Objectives: Through knee amputation (TKA) is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a TKA approach. This paper seeks to: (1) Determine the number of TKAs performed compared with other major lower limb amputations (MLLA) in England over the past decade; (2) identify the theoretical concepts behind TKA surgical approaches and their potential effect on functional and clinical outcomes; and (3) provide a platform for discussion and research on TKA and surgical outcomes.
Methods: National Health Service Hospital Episodes Statistics were used to obtain recent numbers of MLLAs in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on TKA surgery.
Results: In the past decade, 4.6% of MLLA in England were TKAs. Twenty-six articles presenting TKA surgical techniques met our criteria. These articles detailed three TKA surgical techniques; the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape; and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur.
Conclusions: TKA has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional, and biomechanical outcomes of TKA frequently fail to distinguish between the 3 distinct and differing approaches, making direct comparisons difficult. Future studies that compare TKA approaches to one another and to other amputation levels are needed.