Impact of the Presence of Orthopedic Hardware On Technical Performance of Major Amputations Jeffrey L. Kaufman, MD, Franklin Glockner, MD, Benjamin B. Chang, MD, Alan R. Koslow, MD, Dhiraj M. Shah, MD, Robert P. Leather, MD, Albany, New York Metallic prostheses used for joint reconstruction or open reduction of fractures were discovered pre- or intraoperatively during the performance of six above-knee amputations. The prosthesis was found fortuitously before surgery in two cases on the basis of a surgical scar or radiograph of the leg. In four patients, discovery occurred intraoperatively, with adverse impact on the procedure in two cases: more proximal amputation level to allow hip nail removal was necessary in one case, and difficult transection of the prosthesis stem was encountered in one case. Orthopedic prostheses will be found with an increasing incidence in the population undergoing major amputation. As preparation for amputation, a careful review of the patient's history, a search for scars over the leg and hip, and survey radiographs of the leg must be obtained to prevent a surgical mishap caused by accidental discovery of a prosthesis. (Ann Vasc Surg 1990;4:356-358). KEY WORDS: Orthopedic prostheses; amputations, above-knee. Major amputations, in particular above-knee ampu- tations, while understood to have significant medical risk, are procedures often taken for granted. They are certainly not thought to be fraught with major technical complications. However, the population at risk for major amputation in the 1990s will include many pa- tients who have undergone major joint replacement and internal fixation of fractures years before. Thus, it is necessary for the surgeon to take into account the presence of orthopedic hardware in planning a major amputation. The precise impact of orthopedic prosthe- ses on amputation is described in this report with reference to six cases encountered recently in a vascu- lar surgery practice. From the Departments of Sm'gery and Orthopedics, Albany Medical College, and the Albany, Veterans Ad- ministration Medical Center, Albany, New York. Reprint requests: Jeffrey L. Kaufman, MD, Department of Surgery, Albany Veterans Administration Medical Center, Albany, New York 12208. CLINICAL MATERIAL The records of patients undergoing both elective and emergency above- and below-knee amputation at the Albany Veterans Administration Medical Center over a four year period from 1985 to 1989 were analyzed. Among 84 patients, there were 38 above-knee amputations, 47 below-knee amputa- tions and two hip disarticulations. In the course of amputation, metallic prostheses or plates for ortho- pedic reconstruction of the femur were encountered in six patients undergoing above-knee amputation (16% of all above-knee amputations). No prosthesis was encountered during a below-knee amputation or hip disarticulation. Five of the six patients had alteration of sensorium, such that there was no history from the patient of the orthopedic procedure. One patient forgot that he had undergone the procedure. Medical records supplied by nursing homes or from previous hospitalizations did not indicate the reconstruction in any case. In one 356