberg procedure
  3. teeth

The avulsion of some teeth (mainly incisives) is or was practiced by some cultures for ritual purposes (for instance in the Iberomaurusian culture of Neolithic North Africa).


Symptoms

Amputation of a limb or limbs will affect people in different ways. It is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss. Physically your body will be permanently altered and can affect all areas of your life. How much your amputation affects your life will to some degree depend on the extent of your physical recovery.

There are virtually no activities that a person with an amputation cannot perform with the right help, training and equipment. However, the most important rehabilitation objective for the majority of elderly patients with a lower limb amputation is to walk again. It is important to remember that rehabilitation from an amputation in an elderly person is a much more difficult process than in a young person. Regaining the ability to walk will be a major achievement.

Whether or not a patient will be able to walk following an amputation has been studied by looking at factors present before surgery. Poor pre-operative mobility, age over 70 years, dementia, severe kidney and heart disease are factors which make it unlikely a patient will walk after their amputation


Reasons for amputation

  • Circulatory disorders
  • Neoplasm
  • Trauma
  • Deformities
  • Infection


Treatment

You will probably have a general anaesthetic, and will be asleep for the whole operation. Sometimes patients are numbed from the waist down with an injection in the back. In this case you will be awake, you might feel that 'something is happening' in you leg, but you will not feel any pain from the waist down.

A cut is made so that after removing the diseased part, you end up with a rounded stump made of healthy skin. You should plan to be in the hospital for up to six weeks to cover any delay in healing of the wound. You may well be out before this.

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Risks

There are always risks with surgery. You may bleed more than usual, get an infection, have trouble breathing, or get blood clots. Sometimes bleeding may cause a collection of blood called a hematoma. This may need to be drained to prevent infection. It may be difficult for your wound to heal. Your caregivers will watch you closely for these problems. Some people continue to feel the part of their leg that has been amputated. These are called phantom feelings.

These feelings are normal and may or may not be painful. If you do not have surgery, your problem could get worse. If you have cancer or a badly infected leg and do not get treatment, with time you could die. Call your caregiver if you are worried or have questions about your medicine or care.

If you are elderly and have hardening of the arteries. In this group of patients the chances of dying in hospital after a major amputation are somewhere between 10% and 20%. In other words between 1 in 10 and 1 in 5 patients, undergoing a major amputation for hardening of the arteries, will die in hospital. This is why amputation is always a last resort and your surgeon will not advise you to undergo this operation unless it is absolutely necessary. Remember these statistics also mean that 4 out of 5 patients undergoing an amputation will do well.

If you are younger and healthy and undergo amputation because of an injury or a tumour, the risks of an amputation are usually much less.


Complications of amputation surgery

The most important complication is the risk of dying. However, there are other complications.


General complications : -

These mainly consist of problems such as chest infections, angina, heart attacks and strokes. Because your mobility is restricted after an amputation, pressure sores can also develop. The nursing staff particularly will make great efforts to avoid this occurring. Special mattresses and beds are used to reduce pressure on areas at risk of sores. Regular turning to relieve pressure is also important.


Local complications : -

These mainly consist of wound infections that can develop in the stump. Antibiotics are given to reduce the risk of infection developing at the time of surgery. The stump can sometimes fail to heal or breakdown either as a result of a fall, infection or a poor blood supply. When this happens it can sometimes mean a further operation to revise the amputation or to remove more of the leg.

Sometimes contractures can develop in the knee or hip joint and once present and established can be impossible to correct. The knee or hip will not straighten and then fitting an artificial limb can become impossible. Deep venous thrombosis can also occur because the veins in the leg will have been tied during the amputation operation and because of the immobility after the surgery. Blood thinners (heparin) will usually be given to reduce the risk of blood clots developing.


Phantom Limb pain

Phantom limb is the sensation of still being able to feel the amputated limb. Most amputees experience this sensation, although the intensity can vary from person to person.

