disarticulation

Disarticulation is a surgical procedure in which a limb is removed through a joint, rather than transecting bones in the shaft. By dividing at the joint, the articular ends of the bones are preserved, and the remaining limb segments may retain their natural articulation. It is distinct from most amputations that cross bone shafts.

Common forms include shoulder disarticulation (removal of the entire upper limb at the shoulder joint), elbow disarticulation (through the elbow joint), knee disarticulation (through the knee joint), ankle disarticulation (through the ankle joint), and hip disarticulation (through the hip joint).

Indications include malignant tumors around a joint, irreparable traumatic destruction, severe infection, congenital limb abnormalities, or deformity where joint preservation is not possible or would impair function. The choice of disarticulation depends on anatomy, tumor margins, and functional goals. Surgical technique emphasizes preserving soft tissue balance, securing muscle attachments to reduce distal and proximal stump movement, and managing nerves to limit painful neuromas. Procedures may be planned or performed emergently and can be done in one stage or with staged tissue rearrangement.

Rehabilitation focuses on wound healing, pain management, and prosthetic fitting. Modern prosthetics include body-powered and myoelectric devices; some levels benefit from stable socket designs that preserve joint remnants. Functional outcomes vary by joint level and motivation, with factors such as phantom limb sensation and risk of infection influencing recovery.

Complications can include infection, wound healing delay, necrosis, neuroma, phantom limb pain, and challenges with prosthetic fit. Overall prognosis depends on indication, surgical technique, and access to multidisciplinary rehabilitation.