Hayley Gordon
Exploring UK clinician perceptions of through-knee amputation compared to above-knee amputation: a mixed methods study
Gordon, Hayley; Boam, Gemma; Carradice, Dan; Smith, George E.; Twiddy, Maureen
Authors
Gemma Boam
Professor Daniel Carradice D.Carradice@hull.ac.uk
Senior Lecturer in Vascular and Endovascular Surgery
Mr George Smith George.Smith@hull.ac.uk
Senior Lecturer
Dr Maureen Twiddy M.Twiddy@hull.ac.uk
Reader in Mixed Methods Research
Abstract
Background: Through-knee amputation (TKA) has potential advantages over above-knee amputation (AKA) but is rarely performed in the United Kingdom (UK). This mixed methods study aimed to explore clinicians’ perceptions of TKA compared to AKA. Method: An online survey of vascular surgeons, prosthetists, and physiotherapists between May 2019 and April 2020. Follow-up semi-structured interviews explored themes from the survey. Thematic analysis was used to draw conclusions from the data. Results: Seventy-eight clinicians returned surveys, and follow-up interviews were completed with 21 clinicians. Reported advantages of TKA include its long lever and the femoral condyles to anchor (suspend) the prosthesis. Perceived disadvantages include poor wound healing and unsatisfactory prosthetic appearance. The interviews uncovered ineffective communication along the amputation pathway, contributing to a compartmentalised approach to amputation surgery and rehabilitation. Clinicians with strong feelings against TKA and a lack of desire/perceived ability to drive change from clinicians in favour of TKA are barriers to increasing its use. Conclusion: Current TKA surgery and rehabilitation practice is based on personal opinions, assumptions, or “accepted wisdom” and lacks an underpinning evidence base. Overall, opinions of TKA are divided, with conflicting views between different professional groups, highlighting the importance of multidisciplinary decision-making.Implications for rehabilitation Through-knee amputation has advantages and disadvantages compared to above-knee amputation which have been observed in clinical practice. Decision regarding level of amputation should involve multiple members of the multidisciplinary team. Lack of amputation pathway guidance and communication barriers prevent effective multidisciplinary collaboration.
Citation
Gordon, H., Boam, G., Carradice, D., Smith, G. E., & Twiddy, M. (online). Exploring UK clinician perceptions of through-knee amputation compared to above-knee amputation: a mixed methods study. Disability and Rehabilitation, https://doi.org/10.1080/09638288.2024.2441423
| Journal Article Type | Article |
|---|---|
| Acceptance Date | Dec 8, 2024 |
| Online Publication Date | Dec 27, 2024 |
| Deposit Date | Apr 8, 2025 |
| Publicly Available Date | Apr 10, 2025 |
| Journal | Disability and Rehabilitation |
| Print ISSN | 0963-8288 |
| Publisher | Taylor and Francis |
| Peer Reviewed | Peer Reviewed |
| DOI | https://doi.org/10.1080/09638288.2024.2441423 |
| Keywords | Through-knee amputation; Above-knee amputation; Vascular surgeon; Physiotherapist; Prosthetist |
| Public URL | https://hull-repository.worktribe.com/output/5003225 |
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Copyright Statement
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
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