Alexander V Orfanos1, Rowan J Michael2, Benjamin J Keeney3, Wayne E Moschetti4. 1. Department of Orthopaedic Surgery, Brown Alpert Medical School|Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA. Electronic address: Alexander_Orfanos@Brown.edu. 2. Premier Orthopaedics and Sports Medicine, 915 Old Fern Hill Road, Suite 1A, West Chester, PA 19380, USA. Electronic address: RMichael@PremierOrtho.com. 3. Berkley Medical Management Solutions, 10851 Mastin St., Suite 200, Overland Park, Kansas 66210, USA; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH 03756, USA; Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA. Electronic address: BKeeney@BerkleyMMS.com. 4. Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH 03756, USA; Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA. Electronic address: Wayne.E.Moschetti@Dartmouth.edu.
Abstract
BACKGROUND: Prosthetic joint infection (PJI) is a challenging complication after total knee arthroplasty (TKA). Above-knee amputation (AKA) is a salvage procedure that may be performed after revision TKAs fail to eradicate PJI. Few studies have investigated patient-reported outcomes. This study investigates patient-reported functional outcomes and overall satisfaction in a cohort of patients who underwent AKA for PJI. METHODS: We performed a retrospective study of all patients who underwent AKA for PJI from 2002 to 2015 at a tertiary academic institution in the rural northeastern United States, along with prospective phone interviews. Functional outcomes and overall satisfaction were adapted from the Above-The-Knee Amputation Functional Ability Questionnaire. Additional variables included age, sex, American Society of Anesthesiologists (ASA) Score, and mortality. RESULTS: Forty-four patients were included in the study. Eighteen patients died prior to study initiation, with a mean time of 948 days (2.6 years) between AKA and death. The 5-year mortality rate was 50%. Among the 14 patients who completed the survey, 12 (86%) were fit for prosthesis following AKA. Of these, 10 (71%) required the use of an assistive device and one (seven percent) reported being functionally independent with their prosthesis. Five (36%) required further surgery after their AKA. Twelve (86%) stated that they were satisfied with their AKA and 5 (42%) would have done it sooner if offered. CONCLUSIONS: Patients who underwent AKA for PJI reported a low level of independence and ability to ambulate with a high mortality rate. However, most were satisfied with their AKA and would choose it again.
BACKGROUND: Prosthetic joint infection (PJI) is a challenging complication after total knee arthroplasty (TKA). Above-knee amputation (AKA) is a salvage procedure that may be performed after revision TKAs fail to eradicate PJI. Few studies have investigated patient-reported outcomes. This study investigates patient-reported functional outcomes and overall satisfaction in a cohort of patients who underwent AKA for PJI. METHODS: We performed a retrospective study of all patients who underwent AKA for PJI from 2002 to 2015 at a tertiary academic institution in the rural northeastern United States, along with prospective phone interviews. Functional outcomes and overall satisfaction were adapted from the Above-The-Knee Amputation Functional Ability Questionnaire. Additional variables included age, sex, American Society of Anesthesiologists (ASA) Score, and mortality. RESULTS: Forty-four patients were included in the study. Eighteen patients died prior to study initiation, with a mean time of 948 days (2.6 years) between AKA and death. The 5-year mortality rate was 50%. Among the 14 patients who completed the survey, 12 (86%) were fit for prosthesis following AKA. Of these, 10 (71%) required the use of an assistive device and one (seven percent) reported being functionally independent with their prosthesis. Five (36%) required further surgery after their AKA. Twelve (86%) stated that they were satisfied with their AKA and 5 (42%) would have done it sooner if offered. CONCLUSIONS:Patients who underwent AKA for PJI reported a low level of independence and ability to ambulate with a high mortality rate. However, most were satisfied with their AKA and would choose it again.
Authors: A C Steinicke; J Schwarze; G Gosheger; B Moellenbeck; T Ackmann; C Theil Journal: Arch Orthop Trauma Surg Date: 2022-01-04 Impact factor: 3.067