Abstract
Noting a decreasing number of transfemoral amputations following infection of Total Knee Arthroplasty (TKA) I studied a case of a patient which suffered an amputation following infection of TKA by MRSA. With assistance of all hospitals and the NHS it was able to classify all costs of this poor case.
This study exposes a drama of a person which received a Total Knee Arthroplasty in the right knee at 66.0 years. 2 weeks after the implantation of TKA she presented a wound secretion, the microbiology shows: MRSA, Pseudomonas aeroguinos and Streptococcus. 4 surgical revisions followed without removing the TKA. 35 month later, with 68.9 years it was indispensable to remove the TKA in a 6th operation, implanting a spacer with Vancomycine. 1 month later removing of the spacer and implanting a second cemented TKA in the 7th surgery. With 70.2 years the removal of the second TKA was necessary because of infection with Pseudomonas aeroguinosa and Morganelli morganii. Now implantation of another spacer with Vancomycine. 1 month later with 70.3 years removal of the spacer molding an arthrodesis of the knee using an intramedullary femur to tibia rod. After that 4 revision surgeries with changing the intramedullary rod some wound revisions followed, ending in the 23rd operation with a transfemoral amputation with 71.1 years – 5 years after primary TKA. 3 month after transfemoral amputation the patient presented high temperature and a secretion of the scarf of the TT-stump; microbiology: MRSA. 2 more surgeries are necessary to stop the infection.
This patient suffered over all 25 surgical procedures in 5.5 years. The hospitalization for acute infection of TKA led to 431 days in different hospitals in 33 months. Statement of charges from the hospitals € 74.046,92 in the last three years before amputation. Payments by the health insurance € 155.424,00 for all procedures. We will demonstrate the different costs of hospital procedures and distribution for the insurance for all performances.
