Amputation after failure or complication of total knee arthroplasty: prevalence, etiology and functional outcomes

Abstract

Objective Identify the etiology and incidence, as well to assess functional outcomes of patients, undergoing lower limb amputation after failure or complication of total knee arthroplasty. These patients were treated at the Center for Knee Surgery at the National Institute of Traumatology and Orthopedics (INTO), during the period of January 2001 to December 2010. Methods The patients were interviewed and their charts were retrospectively analyzed to evaluate their functional outcome. Results The incidence of amputation due to failure or complication of total knee arthroplasty was 0.41% in 2409 cases. Recurrent deep infection was the cause of amputation in 81% of cases, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequent germs. Vascular complications and periprosthetic fracture associated to metaphyseal bone loss were also causes of amputation. In our study, 44% of amputees patients were using orthesis and 62.5% have had the ability to walk. Conclusion Incidence of 0.41%, being the main cause recurrent infection. The functional outcome is limited, and the fitting achieved in 44% of patients and only 62.5% are ambulatory.

Socioeconomic Status Is Associated with Risk of Above-knee Amputation After Periprosthetic Joint Infection of the Knee

“…The use of ICD-9-CM codes and the nonlongitudinal nature of the NIS prevent us from knowing with certainty that all patients who were identified as having an AKA indeed had the amputation as a result of a PJI. However, given that our calculated incidence of AKA after TKA is consistent with those from other studies [8,16,19], it is likely that our sample is representative of patients undergoing AKA in the context of PJI of the knee. Other large administratively coded databases would not have allowed us to more definitively identify AKA after TKA because they do not have followup data in the range of several years that would be needed to definitively identify such cases of AKA.…”

“…George et al [8] found that with regard to PJI or aseptic TKA complications, black race was associated with an increased frequency of AKA, particularly for black males. Given the poor functional outcomes associated with AKA, it is essential to identify the patients at greatest risk of this complication to appropriately risk stratify patients who have undergone TKA with subsequent PJI of the knee [6,16,17,19]. We found that patients with low socioeconomic status or Medicaid or Medicare insurance were more likely to undergo AKA after PJI of the knee.…”

“…AKA secondary to vascular disease is more common in patients with nonprivate health insurance, female sex, and black race [4,21]. Recent estimates of the frequency of AKAs after TKA range from 14 of 10,000 to 41 of 10,000 with periprosthetic joint infection (PJI) of the knee contributing to most of these cases [11,16,19]. Although the rate of AKAs has declined over the past two decades, the rate of AKAs resulting from PJIs, most often associated with TKA, appears to be increasing [7].…”

“…Although the rate of AKAs has declined over the past two decades, the rate of AKAs resulting from PJIs, most often associated with TKA, appears to be increasing [7]. Most studies examining AKA specifically after TKA have been case series with limited sample sizes [6,11,16,17,19]. Given the rarity of AKA, large national databases such as the National Inpatient Sample (NIS) are well suited for the study of this devastating complication.…”

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

“…Above-knee amputation (AKA) is a rare but serious complication of TKA. The reported prevalence of AKA after TKA ranges from 140 to 410 AKAs per 100,000 TKAs [10,21]. The functional outcomes after amputation are poor with approximately half of the patients being nonambulatory after TKA-related AKAs [6,7].…”