Above-knee amputation: surgery, recovery, prosthetics and living with limb loss

An amputation is the surgical removal of part of the body, such as an arm or leg, as the NHS puts it. In an above-knee amputation, sometimes called a transfemoral amputation, the leg is removed through the thigh bone (femur), so the knee joint and everything below it are lost. This differs from a below-knee amputation, where the knee is kept. The level chosen depends on how far the disease or injury extends, on the blood supply to the tissues and on what is likely to give the best chance of healing and mobility.

The NHS describes how surgeons typically work: most amputations remove a section of the limb rather than the whole limb, and additional techniques may be used afterwards to improve the function of the remaining part and to reduce the risk of complications. These include shortening and smoothing the bone so that it is covered by enough soft tissue and muscle, and stitching the muscle to the bone to strengthen the remaining section (myodesis).

Reasons for amputation listed by the NHS include severe infection, gangrene often linked to peripheral arterial disease, complications from diabetes, serious trauma, and deformity with limited movement and function. A higher amputation is more likely when disease or poor circulation reaches further up the limb, or when tissue lower down is unlikely to heal. The surgical team will explain why this level has been recommended in your own case.

It is important to ask questions. Being told that a limb needs to be amputated can be devastating and frightening, as the NHS acknowledges. If the operation is planned, you may be able to talk to someone who has had a similar amputation, which the NHS says a member of your care team may be able to arrange.

Unless you need an emergency amputation, you will be fully assessed before the operation. The NHS says this is likely to include a medical examination to check your heart, blood vessels and lungs, a check of the condition and function of your other leg, and possibly a psychological assessment to see how well you will cope and whether you need more support. There may also be an assessment of your home, work and social environment to see what changes could help.

You may be introduced to a physiotherapist who will be involved in your recovery, and to a prosthetist, a specialist in artificial limbs, who can talk about the options. Anaesthesia may be general, or an epidural or spinal anaesthetic that numbs the lower half of the body, with the choice depending on the part of the body involved.

After surgery the NHS says you may be given oxygen through a mask and fluids through a drip for the first few days on the ward, and a catheter may be in place to drain urine so you do not have to get up to use the toilet. The wound is sealed with stitches and covered with a bandage, and a tube may be placed under the skin to drain excess fluid. Painkillers are available, and you should tell your team if they are not working because you may need a larger dose or a stronger medicine.

The NHS notes that swelling (oedema) of the stump after surgery is normal and may continue after discharge. A compression garment, fitted once the wound has healed, helps with swelling and the shape of the stump and may reduce phantom pain. You should be given at least two garments, to be worn every day and taken off at bedtime.

Physiotherapists teach exercises to prevent blood clots and improve blood supply. The NHS says that after a leg amputation you are encouraged to move around as soon as possible using a wheelchair and are taught transfer techniques, such as getting from the bed into the wheelchair. An occupational therapist may visit your home before discharge to see whether adaptations such as a ramp or stairlift are needed.

Not everyone is fitted with a prosthetic leg. The NHS and NHS inform say it depends on factors including your general health, the strength in the remaining part of the limb and the tasks the limb will need to perform. Walking with an artificial leg uses considerably more energy, and frail people or those with serious heart disease may not be suitable. A cosmetic limb that looks like a real limb but cannot be used for walking may be recommended instead.

If a prosthesis is suitable, preparation starts in hospital. Skin desensitisation, using gentle tapping with a face cloth, compression bandages and massage of the skin around the bone, helps the stump tolerate a socket. NHS inform says it can take several months before the first appointment with a prosthetist. When one is fitted, a physiotherapist teaches you how to use it, such as how to walk on a prosthetic leg.

Looking after the skin of the stump matters. The NHS advises washing it gently at least once a day with mild unscented soap and warm water, drying it carefully, avoiding long soaks in water, and using an unscented moisturiser if it is dry. Check it daily for warm, red, tender skin, discharge of fluid or pus, or increasing swelling, and contact your care team if you suspect infection.

Many people experience stump pain or phantom limb pain. Stump pain can come from rubbing or sores, nerve damage during surgery and neuromas, while phantom sensations seem to come from the missing limb and can range from brief flashes to constant severe pain. The NHS says it usually improves over time and lists medicines such as NSAIDs, nerve pain medicines, antidepressants used for nerve pain, opioids and injections, plus measures such as adjusting prosthesis fit, massage, TENS, mental imagery and mirror therapy.

The NHS says the loss of a limb can have a considerable psychological impact because of loss of sensation, loss of function and changes to body image. Depression, anxiety, grief and denial are common, and post-traumatic stress disorder is more likely after a traumatic amputation. It stresses that you should talk to your care team about your thoughts and feelings, particularly if you feel depressed or suicidal, and that antidepressants or counselling may help.

Many people enjoy a good quality of life once they have adapted, and charities including the Limbless Association, the Douglas Bader Foundation, Steel Bones and Blesma are named by the NHS as sources of advice. Caring for the remaining leg is also vital: the NHS recommends well-fitting footwear and regular review by a podiatrist or foot care team, especially if diabetes was the reason for amputation.

The NHS lists complications of amputation that include heart problems such as a heart attack, deep vein thrombosis, slow wound healing or wound infection, pneumonia, and stump and phantom limb pain. The risk is influenced by your age, the type of amputation and your general health. Further surgery is sometimes needed, for example to deal with a neuroma.

Seek advice from your care team or GP if the stump looks infected, if pain is uncontrolled, or if you are low in mood. Call 999 in an emergency such as chest pain, severe breathlessness or heavy bleeding from the wound.