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On the day of surgery the patient will be admitted in to hospital either in the morning or midday, depending on when the surgery has been scheduled. Patients will be to have their last meal at least 6 hours before the list starts (2am for 8am start and 5am for 1pm start) and clear fluids up to two hours before the list starts. After checking in, they will be appropriately marked and the consent form will be reviewed after Mr Matija Krkovic has answered all their questions and addressed any concerns.
Positioning on the operating table will be supine (lying on the back) for majority of the patients. Depending on the clinical situation either one sided or bilateral draping will be used. For high transfemoral amputations, special drapes will be used.
Stumps with abundant soft tissue will have to be reshaped before the insertion of the endoprosthesis. After appropriate soft tissue resection where necessary, the bone will be approached. If needed, the original distal femoral bone cut that was made at the time of amputation will be reopened to match the prosthesis requirements which is usually a perpendicular cut to the anatomical axis. The medullary canal will be opened and reamed to the correct dimension enabling strong cortical contact following the preoperative templating. Providing that the relevant size trial component gives a strong enough fit, the definitive stem of endo-prosthesis will be inserted. Depending on whether this is a planned one or two stage procedure, the relevant parts of the coupling parts will be used. To complete the first stage, a pre-shaped spacer will be secured to the stem with a screw. At this stage definitive intraoperative X-rays using Image intensifier will be obtained. The soft tissue wound will be closed over the endoprosthesis using standard wound closing techniques.
The second second stage will take place 4-8 weeks after the first stage. This will include cutting a cylindrical opening through the skin (stoma) at the level of the tip of the endoprosthesis, removal of the pre-shaped spacer and insertion of a bridge module, this will allow coupling of the exo prosthesis to the already inserted endoprosthesis stem. A stoma will be created and dressed using standard non-adherent dressings. At this stage we might consider using NPVT (negative pressure vacuum treatment) dressings to minimise the oozing and swelling through the stoma.
