A client has just returned to a nursing unit after an above-knee amputation of the right leg.

Explanation

Core Concept: Following an above-knee amputation (AKA), the primary musculoskeletal risk is the development of a hip flexion contracture, which severely impairs future prosthetic fitting and ambulation. To prevent this, the residual limb must be kept in extension. Initially, the patient is placed supine with the amputated limb completely flat on the bed. Pillows must NEVER be placed under the stump, as this promotes flexion.

Clinical Presentation:

• Hip flexion contractures present with an inability to fully extend the hip joint, leading to a severe limp, lower back pain, and inability to use a prosthetic leg effectively.
• Other complications include phantom limb pain, neuroma formation, and wound infection.

Diagnosis:

• First-line diagnostic tool: Physical assessment of the hip joint's range of motion and evaluation of the surgical stump for healing and edema.
• Gold standard diagnostic test: Clinical gait analysis and physical therapy evaluation once the patient is ready for prosthetic training.

Management:

• Acute management: Positioning the limb flat on the bed while supine, and having the patient lie in a prone position for 20-30 minutes several times a day to stretch the hip flexors. Elevating the foot of the bed for edema control rather than using pillows under the limb.
• Gold standard long-term/definitive management: Rigid stump dressings or shrinker socks to shape the limb, intensive physical therapy for strengthening, and eventual fitting and training with a definitive lower-extremity prosthesis.