Medical Oncologist
CION Cancer Clinics
Types of amputation for bone and soft tissue cancer | CION Cancer Clinics
Amputations are named by the level at which the limb is removed: below the knee, through or above the knee, at the hip, or with part of the pelvis; and in the arm, below or above the elbow, at the shoulder, or with the shoulder blade. The level is set by where the tumour ends plus a clear margin. This page explains what each level means for daily life afterwards. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What are the types of amputation for cancer?
- The four main levels of leg amputation
- Levels of arm amputation, in plain language
- What actually happens during the operation
- Below-knee and above-knee, compared
- Four things families tell us, and what is actually true
- What this page cannot tell you
- Common questions about types of amputation
The short answer
What are the types of amputation for cancer?
Amputations are named by the level at which the limb is removed. In the leg that means below the knee, through or above the knee, at the hip, or with part of the pelvis. In the arm it means below the elbow, above the elbow, at the shoulder, or with the shoulder blade and collarbone. The level is set by where the tumour ends plus a clear margin, a rim of healthy tissue, not by choice.
Why the level matters so much
Every joint that can be kept makes life afterwards easier. A person with their own knee walks with a lighter, simpler artificial limb and uses far less energy than someone whose knee has gone. So the surgeon keeps every joint the margin allows, and no more is removed than the tumour demands.
Who decides the level
The surgical oncologist, from the MRI, at a tumour board. The scan shows how far the tumour runs inside the bone and along the muscle, often further than the lump you can feel. The level is placed a safe distance beyond that.
This page explains what each level means. It cannot tell you which level applies to the person you are worried about.In the leg
The four main levels of leg amputation
Most cancer amputations in the leg are around the knee, because that is where bone tumours most often start.
Below the knee
The shin bone is divided and the knee is kept. This is the level that gives the most natural walking with a prosthesis, because your own knee does the bending.
What it means for walking
- A lighter, simpler artificial limb
- Stairs and uneven ground are manageable
Through or above the knee
The thigh bone is divided, or the leg is removed at the knee joint. The prosthesis must now supply the knee, which takes more practice and more effort to control.
What it means for walking
- A longer stump helps control the prosthetic knee
- Walking uses more energy than below-knee
At the hip
The whole leg is removed at the hip joint, when the tumour sits high in the thigh. A prosthesis is possible but is heavier and harder to use; many people move between a limb and crutches.
With part of the pelvis
Called a hemipelvectomy. Part of the pelvic bone is removed with the leg, for tumours in the pelvis itself. It is a major operation with a long recovery.
Some pelvic tumours can be removed while keeping the leg. Ask whether that applies.Not sure whether this applies to you?
Ask an oncologistIn the arm
Levels of arm amputation, in plain language
- Finger or ray amputation
- A finger is removed, sometimes with the long bone of the hand behind it. Used for small tumours of the hand. Grip is changed but the hand remains useful.
- Below the elbow
- The forearm is divided and the elbow is kept. A prosthesis can carry a hook or a hand, and your own elbow does the positioning.
- Above the elbow
- The upper arm bone is divided. The prosthesis must supply the elbow as well as the hand, which is harder to learn and heavier to wear.
- At the shoulder
- The whole arm is removed at the shoulder joint. The shoulder outline is kept, and a light cosmetic arm is often preferred to a working one.
- Forequarter
- The arm is removed with the shoulder blade and collarbone, for tumours around the shoulder itself. Uncommon, and a large operation.
In theatre
What actually happens during the operation
Anaesthetic and marking
You are asleep under a general anaesthetic, often with a nerve block added to ease pain afterwards. The surgeon marks the level and the skin flaps on the limb before starting.
Removing the tumour with its margin
The limb is divided at the planned level, taking the tumour and a rim of healthy tissue in one piece. The removed part goes to the pathologist, who checks that the edge is clear.
Shaping the muscle over the bone
The end of the bone is smoothed. Muscles are stitched over it and to each other, so the stump has padding, strength and a shape that a prosthesis can grip.
Handling the nerves
The main nerves are cut cleanly and tucked into muscle, away from where the socket will press. This reduces painful nerve endings later.
Closing and dressing
The skin flaps are brought together over the stump with a drain left for a few days. A firm dressing or a rigid cover protects the wound and starts shaping the stump.
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Side by side
Below-knee and above-knee, compared
Below the knee
Above the knee
Your own knee bends and locks
The prosthesis supplies the knee
Walking takes modestly more effort than before
Walking takes noticeably more effort and balance
Learning to walk is usually quicker
Learning takes longer and needs more physiotherapy
Lighter socket and simpler components
Heavier limb, and a prosthetic knee that costs more
Chosen when the tumour ends well below the knee
Chosen when the tumour involves the knee or the lower thigh
Commonly believed
Four things families tell us, and what is actually true
"A higher amputation is safer, so we should ask for more to be removed."
