• INTRODUCTION
    • The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues.
  • STEP 1 PREOPERATIVE PLANNING
    • As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure.
  • STEP 2 FLAP DESIGN
    • Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure.
  • STEP 3 SOFT-TISSUE DISSECTION
    • Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain.
  • STEP 4 DISTAL FEMORAL AND PATELLAR CUTS
    • Use a high-speed saw to transect the femur and patella.
  • STEP 5 POSTERIOR DISSECTION
    • Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures.
  • STEP 6 PATELLOFEMORAL ARTHRODESIS
    • Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture.
  • STEP 7 SOFT-TISSUE CLOSURE
    • Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion.
  • STEP 8 POSTOPERATIVE MANAGEMENT
    • Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes.
  • RESULTS
    • The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium.
  • WHAT TO WATCH FOR
    • IndicationsContraindicationsPitfalls & Challenges.