This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sierra, R. J.
Right arrow Articles by Pagnano, M. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sierra, R. J.
Right arrow Articles by Pagnano, M. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?
The Journal of Bone and Joint Surgery (American) 85:1000-1004 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Above-the-Knee Amputation After a Total Knee Replacement

Prevalence, Etiology, and Functional Outcome

Rafael J. Sierra, MD, Robert T. Trousdale, MD and Mark W. Pagnano, MD

Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

Rafael J. Sierra, MD
Robert T. Trousdale, MD
Mark W. Pagnano, MD
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for R.T. Trousdale: trousdale.robert{at}mayo.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Despite modern surgical techniques, salvage of a failed total knee replacement remains a challenge. In certain situations, when other treatment options have been exhausted, patients with a failed total knee replacement may become candidates for above-the-knee amputation. The objective of this study was to assess the prevalence, etiology, and functional outcome of above-the-knee amputation performed proximal to an ipsilateral total knee replacement.

Methods: From 1970 to 2000, 18,443 primary total knee replacements were performed at our institution; sixty-seven (0.36%) were eventually followed by above-the-knee amputation. Forty-two of the amputations were performed for a cause unrelated to the total knee replacement, most commonly peripheral vascular disease (twenty-four knees). The remaining twenty-five above-the-knee amputations were performed for causes related to the total knee replacement: nineteen were done for uncontrollable infection; two, for periprosthetic fracture; two, for pain; one, for severe bone loss; and one, for a vascular complication.

Results: The twenty-five above-the-knee amputations performed for causes related to the total knee replacement were done at an average of 8.6 years (range, eight days to 23.6 years) after the replacement. The prevalence of above-the-knee amputations done for causes related to total knee replacement was 0.14%. Complications after the above-the-knee amputation included deep infection in five patients and superficial infection and skin necrosis in one each; there was also one perioperative death. Nine of the twenty-five limbs were fitted with an above-the-knee prosthesis, but only five patients were walking even to a limited degree with the prosthesis at the time of the last follow-up.

Conclusions: The overall prevalence of amputation after total knee arthroplasty at our tertiary care center was 0.36%. The majority (63%) of the amputations were performed for reasons not attributable to complications of the arthroplasty. The functional outcome after amputation performed above a total knee replacement is poor. A substantial percentage of the patients were never fitted with a prosthesis, and those who were seldom obtained functional independence.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Vasc MedHome page
J. Bernstein, J. L Esterhai, M. Staska, S. Reinhardt, and M. E Mitchell
The prevalence of occult peripheral arterial disease among patients referred for orthopedic evaluation of leg pain
Vascular Medicine, August 1, 2008; 13(3): 235 - 238.
[Abstract] [PDF]

Home page
 JBJSHome page
F. Bottner, C. Gotze, A. Koller, J. Steinbeck, W. Winkelmann, and G. Gosheger
Creation of an Above-the-Knee Amputation Stump After Hip Disarticulation for Severe Periprosthetic Infection and Fracture. A Report of Two Cases
J. Bone Joint Surg. Am., February 1, 2005; 87(2): 410 - 413.
[Full Text] [PDF]