Short- and Long-Term Outcomes in Patients With Lower Extremity Amputations Undergoing Total Hip and Knee Arthroplasty

Joint replacement following amputation is scarcely reported. The primary aim of this study was to evaluate patient-reported outcomes (PROMS) and revision rates among lower extremity amputees undergoing total hip (THA) or knee arthroplasty (TKA).

This was a retrospective cohort analysis of lower extremity amputees undergoing THA/TKA between August 2002 and August 2022 in a single tertiary center. Demographic and clinical data were collected from prospectively populated surgical databases and patient electronic records. PROMS included Oxford Knee Score, Oxford Hip Score, and 5-level EuroQol 5-dimension questionnaires. Twenty-three TKAs and 21 THAs were performed in 38 patients. The mean age at arthroplasty procedures was 59.8 (24-87) years. The mean clinical follow-up duration for THA and TKA was 9.1 and 4.5 years, respectively. Seven TKAs and 6 THAs were ipsilateral to the amputated side.

The 10-year revision rates were 9.5% (2/21) and 5.9% (1/17) in the TKA and THA cohorts, respectively. TKA revisions occurred due to aseptic loosening. Six (26%) TKA cases experienced stump complications. Overall PROMS completion was 61.9% (13/21) and 64.7% (11/17) in TKA and THA patients, respectively. The average Oxford Hip Score/Oxford Knee Score of THA and TKA cohorts were 40.8 and 34.2, respectively. EuroQol 5-dimension questionnaire visual analog scores were higher in the THA cohort than those in the TKA cohort without statistical significance (59.1 vs 50.5, P = .214). The overall survival rate for the study was 94.7% at 5 years (36/38).

TKA/THA in lower extremity amputees can be successful, with low revision rates and good prosthesis function. Potential pitfalls highlighted include prosthesis malalignment, postprocedural rehabilitation, and stump complications.