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Amputation after Multiple Times Failed Total Knee Arthroplasties: The Last Resort
Bushu Harna1, Shivali Arya2, Anil Arora3
1Consultant Joint Replacement and Sports Medicine, Indus International Hospital, Derrabassi, Panjab, India.
The Archives of Bone and Joint Surgery
|May 7, 2025
Summary
Transfemoral amputation is a viable option for managing severe complications after total knee arthroplasty (TKA), especially persistent periprosthetic joint infections. This procedure can lead to improved functional outcomes and mobility in patients with multiple failed TKAs.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Rehabilitation Medicine
Background:
- Total knee arthroplasty (TKA) complications can necessitate complex surgical interventions.
- Periprosthetic joint infection (PJI) is a significant challenge following TKA, often leading to multiple revision surgeries.
- Transfemoral amputation is considered in extreme cases of TKA failure and infection.
Purpose of the Study:
- To assess the clinical and functional outcomes of transfemoral amputations in patients with TKA complications.
- To investigate the role of PJI as a primary driver for amputation after TKA.
- To provide insights into managing patients requiring amputation due to TKA failure.
Main Methods:
- Retrospective analysis of six patients undergoing above-knee amputation due to TKA complications.
- Diagnosis of PJI based on clinical presentation and established criteria.
- Recording of patient demographics, comorbidities, and detailed surgical histories.
- Minimum 12-month follow-up including wound healing, prosthetic limb application, and functional outcome assessment using the Sickness Impact Profile (SIP).
Main Results:
- The study cohort had a mean age of 78.8 years, with diabetes being a prevalent comorbidity.
- The average time between TKA and amputation was 6.3 years, with patients undergoing numerous prior interventions.
- Stump wounds healed successfully, and three patients were fitted with prosthetic limbs, showing significant improvement in mobility and disability scores (SIP).
Conclusions:
- Periprosthetic joint infection is a major cause of TKA failure leading to amputation.
- Transfemoral amputation is a feasible solution for select patients with recurrent TKA failures and persistent infections.
- Decision-making for amputation should involve comprehensive evaluation of procedure history, cost-benefit, and psychosocial factors. Further multicentric studies are needed.
