The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues.
Step 1: Preoperative Planning
As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure.
Step 2: Flap Design
Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure.
Step 3: Soft-Tissue Dissection
Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain.
Step 4: Distal Femoral and Patellar Cuts
Use a high-speed saw to transect the femur and patella.
Step 5: Posterior Dissection
Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures.
Step 6: Patellofemoral Arthrodesis
Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture.
Step 7: Soft-Tissue Closure
Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion.
Step 8: Postoperative Management
Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes.
The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium.
What to Watch For
Pitfalls & Challenges