Above-Knee Amputation Following Chronically Infected Total Knee Arthroplasty: Patient-Reported Satisfaction and Functional Outcomes

Abstract

Background: Periprosthetic joint infection (PJI) that arises following total knee arthroplasty (TKA) can usually be resolved through surgical and antimicrobial therapy. However, in approximately 5% of cases, an infection that is chronic and persistent will require treatment by above-knee amputation (AKA). This study seeks to provide an enhanced understanding of patient functionality and satisfaction following this devastating complication of one of the most commonly performed surgeries in the world.

Methods: A retrospective chart review of all patients who underwent an AKA as a result of PJI following TKA at our center between January 2000 and November 2023 was performed. Patients completed a post-TKA AKA functionality and satisfaction questionnaire, as well as the 12-item short form survey. Of 27 eligible patients, 14 were contacted by phone for follow-up, six were deceased, six could not be reached, and one declined participation. The mean age at AKA was 62 years old (range, 43 to 85). Patients had an average of 5.5 procedures (range, 3 to 8) between primary TKA and AKA. The average follow-up time post-AKA was 38.5 months (range, 12 to 102).

Results: Of the patients, 85.7% were satisfied with their AKA, 85.7% would choose AKA again, and 71.4% would have proceeded with AKA earlier in retrospect. The average 12-item short form survey physical and mental component scores were 37.1 and 50.6, respectively.

Conclusions: Despite important limitations in functional and ambulatory status, the vast majority of patients who underwent an AKA following an infected TKA are satisfied with their amputation and would choose this treatment modality again if necessary, with many indicating they would do so at an earlier time point. In light of these results, the option of amputation should, when medically indicated, be discussed in a sensitive, but timely manner with patients undergoing treatment for recalcitrant PJI.

Keywords: above-knee amputation; patient-reported outcomes; periprosthetic joint infection; revision knee arthroplasty; total knee arthroplasty.