Major lower extremity amputations based on end-stage chronic leg ischaemia or diabetic ulcers with infection are relatively common orthopaedic procedures. Patients are usually evaluated for the possibility of lower extremity revascularisation. Those who are not fit for vascular surgery are transferred to an orthopaedic department for amputation. These patients are a big challenge as they are by definition multi-morbid individuals, who have to undergo major surgery. The high mortality rate in this population warrants new approaches, including optimised multidisciplinary regimes.