Knee-disarticulation Amputation "

n r rarlons ~e~ow-mlgh level and proxlnial to nee-aisarticu~anon :I inclu,, .ill the transcondylar procedures such as the Gritti Stokes (1,2) ---d Callender (3,4) procedures and are not considered in this contribution. In my view they are largely undesirable because they provide little end bearing, may not leave sufficient space for the inclusion of assistive devices in the prosthetic knee, and are perhaps better replaced by a long myoplasty amputation. The Gritti Stokes procedure in particular often gives rise to a number of complications most of these being due to the retention of the patella. Recent contributions suggest this operation is excellent at least in terms of wound healing. Unfortunately, it has persuaded a number of surgeons to employ the procedure for this reason alone. We are concerned in this contribution with the through-knee amputation or knee disarticulation. At the outset I should say that there seems to me very little validity in an argument about the relative merits of operative procedures at different levels of limb ablation except in the individual case. On this basis it will be assumed that an amputation can properly be done below-thigh level but for one reason or another cannot be done at below-knee level The knee-disarticulation operation has a long history of use extending back to the sixteenth century if not before (5,6,7,8). Like many surgical procedures its popularity has waxed and waned with changing surgical fashion and in this particular case with the prosthetic practice of the day. I believe the procedure has a stated place in our surgical armamentarium. In the first place it has a particular application during the growth period as it preserves the distal femoral epiphysis and thus the capacity for 80-90 percent of femoral growth. In this way we obtain a stump of maximum length when skeletal maturity is reached yet somewhat shorter than the