Background: Through-knee amputation (TKA) is often overlooked in favor of transfemoral amputations (TFAs) despite potential benefits. Evidence is limited regarding functional outcomes. This study aimed to evaluate functional, clinical, and patient-reported outcomes in patients undergoing TKA at a single UK center over 10 years. Methods: A retrospective service evaluation was conducted in a tertiary Vascular Surgery unit in the UK. Adults undergoing a TKA between 2015 and 2025 with ≥6 months follow-up were included. Demographic and perioperative data, including comorbidities, indication, and complications, were extracted from electronic records. Long-term outcomes, including survival, mobility, quality of life, and prosthesis use and patient feedback, were obtained through follow-up questionnaires. Results: Twenty-seven patients underwent TKA during the study period. The mean age was 65 years, and the median follow-up was 29 months. Ulcers and infection were the commonest indications. Complications included surgical site infections in five patients (19%) and six (22%) required revision to TFA. At follow-up, 80% of patients were living at home, 60% required a carer, and 30% reported regular prosthesis use. Special Interest Group in Amputee Medicine grades ranged from A to Db, indicating limited prosthetic mobility. The mean EuroQol 5 domain questionnaire overall health score was 54, reflecting a moderate level of perceived health. Conclusion: This service evaluation highlights the need to select patients likely to walk on a prosthesis and who would be able to tolerate a reintervention if TKA failed. Future work should explore patient’s perceptions of these risks and their priorities when choosing TKA over TFA to better guide shared decision-making.
Gbolaru et al. (Thu,) studied this question.