Above-the-knee amputation after a total knee replacement

Prevalence, etiology, and functional outcome

Rafael J. Sierra, Robert T. Trousdale, Mark Pagnano

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Background: Despite modern surgical techniques, salvage of a failed total knee replacement remains a challenge. In certain situations, when other treatment options have been exhausted, patients with a failed total knee replacement may become candidates for above-the-knee amputation. The objective of this study was to assess the prevalence, etiology, and functional outcome of above-the-knee amputation performed proximal to an ipsilateral total knee replacement. Methods: From 1970 to 2000, 18,443 primary total knee replacements were performed at our institution; sixty-seven (0.36%) were eventually followed by above-the-knee amputation. Forty-two of the amputations were performed for a cause unrelated to the total knee replacement, most commonly peripheral vascular disease (twenty-four knees). The remaining twenty-five above-the-knee amputations were performed for causes related to the total knee replacement: nineteen were done for uncontrollable infection; two, for periprosthetic fracture; two, for pain; one, for severe bone loss; and one, for a vascular complication. Results: The twenty-five above-the-knee amputations performed for causes related to the total knee replacement were done at an average of 8.6 years (range, eight days to 23.6 years) after the replacement. The prevalence of above-the-knee amputations done for causes related to total knee replacement was 0.14%. Complications after the above-the-knee amputation included deep infection in five patients and superficial infection and skin necrosis in one each; there was also one perioperative death. Nine of the twenty-five limbs were fitted with an above-the-knee prosthesis, but only five patients were walking even to a limited degree with the prosthesis at the time of the last follow-up. Conclusions: The overall prevalence of amputation after total knee arthroplasty at our tertiary care center was 0.36%. The majority (63%) of the amputations were performed for reasons not attributable to complications of the arthroplasty. The functional outcome after amputation performed above a total knee replacement is poor. A substantial percentage of the patients were never fitted with a prosthesis, and those who were seldom obtained functional independence. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1000-1004
Number of pages5
JournalJournal of Bone and Joint Surgery - Series A
Volume85
Issue number6
StatePublished - Jun 1 2003

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Knee Replacement Arthroplasties
Amputation
Knee
Prostheses and Implants
Infection
Periprosthetic Fractures
Knee Prosthesis
Peripheral Vascular Diseases
Tertiary Care Centers
Arthroplasty
Walking
Blood Vessels
Necrosis
Extremities
Retrospective Studies

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Above-the-knee amputation after a total knee replacement : Prevalence, etiology, and functional outcome. / Sierra, Rafael J.; Trousdale, Robert T.; Pagnano, Mark.

In: Journal of Bone and Joint Surgery - Series A, Vol. 85, No. 6, 01.06.2003, p. 1000-1004.

Research output: Contribution to journalArticle

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abstract = "Background: Despite modern surgical techniques, salvage of a failed total knee replacement remains a challenge. In certain situations, when other treatment options have been exhausted, patients with a failed total knee replacement may become candidates for above-the-knee amputation. The objective of this study was to assess the prevalence, etiology, and functional outcome of above-the-knee amputation performed proximal to an ipsilateral total knee replacement. Methods: From 1970 to 2000, 18,443 primary total knee replacements were performed at our institution; sixty-seven (0.36{\%}) were eventually followed by above-the-knee amputation. Forty-two of the amputations were performed for a cause unrelated to the total knee replacement, most commonly peripheral vascular disease (twenty-four knees). The remaining twenty-five above-the-knee amputations were performed for causes related to the total knee replacement: nineteen were done for uncontrollable infection; two, for periprosthetic fracture; two, for pain; one, for severe bone loss; and one, for a vascular complication. Results: The twenty-five above-the-knee amputations performed for causes related to the total knee replacement were done at an average of 8.6 years (range, eight days to 23.6 years) after the replacement. The prevalence of above-the-knee amputations done for causes related to total knee replacement was 0.14{\%}. Complications after the above-the-knee amputation included deep infection in five patients and superficial infection and skin necrosis in one each; there was also one perioperative death. Nine of the twenty-five limbs were fitted with an above-the-knee prosthesis, but only five patients were walking even to a limited degree with the prosthesis at the time of the last follow-up. Conclusions: The overall prevalence of amputation after total knee arthroplasty at our tertiary care center was 0.36{\%}. The majority (63{\%}) of the amputations were performed for reasons not attributable to complications of the arthroplasty. The functional outcome after amputation performed above a total knee replacement is poor. A substantial percentage of the patients were never fitted with a prosthesis, and those who were seldom obtained functional independence. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.",
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AU - Pagnano, Mark

