119: Lower Limb Amputations

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CHAPTER 119

Lower Limb Amputations

Michelle Gittler, MD

Synonyms

Below-knee amputation—transtibial amputation

Above-knee amputation—transfemoral amputation

Syme amputation (foot disarticulation)

Neuropathic pain—dysesthetic pain

Residual limb—stump

ICD-9 Codes

353.6   Phantom limb (syndrome)

718.45  Joint contracture (hip), pelvis and thigh

718.46  Joint contracture (knee), lower leg

719.7   Difficulty walking (ankle and foot)

Note: all 89_ codes are for traumatic amputations

895  Traumatic amputation of toe(s) (complete) (partial)

895.0   Without mention of complication

895.1   Complicated

896  Traumatic amputation of foot (complete) (partial)

896.0   Unilateral, without mention of complication

896.1   Unilateral, complicated

896.2   Bilateral, without mention of complication

896.3   Bilateral, complicated

897  Traumatic amputation of leg(s) (complete) (partial)

897.0   Unilateral, below knee, without mention of complication

897.1   Unilateral, below knee, complicated

897.2   Unilateral, at or above knee, without mention of complication

897.3   Unilateral, at or above knee, complicated

897.4   Unilateral, level not specified, without mention of complication

897.5   Unilateral, level not specified, complicated

897.6   Bilateral (any level), without mention of complication

897.7   Bilateral (any level), complicated

905.9   Late effect of traumatic amputation

997.60  Amputation stump complication, unspecified

997.61  Neuroma of amputation stump

997.62  Infection (chronic)

V52  Fitting and adjustment of prosthetic device and implant

V52.1   Artificial leg (complete) (partial)

V49.70  Unspecified level lower limb amputation

V49.75  Below knee amputation status

V49.76  Above knee amputation status

ICD-10 Codes

G54.7       Phantom limb syndrome with pain

G54.6       Phantom limb syndrome without pain

M24.551  Contracture, right hip

M24.552  Contracture, left hip

M24.559  Contracture, unspecified hip

M24.561  Contracture, right knee

M24.562  Contracture, left knee

M24.569  Contracture, unspecified knee

R26.2  Difficulty walking

S98.131   Complete traumatic amputation of one right lesser toe

S98.132   Complete traumatic amputation of one left lesser toe

S98.139   Complete traumatic amputation of one unspecified lesser toe

S98.141   Partial traumatic amputation of one right lesser toe

S98.142   Partial traumatic amputation of one left lesser toe

S98.149   Partial traumatic amputation of one unspecified lesser toe

S98.911   Unspecified injury of right ankle

S98.912   Unspecified injury of left ankle

S98.919   Unspecified injury of unspecified ankle

S98.921   Unspecified injury of right foot

S98.922   Unspecified injury of left foot

S98.929   Unspecified injury of unspecified foot

S88.911   Complete traumatic amputation of right lower leg, level unspecified

S88.912   Complete traumatic amputation of left lower leg, level unspecified

S88.919   Complete traumatic amputation of unspecified lower leg, level unspecified

S88.921   Partial traumatic amputation of right lower leg, level unspecified

S88.922   Partial traumatic amputation of left lower leg, level unspecified

S88.929   Partial traumatic amputation of unspecified leg, level unspecified

S88.111   Complete traumatic amputation at level between knee and ankle, right lower leg

S88.112   Complete traumatic amputation at level between knee and ankle, left lower leg

S88.119   Complete traumatic amputation at level between knee and ankle, unspecified lower leg

S88.121   Partial traumatic amputation at level between knee and ankle, right lower leg

S88.122   Partial traumatic amputation at level between knee and ankle, left lower leg

S88.129   Partial traumatic amputation at level between knee and ankle, unspecified lower leg

S88.011   Complete traumatic amputation at knee level, right lower leg

S88.012   Complete traumatic amputation at knee level, left lower leg

S88.019   Complete traumatic amputation at knee level, unspecified leg

S88.021   Partial traumatic amputation at knee level, right lower leg

S88.022   Partial traumatic amputation at knee level, left lower leg

S88.029   Partial traumatic amputation at knee level, unspecified lower leg

T87.40    Infection of amputation stump, unspecified extremity

T87.30    Neuroma of amputation stump, unspecified extremity

T87.31    Neuroma of amputation stump, right upper extremity

T87.32    Neuroma of amputation stump, left upper extremity

T87.33    Neuroma of amputation stump, right lower extremity

T87.34    Neuroma of amputation stump, left lower extremity

Z44.9  Encounter for fitting and adjustment of unspecified external prosthetic device

Z89.511   Acquired absence of right leg below knee

Z89.512   Acquired absence of left leg below knee

Z89.519   Acquired absence of unspecified leg below knee

Z89.611   Acquired absence of right leg above knee

Z89.612   Acquired absence of left leg above knee

Z89.619   Acquired absence of unspecified leg above knee

Definition

In 2005, an estimated 1.6 million persons in the United States were living with loss of a limb, of whom 65% have had a lower limb amputation [1]. Vascular conditions account for most cases of amputation (54%), with two thirds of these having a secondary diagnosis of diabetes [2]. Lower limb amputations account for 97% of all dysvascular amputations. More than half of dysvascular amputations are major lower limb amputations (transfemoral, 25.8%; transtibial, 27.6%) [2,3]; 42.8% involve other levels (ray, toes). Most of these amputations occur in people aged 60 years and older. There are approximately 82,000 nontraumatic diabetes-related lower extremity amputations each year [3]. Trauma is the next most common cause of lower extremity amputation (22%), followed by tumors (5%). However, in children aged 10 to 20 years, tumor is the most common cause of both upper and lower extremity amputations. Male amputees outnumber female amputees 2.1:1 in disease and 7.2:1 in trauma [4]. Across all causes, 42% of the persons living with the loss of a limb are 65 years or older; 65% are men, and 42% are nonwhite [2].

Symptoms

The postoperative or post-traumatic sequela of an amputation is that the patient is missing all or part of a limb. In addition, there may be associated symptoms, such as phantom limb sensation, phantom pain, stump pain, and pain from the surgery itself.

Phantom limb sensation is the perception that the extremity is still present and occasionally distorted in position. Phantom limb sensation typically fades away within the first year after amputation, usually in a “telescoping” phenomenon. This includes the perception that the distal aspect of the limb (that is, the foot) is moving closer and closer to the site of amputation.

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