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Clinical and confidence outcomes following through-knee versus above-knee amputation : a quantitative study

Boam, Gemma Louise


Gemma Louise Boam



Following surgery, patients with a major lower limb amputation face physical and mental health challenges. For clinicians and physiotherapists to reach a consensus and provide a suitable level of amputation for each patient, the understanding of post-operative outcomes based on varied levels of amputation must be established. The scientific literature has reported extensively on the clinical, biomechanical and rehabilitation outcomes of patients with an above-knee amputation (AKA). Many patients who receive an AKA may not have been considered for a through-knee amputation (TKA). Reported benefits of a TKA include an end weight-bearing residual limb, longer mechanical lever arm, which may be important for sitting balance and when mobilising with a prosthesis. However, patients are not considered for a TKA due to the historical association with poor wound healing. The aim of this thesis was to investigate and compare clinical and rehabilitation outcomes between patients with a TKA and patients with an AKA.
The first study was a systematic review and meta-analysis, thus aiming to compare the functional outcomes and balance confidence of patients with a TKA versus (vs.) AKA during activities of daily living. Existing literature suggested that patients with a TKA had a significantly increased walking distance during the six-minute walk test (6MWT).
The second overarching study aimed to perform a large-scale retrospective analysis of a case control series using data held within the NVR database, to determine the differences in clinical and post-operative outcomes between patients with a unilateral TKA and patients with a unilateral AKA. We found that TKA was more commonly performed in patients with diabetes, and is significantly associated with more elective admissions, fewer post-operative complications, and a lower mortality rate compared with AKA. Further, patients with a unilateral TKA had similar levels of successful wound healing as AKA patients, despite previous literature reporting of poor wound healing. Significantly more patients with a TKA were referred to amputation rehabilitation.
The aim of the final study was to compare the differences in ambulatory and non-ambulatory patients with a TKA and patients with an AKA, and to compare their balance confidence and falls history. Findings from this thesis indicated no differences between TKA and AKA when performing the six-minute walk test (6MWT), functional tests and self-reported balance confidence during daily tasks.


Boam, G. L. (2023). Clinical and confidence outcomes following through-knee versus above-knee amputation : a quantitative study. (Thesis). University of Hull and University of York. Retrieved from

Thesis Type Thesis
Deposit Date Mar 1, 2024
Publicly Available Date Mar 1, 2024
Keywords Through-knee amputation; Above-knee amputation; Gait; Clinical
Public URL
Additional Information Hull York Medical School
University of Hull and University of York
Award Date Jan 1, 2023


Thesis (4 Mb)

Copyright Statement
© 2023 Gemma Louise Boam. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

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