Objectives: 

The objective of this study was to survey a broad group of prosthetists on their experience with amputees with knee disarticulation (KD) and transfemoral amputation (TFA) to determine their preference of amputation level, opinions on patient preference, and common problematic issues to guide decision-making for patients and surgeons faced with the decision of a high-level lower extremity amputation.

Design: 

This is a survey-based study.

Intervention: 

A blinded electronic mail survey was completed by 102 prosthetists.

Main Outcome Measurements: 

Each prosthetist was asked (1) what amputation level (KD or TFA) do they prefer and why and (2) which amputation level do they believe patients prefer and why

Results: 

There was no consensus among prosthetists regarding amputation level preference. Fifty-four (53%) prosthetists preferred KD and 48 (47%) preferred TFA. Fifty-five (54%) prosthetists believed patients preferred TFA and 47 (46%) believed patients preferred KD. Amputation level preference often depended on age, functional goals, and concerns with cosmesis. The most common benefits given for KD over TFA included distal-end weight-bearing (n = 53), a lower subischial socket (n = 43), and better function (n = 30). The most common disadvantages given for KD over TFA included component limitations due to space available below amputation (n = 56), poor cosmesis (n = 49), an asymmetrical knee axis (n = 42), and difficulties with sitting/standing (n = 13).

Conclusion: 

No consensus exists between prosthetists regarding preference for KD versus TFA. The advantages and disadvantages of KD reported in this study, along with the associated decision tree, can be used for future counseling of patient's faced with high-level lower extremity amputations.

中文翻译：

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膝关节离断与经股截肢：修复师的观点

目标： 

本研究的目的是调查一组广泛的假肢医生对膝关节离断 (KD) 和经股截肢 (TFA) 截肢患者的经验，以确定他们对截肢水平的偏好、对患者偏好的看法以及指导决策的常见问题- 为面临高水平下肢截肢决定的患者和外科医生提供帮助。

设计： 

这是一项基于调查的研究。

干涉： 

102 名修复师完成了一项不知情的电子邮件调查。

主要成果测量： 

每位假肢师都被问及（1）他们更喜欢哪种截肢水平（KD 或 TFA）以及为什么；（2）他们认为患者更喜欢哪种截肢水平以及为什么

结果： 

假肢专家对截肢水平的偏好没有达成共识。54 名 (53%) 的修复师更喜欢 KD，48 名 (47%) 更喜欢 TFA。55 名 (54%) 的修复师认为患者更喜欢 TFA，47 名 (46%) 认为患者更喜欢 KD。截肢水平偏好通常取决于年龄、功能目标和对美容的关注。与 TFA 相比，KD 最常见的益处包括远端负重（n = 53）、坐骨下窝更低（n = 43）和更好的功能（n = 30）。与 TFA 相比，KD 最常见的缺点包括由于截肢下方可用空间（n = 56）、美容效果差（n = 49）、膝关节轴不对称（n = 42）以及坐/站困难（n = 13)。

结论： 

对于 KD 与 TFA的偏好，修复师之间没有达成共识。本研究报告的 KD 的优缺点，以及相关的决策树，可用于未来高水平下肢截肢患者的咨询。