Patient-reported outcomes after above-knee amputation for prosthetic joint infection

• Published in: The knee 2020-06, Vol.27 (3), p.1101-1105
• Main Authors: Orfanos, Alexander V., Michael, Rowan J., Keeney, Benjamin J., Moschetti, Wayne E.
• Format: Article
• Language: English
• Subjects: Above-knee amputation; Adult; Age; Aged; Aged, 80 and over; Amputation; Arthritis, Infectious - diagnosis; Arthritis, Infectious - etiology; Arthritis, Infectious - surgery; Arthroplasty (knee); Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - instrumentation; Cohort Studies; Databases, Factual; Female; Humans; Infections; Joint diseases; Knee Prosthesis - adverse effects; Male; Middle Aged; Mortality; Patient Reported Outcome Measures; Patient-reported outcomes; Patients; Prostheses; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Prosthetic joint infection; Revision; Satisfaction; Studies; Surgery; Surveys and Questionnaires; Total knee arthroplasty
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2019.10.007

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. 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. 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. 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.