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Above knee amputation following total knee arthroplasty: when enough is enough
Vickas Khanna1, Daniel M Tushinski1, Leslie J Soever2
1University of Toronto, Mount Sinai Hospital, Department of Orthopedics, Toronto, ON, Canada.
The Journal of Arthroplasty
|December 16, 2014
Summary
Above-knee amputation (AKA) offers a satisfying solution for chronic knee replacement infections. Most patients would have opted for amputation sooner, despite functional limitations.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Reconstructive Surgery
Background:
- Chronic infections following total knee arthroplasty (TKA) present significant challenges.
- Limb salvage procedures may fail, necessitating further intervention.
- Above-knee amputation (AKA) is sometimes the only viable option for managing these complex cases.
Purpose of the Study:
- To evaluate patient satisfaction after undergoing an above-knee amputation (AKA) for a chronically infected total knee arthroplasty (TKA).
- To identify potential indicators of a successful outcome following AKA in this patient population.
Main Methods:
- A retrospective review of 7 patients who underwent AKA for recurrent peri-prosthetic knee infection.
- Patient satisfaction was assessed using a modified questionnaire.
Main Results:
- All 7 patients reported satisfaction with their AKA.
- Six out of seven patients expressed that they would have preferred an amputation earlier.
- Expert opinion identified >6 limb salvage attempts and failed gastrocnemius flap as potential poor prognostic factors.
Conclusions:
- Despite potential functional deficits, patients experiencing chronic TKA infections report high satisfaction levels following an above-knee amputation (AKA).
- Early consideration of AKA may be beneficial in select cases of intractable TKA infection.