In many patients pain is also experienced in the amputated limb. This is phantom limb pain and can occur in many patients, but is usually fairly mild and self limiting, although it may be a nuisance. In a few patients phantom limb pain can be a serious problem and difficult to treat.

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FAQs

Q. Is it possible to walk after an amputation ?

Yes, it is possible to walk after an amputation. How easy it will be to walk depends on a number of factors. For instance it is generally easier to walk with an artificial leg (prosthesis) after a below knee amputation. If you were able to walk normally before your amputation and do not have other illnesses such as angina or breathing difficulties this will also make it more likely you will walk after your amputation.

Some studies have shown that in elderly patients undergoing major amputation (below or above knee) for hardening of the arteries, over half the patients fitted with an artificial leg never used it effectively, especially if rehabilitation was delayed for longer than two months after the amputation. It can take between 6 and 12 months for full rehabilitation potential to be reached. Most patients undergoing minor amputation will be able to walk virtually normally after surgery


Q. How will having an amputation affect me ?

Amputation of a limb or limbs will affect people in different ways. It is a very personal loss and in many patients can feel like a bereavement. The emotional loss can be like losing a relative and it will take time to adapt to such a loss. Physically your body will be permanently altered and can affect all areas of your life. How much your amputation affects your life will to some degree depend on the extent of your physical recovery.

There are virtually no activities that a person with an amputation cannot perform with the right help, training and equipment. However, the most important rehabilitation objective for the majority of elderly patients with a lower limb amputation is to walk again. It is important to remember that rehabilitation from an amputation in an elderly person is a much more difficult process than in a young person. Regaining the ability to walk will be a major achievement.

Whether or not a patient will be able to walk following an amputation has been studied by looking at factors present before surgery. Poor pre-operative mobility, age over 70 years, dementia, severe kidney and heart disease are factors which make it unlikely a patient will walk after their amputation



The list of of General Surgery Hospitals in India is as follows : -


Apollo Hospitals Bangalore Apollo Hospitals, Bangalore, India
Apollo Hospital Chennai Apollo Hospital, Chennai, India
Apollo Hospitals Hyderabad Apollo Hospitals, Hyderabad, India
Apollo Hospitals Delhi Indraprastha Apollo Hospital, Delhi, India
Apollo Hospitals Kolkata Apollo Gleneagles Hospital, Kolkata, India
Apollo Hospital, Goa, India Apollo Hospital, Goa, India
Wockhardt Hospital Bangalore India Wockhardt Hospital, Bangalore India
Wockhardt Hospital hyderabad, India Wockhardt Hospital, hyderabad, India
Wockhardt Hospital Mumbai, India Wockhardt Hospital, Mumbai, India
Wockhardt Hospital and Kidney Institute, Kolkata, India Wockhardt Hospital and Kidney Institute, Kolkata, India
Fortis Hospital, Delhi, India Fortis Hospital, Delhi, India
Fortis Hospital Mohali, India Fortis Hospital, Mohali, India
Fortis Hospital Noida, India Fortis Hospital, Noida, India
Manipal Hospital, Bangalore, India Manipal Hospital, Bangalore, India
MIOT Hospital, Chennai, India MIOT Hospital, Chennai, India
Sparsh Hospital, Bangalore, India Sparsh Hospital, Bangalore, India
Narayana Cancer Hospital, Bangalore, India Narayana Cancer Hospital, Bangalore, India
Artemis Hospital, Gurgaon ( Delhi ) , India Artemis Hospital, Gurgaon ( Delhi ) , India
Max Super Specialty hospital,  Delhi, India Max Super Specialty hospital, Delhi, India
BGS Global Hospital Bangalore, India BGS Global Hospital, Bangalore, India
BGS Global Hospital Chennai, India BGS Global Hospital, Chennai, India
BGS Global Hospital Hyderabad, India BGS Global Hospital, Hyderabad, India


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