Knee Fusion or Above-The-Knee Amputation after Failed Two-Stage Reimplantation Total Knee Arthroplasty

Document Type : CURRENT CONCEPTS REVIEW

Author

Department of Orthopaedic Surgery, La Paz University Hospital, Paseo de la Castellana 261, 28046-Madrid, Spain

Abstract

Prosthetic joint infection (PJI) is a serious complication of total knee arthroplasty (TKA). Control of infection after a failed two-stage TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA) or a the-knee (KF).
The purpose of this review is to determine which treatment method (AKA or KF) yields better function and ambulatory status for patients after a failed two-stage reimplantation.
A PubMed search related to the resolution of infection by means of an above-the-knee amputation (AKA) or a knee fusion was performed until 10 January 2015. The key words were: infected TKA and above-the-knee amputation. Five hundred and sixty-six papers were found, of which ten were reviewed because they were focused on the topic of the article.
KF should be strongly considered as the treatment of choice for patients who have persistent infected TKA after a failed two-stage revision arthroplasty. Patients can walk at least inside the house, and activity of daily living independence is achieved by the patients with successful KF, although walking aids, including a shoe lift, are required. An intramedullary nail leads to better functional results than an external fixator. The functional outcome after AKA performed after TKA is poor. A substantial percentage of the patients never fit with a prosthesis, and those who are seldom obtain functional independence. Only 50% of patients are able to walk after AKA.
Patients receiving KF for treating recurrent PJI after TKA have better function and ambulatory status compared to patients receiving AKA. KF must be recommended as the treatment of choice for patients who have persistent infected TKA after a failed two-stage reimplantation procedure.

Keywords


  1. Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics. 2010;33(9):659.
  2. Wu CH, Gray CF, Lee GC. Arthrodesis should be strongly considered after failed two-stage reimplantation TKA. Clin Orthop Relat Res. 2014;472(11):3295-304
  3. Sierra RJ, Trousdale RT, Pagnano MW. Above-the-knee amputation after a total knee replacement: prevalence, etiology, and functional outcome. J Bone Joint Surg Am. 2003;85(6):1000-4.
  4. Moyad TF, Thornhill T, Estok D. Evaluation and management of the infected total hip and knee. Orthopedics. 2008;31(6):581-8.
  5. Fedorka CJ, Chen AF, McGarry WM, Parvizi J, Klatt BA. Functional ability after above-the-knee amputation for infected total knee arthroplasty. Clin Orthop Relat Res. 2011;469(4):1024-32.
  6. Chen AF, Kinback NC, Heyl AE, McClain EJ, Klatt BA. Better function for fusions versus above-the-knee amputations for recurrent periprosthetic knee infection. Clin Orthop Relat Res. 2012;470(10):2737-45.
  7. Taheri A, Karimi MT. Evaluation of the gait performance of above-knee amputees while walking with 3R20 and 3R15knee joints. J Res Med Sci. 2012;17(3):258-63.
  8. Watanabe K, Minowa T, Takeda S, Otsubo H, Kobayashi T, Kura H, et al. Outcomes of knee arthrodesis following infected total knee arthroplasty: a retrospective analysis of 8 cases. Mod Rheumatol. 2014;24(2):243-9.
  9. Iacono F, Raspugli GF, Bruni D, Lo Presti M, Sharma B, Akkawi I, et al. Arthrodesis after infected revision TKA: Retrospective comparison of intramedullary nailing and external fixation. HSS J. 2013;9(3):229-35.
  10. Schwarzkopf R, Kahn TL, Succar J, Ready JE. Success of different knee arthrodesis techniques after failed total knee arthroplasty: Is there a preferred technique?. J Arthroplasty. 2014 ;29(5):982-8.