Amputations about the Knee

BKA / Below Knee Amputation / Transtibial


Best results

- long posterior musculocutaneous flap 

- well cushioned mobile muscle mass

- full thickness skin

- very anterior scar



- non-ambulator

- get FFD

- better with through knee amputation


Advantages over AKA 


1.  Good Healing 

Scarf Osteotomy



A.  Longitudinal Cut

- plantar proximal / dorsal distally

- ends up being parallel to sole

- leave strong plantar portion of head to prevent dorsiflexion

- mark centre of head

- distally to a point 2mm prox and 3mm above the centre of the head


B.  Transverse cuts

- plantar proximal / dorsal distal




Attempt to reduce outliers in all 3 planes of the knee

- improve alignment

- theoretically improve survival and outcomes


TKR Valgus Femoral Implant Non Navigated




Image based


Pre-op CT

- uncommon

- resource heavy






- resect 30%

- increases contact pressures 3.5 x

- shock absorbing capacity reduced to 20% normal


Results of partial & total meniscectomy are very poor in children

- meniscectomy in children is a last resort

- repair amenable tears

- treat others non-operatively

- only real indication for meniscectomy is locked knee not amenable to repair


Meniscal Transplant



Subtotal Meniscectomy


Young patient

- previous total or near total meniscectomy

- developing joint line pain

- early chondral changes

- normal anatomic alignment

- stable or reconstructable knee




> Grade 2 Chondral changes


Farr et al Am J Sports Med 2007

- combined mensical transplantation with ACI

Conversion HTO to TKR



1.  Incision and skin flaps

- previous incision may be L shaped

- may be good to use a vertical midline incision initially in HTO

- can usually incorporate incision


2.  Removal of hardware

- may wish to consider staged procedure

- staples not usually a problem (can ignore)