(Amputation, Below-the-Knee; BKA)
A below-the-knee amputation (BKA) is the surgical removal of the leg below the knee.
Reasons for Procedure
An amputation below the knee may be done because of:
- Poor blood flow that cannot be fixed
- Trauma or injury
- Severe infection
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Poor healing of the amputation site that may require a higher level amputation
- Skin breakdown at the residual limb
- Decreased range of motion in the hip or knee
- Phantom sensation —feeling that the amputated limb is still there
- Phantom pain —feeling pain in the amputation area
- Stump swelling
- Reaction to anesthesia
- Heart attack
- Blood clots
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
What to Expect
Prior to Procedure
Your doctor may do the following before your procedure:
- Physical exam
- Blood tests
- Imaging tests, such as x-rays or scans
- Have you donate blood in case you need a transfusion
- Prescribe antibiotics to prevent infection
Before surgery, you will need to:
- Arrange for a ride home.
- Arrange for help at home while you recover.
- Ask your doctor about devices you will need after the surgery, such as an artificial limb, walker , crutches , and/or wheelchair .
Talk to your doctor about any medications, herbs, or supplements you are taking. You may need to stop taking some medications up to 1 week before the procedure.
Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
You may be given either:
Description of Procedure
A cut will be made in the skin below the knee. The muscles will be separated and blood vessels clamped. A special saw will be used to cut through the bone. The muscles will be sewn and shaped so that a stump is formed to cushion the bone. Nerves will be separated and placed so that they do not cause pain. Blood vessels will be tied off. The skin will be closed over the muscles, forming the stump. Drains may be inserted into the stump to drain blood for the first few days. A dressing and compression stocking will be placed over the stump.
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
The usual length of stay is 5-14 days. It is possible that you may have to stay longer if complications arise. You may also go to a rehabilitation hospital to help you recover.
At the Hospital
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
- Pain medications
- Antibiotics to prevent infection
- Medication to prevent blood clots
Physical therapy often starts within 24 hours after your surgery. During this time you may need devices to help you walk.
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
- Washing your hands often and reminding your healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
When you return home, take these steps:
- Continue with your physical therapist’s exercise program.
- Be sure to follow your doctor's instructions.
Adjusting to an amputation may be difficult and can lead to depression. Consider talking to a therapist or psychologist.
Call Your Doctor
Call your doctor if any of these occur:
- Increased swelling in the residual limb
- Poorly fitting prosthesis
- Pain that can't be controlled with the medication you've been given
- Signs of infection, such as fever or chills
- Increasing redness, swelling, increasing pain, excess bleeding, or discharge from the incision site
- Persistent nausea or vomiting
- Increased symptoms of depression
- New or persistent cough, shortness of breath, or chest pain
- Joint pain, fatigue, stiffness, rash, or other new symptoms
If you think you have an emergency, call for emergency medical services right away.
American Diabetes Association
Amputee Coalition of America
Canadian Diabetes Association
Amputation. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/physical_medicine_and_rehabilitation/amputation_85,P01141. Accessed December 5, 2014.
Amputation. Society for Vascular Surgery website. Available at: http://www.vascularweb.org/vascularhealth/Pages/amputation.aspx. Updated February 2011. Accessed December 5, 2014.
Amputation procedure. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/amputation_procedure_92,P08292. Accessed December 5, 2014.
Management of critical limb ischemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 16, 2014. Accessed December 5, 2014.
Last reviewed December 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.