Removing more than the margin needs adds no safety against the cancer. It does take away a joint, and with it easier walking for the rest of a life. The level is set by the scan.
"The surgeon can choose any level we prefer."
The tumour chooses. The MRI shows how far it runs inside the bone and along the muscle, and the level must sit beyond that. What the surgeon can do is explain why, and what it will mean for walking or using the hand.
"Below the knee means only a small prosthesis and no real change."
A below-knee prosthesis is simpler, but it still needs a well-shaped stump, careful fitting and weeks of practice. The skin of the stump has to be looked after every day. It is the easier level to live with, not an easy one.
"Rotationplasty is an old-fashioned operation that leaves the child deformed."
It looks unusual, because the foot faces backwards and works as a knee. But it gives a growing child a limb that can run, cycle and play sport, with far fewer operations than an implant.
Being straight with you
What this page cannot tell you
It cannot tell you which level applies to the person you are worried about, or whether an amputation is needed at all. Many bone and soft tissue tumours are removed while keeping the limb, and that decision comes first. Only the MRI and the tumour board can answer it.
It cannot tell you how walking will go
Two people with the same level of amputation can walk very differently, depending on age, weight, the other leg, the fit of the socket and how much practice they put in. The level sets the starting point, not the result.
What to ask your surgical team
- Which level, and can you show me on the scan why?
- Will my own knee or elbow be kept?
- What will the stump be like, and who will shape it?
- When is the first prosthesis fitted, and where?
- Is rotationplasty an option for our child?
Questions we are asked
Common questions about types of amputation
Which is more common for bone cancer, below-knee or above-knee?
Above-knee, because the commonest bone tumours in young people start at the lower end of the thigh bone or the top of the shin, right at the knee. A tumour there usually takes the knee with it. Below-knee amputations are more often for tumours lower in the shin or foot.
Can the knee be saved if the tumour is just above it?
Sometimes, but usually by limb salvage with a metal implant rather than by an amputation below the knee. If amputation is needed and the tumour reaches the knee, the level has to be above it. Ask the surgeon what the MRI shows about the lower end of the thigh bone.
What is a hemipelvectomy and when is it done?
It is removal of the leg together with part of the pelvic bone, for tumours that sit in the pelvis or the very top of the thigh. It is uncommon and it is a large operation with a long recovery. Some pelvic tumours can instead be removed while keeping the leg.
How long is the stay in hospital?
Usually a matter of days for a below-knee or above-knee amputation, longer for hip and pelvic operations. It depends on how the wound settles, pain control and how quickly physiotherapy gets going. Ask your team for their own typical range.
Does a below-knee amputation hurt less afterwards?
The wound pain is similar at any level and is managed with a nerve block and regular medicines. What differs is the effort of walking later, which is less below the knee. Phantom sensations, where the missing part still feels present, can happen at any level and are treatable.
Can an arm amputation be avoided with a smaller operation?
Often, yes. Many arm tumours are removed while keeping the arm, using an implant or a bone graft, because the arm does not have to bear weight. Amputation in the arm is usually kept for tumours that have grown into the main nerves and vessels.
Will the artificial limb be fitted straight after surgery?
Not usually. The stump must heal and settle in shape first, which takes weeks. In that time physiotherapy works on balance, strength and the other leg. Ask who your prosthetist will be and when the first fitting is planned.
Is the operation covered by Aarogyasri or insurance?
Aarogyasri, CGHS, ECHS and EHS cover cancer surgery within their limits, and most cashless insurers are empanelled for the operation itself. The artificial limb is often a separate matter and may not be covered. Call the helpline with your card and reports and we will check your cover before you travel.
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Dr. C. Raghavendra Reddy
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Sources
- NHS — Amputation
- American Cancer Society — Surgery for osteosarcoma
- Cancer Research UK — Treatment for bone cancer
- Macmillan Cancer Support — Bone cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Limb Salvage or Amputation: How the Choice Is MadeThe decision that comes before any level is chosenRotationplasty ExplainedThe operation that turns the ankle into a knee for a growing childThe Stump: Healing, Shaping and CareWhat happens to the stump in the weeks after the operationGetting Fitted for a ProsthesisWhen the first artificial limb is fitted and by whomUpper Limb Amputation and Daily FunctionLiving and working after an arm amputation
Talk to us
Been told an amputation is needed?
Send us the MRI and biopsy reports, or call the helpline. A surgical oncologist will explain which level is being proposed and why, and what it will mean for walking or using the hand. One helpline serves every CION centre.