Transfemoral amputation following total knee arthroplasty: mortality and functional outcomes

The aim of this study was to characterize the factors leading to transfemoral amputation after total knee arthroplasty (TKA), as well as the rates of mortality and functional independence after this procedure in these patients. This was a multicentre retrospective review with a prospective telephone...

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Bibliographic Details
Published in:	Journal of bone and joint surgery. British volume Vol. 101-B; no. 2; pp. 221 - 226
Main Authors:	Ryan, S P, DiLallo, M, Klement, M R, Luzzi, A J, Chen, A F, Seyler, T M
Format:	Journal Article
Language:	English
Published:	England British Editorial Society of Bone & Joint Surgery 01-02-2019
Subjects:	Activities of Daily Living Adult Aged Aged, 80 and over Amputation Amputation - mortality Amputation - rehabilitation Arthroplasty, Replacement, Knee - adverse effects Female Femur - surgery Humans Ischemia - surgery Joint surgery Lower Extremity - blood supply Lower Extremity - surgery Male Middle Aged Mortality Prosthesis-Related Infections - mortality Prosthesis-Related Infections - surgery Quality of Life Recovery of Function Retrospective Studies Total knee arthroplasty Above-knee amputation Transfemoral amputation Mortality Functional outcome
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Summary:	The aim of this study was to characterize the factors leading to transfemoral amputation after total knee arthroplasty (TKA), as well as the rates of mortality and functional independence after this procedure in these patients. This was a multicentre retrospective review with a prospective telephone survey for the assessment of function. All patients with a TKA who subsequently required transfemoral amputation between January 2001 and December 2015 were included. Demographic information, medical comorbidities, and postoperative mortality data were collected. A 19-item survey was used for the assessment of function in surviving patients. A total of 111 patients were included. Their mean age was 61.0 years (42.0 to 88.0) at the time of TKA, with a subsequent mean of 3.7 operations (0 to 15) over a mean period of 6.1 years (0.05 to 30.1) before amputation. The indication for amputation was chronic infection in 97 patients (87.4%). The rate of five-year survival was 51.7%, and advanced age (p = 0.001) and renal failure (p = 0.045) were associated with an increased risk of mortality. Of the 62 surviving patients, 34 completed the survey; 32 (94.1%) owned a prosthesis but only 19 (55.9%) used it; 19 (55.9%) primarily used a wheelchair for mobility; 27 (79.5%) had phantom pain; and 16 (47.1%) required chronic pain medication. Only 18 patients (52.9%) were satisfied with the quality of life. Patients with complications after TKA, in whom transfemoral amputation is considered, should be made aware of the high rate of mortality and the poor functional outcome in the survivors. Alternative forms of treatment including arthrodesis of the knee should be investigated.
ISSN:	2049-4394 2049-4408
DOI:	10.1302/0301-620X.101B2.BJJ-2018-0784.R1