Abstract
Observing a decreasing number of transfemoral amputations following infection of Total Knee Arthroplasty (TKA) we performed a retrospective case control study of all rehabilitated amputees in the HELIOS centre of rehabilitation for amputees, located in Bad Berleburg, Germany.
This study examines all patients who had undertaken a transfemoral amputation (TF) after infection of TKA since 2007.
Methods: retrospective case control study. The clinical reports of 355 patients with transfemoral amputation rehabilitated from 2007 to 2013 were systematically and statistically evaluated. In this period we rehabilitate 636 amputees.
Results: 9 patients – 2.53% of all TF-amputations suffered a loss of the lower extremity caused by an infection of TKA. 3 patients presented an infection only by MRSA (multiresistant Staph. aureus 33.33%), 2 patients only with MSSA (multisensible Staph. aureus); other 4 patients presented mixed infections with MRSE (multiresistant Staph. epidermidis), multiresistant Acinetobacter baumannii, E. coli, Enterococcus faecalis, Pseudomonas aeroguinosa.
Epidemiology: The mean age of the patients at time of amputation was 70.07 years, with 4 men and 5 women. Marital status: 6 patients are married (66.66%), 1 divorced, 1 widowed, 1 unmarried. All patients are retired. School-leaving qualifications: 7 elementary school (60.87%), 1 secondary school, 1 unknown. Health insurance: AOK 3 patients (33.33%), BKK 3 patients (33.33%), employers insurance 1 patients (11.11%) and 2 more patients. The medial time of hospitalization in the clinic for rehabilitation after suffering amputation because of infection of TKA was 29.22 days.
Mobility class of amputees at the beginning of hospitalization: class 0 (= non walkers) all 9 patients (100%). Mobility class of amputees at the end of hospitalization: class 0 (= non walkers) are 2 patients (22.22%), class 1 (= walking only inside) are 5 patients (55.55%), class 2 (= walking inside and a little outside) are 2 patients (22.22%), class 3 (= walking well inside and outside) no patient.
This retrospective case control study shows for the first time that amputation of the lower extremity following infection in TKA is rare – in our group we found 2.53%. In the national and international literature one does not find much research about transfemoral amputations caused by infection in TKA. In our clinic we notice a decreasing number.
