Amputation Levels

An anatomy-style illustration of a man's body with exposed muscle and includes text indicating the types of amputation levels.

Amputees, as well as their friends and family, may not have a clear understanding of amputation procedures and how the level of amputation affects what types of prostheses can be fitted. You also may not be familiar with all the terms that specialists (like an orthopedic surgeon and prosthetist) use. Having a visual diagram that explains the amputation levels, and a list of frequently used technical terms can be very useful in helping you understand your amputation.

The level of your amputation(s) will be referred to by the clinic team and will have a bearing on what type of prostheses you can be fitted with. We have indicated the amputation levels, as well as the commonly used abbreviations and names with the medical term in brackets where necessary.

PFFD / Proximal Femoral Focal Deficiency

An anatomy-style illustration of a man's body showing a PFFD / Proximal Femoral Focal Deficiency.

Proximal – nearest point to centre or to point of attachment
Femoral – the thigh bone (the longest and strongest bone in the body – extending from the pelvis to the knee)
Focal – focus or starting point
Deficiency – lack or shortage; less than necessary

Levels of PFFD vary:

  • A shorter femur (can vary in length)
  • Hip joint is also affected or may be absent
  • One or both legs may be affected
  • Varying effects on the foot
  • Knee may be absent, or not fully functional

Solutions that may be recommended:

  • An extension prosthesis
  • Amputation of the foot, giving the function of an above knee amputation
  • A rotationplasty procedure providing similar function to a below knee amputation
  • Limb-lengthening (length of the femur, condition of the hip and knee are factors in determining if limb-lengthening is feasible)

Rotationplasty (Van Nes Rotation)

An anatomy-style illustration of a man's body showing a Rotationplasty (Van Nes Rotation).

Rotationplasty (e.g. Van Nes Rotation) – a procedure where the lower portion of the leg is rotated 180° and reattached – the ankle acts like a knee joint, providing extra function.

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