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N2 - Background: Despite modern surgical techniques, salvage of a failed total knee replacement remains a challenge. In certain situations, when other treatment options have been exhausted, patients with a failed total knee replacement may become candidates for above-the-knee amputation. The objective of this study was to assess the prevalence, etiology, and functional outcome of above-the-knee amputation performed proximal to an ipsilateral total knee replacement. Methods: From 1970 to 2000, 18,443 primary total knee replacements were performed at our institution; sixty-seven (0.36%) were eventually followed by above-the-knee amputation. Forty-two of the amputations were performed for a cause unrelated to the total knee replacement, most commonly peripheral vascular disease (twenty-four knees). The remaining twenty-five above-the-knee amputations were performed for causes related to the total knee replacement: nineteen were done for uncontrollable infection; two, for periprosthetic fracture; two, for pain; one, for severe bone loss; and one, for a vascular complication. Results: The twenty-five above-the-knee amputations performed for causes related to the total knee replacement were done at an average of 8.6 years (range, eight days to 23.6 years) after the replacement. The prevalence of above-the-knee amputations done for causes related to total knee replacement was 0.14%. Complications after the above-the-knee amputation included deep infection in five patients and superficial infection and skin necrosis in one each; there was also one perioperative death. Nine of the twenty-five limbs were fitted with an above-the-knee prosthesis, but only five patients were walking even to a limited degree with the prosthesis at the time of the last follow-up. Conclusions: The overall prevalence of amputation after total knee arthroplasty at our tertiary care center was 0.36%. The majority (63%) of the amputations were performed for reasons not attributable to complications of the arthroplasty. The functional outcome after amputation performed above a total knee replacement is poor. A substantial percentage of the patients were never fitted with a prosthesis, and those who were seldom obtained functional independence. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

AB - Background: Despite modern surgical techniques, salvage of a failed total knee replacement remains a challenge. In certain situations, when other treatment options have been exhausted, patients with a failed total knee replacement may become candidates for above-the-knee amputation. The objective of this study was to assess the prevalence, etiology, and functional outcome of above-the-knee amputation performed proximal to an ipsilateral total knee replacement. Methods: From 1970 to 2000, 18,443 primary total knee replacements were performed at our institution; sixty-seven (0.36%) were eventually followed by above-the-knee amputation. Forty-two of the amputations were performed for a cause unrelated to the total knee replacement, most commonly peripheral vascular disease (twenty-four knees). The remaining twenty-five above-the-knee amputations were performed for causes related to the total knee replacement: nineteen were done for uncontrollable infection; two, for periprosthetic fracture; two, for pain; one, for severe bone loss; and one, for a vascular complication. Results: The twenty-five above-the-knee amputations performed for causes related to the total knee replacement were done at an average of 8.6 years (range, eight days to 23.6 years) after the replacement. The prevalence of above-the-knee amputations done for causes related to total knee replacement was 0.14%. Complications after the above-the-knee amputation included deep infection in five patients and superficial infection and skin necrosis in one each; there was also one perioperative death. Nine of the twenty-five limbs were fitted with an above-the-knee prosthesis, but only five patients were walking even to a limited degree with the prosthesis at the time of the last follow-up. Conclusions: The overall prevalence of amputation after total knee arthroplasty at our tertiary care center was 0.36%. The majority (63%) of the amputations were performed for reasons not attributable to complications of the arthroplasty. The functional outcome after amputation performed above a total knee replacement is poor. A substantial percentage of the patients were never fitted with a prosthesis, and those who were seldom obtained functional independence. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

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