Introduction 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.
Results The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium.
What to Watch For Indications
Pitfalls & Challenges
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.
A retrospective review showed that patients with a Gritti-Stokes amputation, as compared with those with a transfemoral amputation, had increased limb length, improved patient-assessed outcomes, and an increased rate of unassisted walking while wearing the prosthesis1. This procedure establishes osseous continuity between the patella and the distal part of the femur remaining after transection, while maintaining the intact prepatellar soft tissues. The technique has several …
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