Exploring UK clinician perceptions of through-knee amputation compared to above-knee amputation: a mixed methods study.

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 rehabilitationThrough-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.