Total hip and knee arthroplasty after lower extremity amputation in a military population

Abstract

IntroductionThe military includes lower extremity amputees requiring arthroplasty; however, there is little literature on this population. The primary aim of this study was to report demographics and clinical factors in amputees who undergo total hip or knee arthroplasty (THA/TKA) in the Military Health System (MHS). Second, patient-reported outcome measures (PROMs) are reported.MethodsThe Military Data Repository was queried for patients with lower extremity amputations and TKA or THA between 1 October 2014 and 12 October 2020. The medical records were reviewed and patients were contacted to complete PROMs. Mean follow-up for TKA and THA was 5.5 and 2.5 years, respectively.ResultsNineteen TKAs (76%) and eight THAs (28%) were performed in 25 patients. Mean age of TKA and THA patients at the time of arthroplasty was 57 years old. A majority of TKA (68%) and THA (57%) patients underwent amputations secondary to trauma. Nearly all TKAs were performed on the contralateral side to the amputation (95%), while half of THAs were performed on the ipsilateral side (50%). Two THAs (29%) were revised due to periprosthetic fractures, whereas six TKAs (32%) were revised or reoperated on due to infection. Ten TKA patients completed PROMs. The mean score on Knee Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) was 41.8 and Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) was 41.6 (Global Physical Health) and 49.6 (Global Mental Health).ConclusionsMost TKAs were performed on the contralateral limb, suggesting increased demand on the joint. The most common indication for amputation and post-TKA complication was trauma and infection, respectively. KOOS JR may not accurately capture the outcomes of this population, or they simply do worse. However, PROMIS-10 scores were similar to the non-amputee population, suggesting that the PROMIS-10 may be more useful than the KOOS JR.

Hip and knee replacement in lower limb amputees: a scoping review

“… TKR Total knee replacement, Hemi Hip hemiarthroplasty, NOF Neck of femur, NB Two patients received a combination of arthroplasty (THR and TKR) and therefore are counted in both groups [ 25 , 35 ]. No sub-group demographic description of gender status in Li ADF et al, so incomplete gender demographics compared to total participants.…”

“…Of the 40 included studies, only 13 reported any post-operative complications.Where reported, complications included peri-prosthetic fracture [ 15 , 18 , 19 , 35 , 52 ], dislocation [ 15 , 18 , 19 ], infection (superficial and deep) [ 15 , 35 , 39 , 44 ], aseptic loosening [ 15 , 31 ], stump complications [ 28 , 34 ], failed rehabilitation [ 43 ], and suboptimal implant positioning [ 47 , 48 ]. Amanatullah et al [ 15 ] reported a high overall percentage of complications (28.6%), with periprosthetic fracture (14.3%) and dislocation (8.6%) accounting for the majority.…”