Abstract
Introduction
Total Knee Arthroplasty (TKA) in high risk patients may result in numerous post-operative complications that may ultimately lead to above knee amputation (AKA). There is a paucity of literature regarding AKA in patients with prior TKA. We sought to characterize the factors leading to AKA, as well as patient functional and clinical outcomes post-operatively, with the hypothesis that minimal activity would be achieved.
Methods
This is a multicenter retrospective review for patient identification, with prospective telephone survey completion for assessment of functional status. All patients from January 2001 to December 2015 with AKA and prior TKA at two academic centers were included for possible survey enrollment. Demographic information and medical comorbidities were collected, in addition to perioperative and post-operative mortality data. A 23-item survey was provided to all available patients and analyzed for patient functional status.
Results
112 patients with AKA following TKA were included for analysis with mean age 60.6 (11.5) years at TKA, with 3.7 (3.14) surgeries over 6.0 (6.3) years prior to AKA. The most common medical comorbidities were cardiac disease (64.3%), renal insufficiency (34.8%), and atherosclerosis (26.8%). Indications for AKA were multifactorial, however, were primarily driven by infection (87.5%) and vascular disease (10.7%). At the time of the survey, 49 (43.8%) patients were deceased and the 5-year survival rate was 60.2% (figure I). 34 (30.4%) patients were enrolled for survey completion. Of the respondents, 32 (94.1%) reported owning a prosthesis but only 19 (55.9%) reported wearing it, and 19 (55.9%) primarily used a wheelchair for mobility. 27 (79.5%) noted phantom pain with 16 (47.1%) requiring chronic medication. Overall, only 18 patients (52.9%) were satisfied with their quality of life.
Discussion and Conclusion
TKA patients often undergo multiple surgeries over many years prior to AKA. Following this procedure, there is a high mortality rate; for patients surviving, almost half are dissatisfied with their quality of life, and low functional status is observed. TKA patients that might be considered candidates for AKA should be made aware the expected clinical and functional outcomes.
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