Evaluation of quality of life and walking ability among amputated patients and those who refused to undergo amputation following infection of total knee arthroplasty: Small case series.

BACKGROUND: Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not have good functional outcomes and have major difficulty walking. OBJECTIVES: To evaluate the quality of life and walking ability among patients who underwent amputation and among those who refused to undergo amputation following infection of a total knee arthroplasty. STUDY DESIGN: Retrospective case series. METHODS: Patients who received an indication for amputation following an infection of a total knee arthroplasty were evaluated retrospectively. The patients were divided between those who accepted the amputation procedure and those who refused amputation (four amputee vs four non-amputees). Walking ability and quality of life were evaluated using the Short Form-36 questionnaire. RESULTS: The average physical health was 27.4 for the amputees and 31.3 for the non-amputees. The average mental health was 49.9 for the amputees and 47.1 for the non-amputees. In relation to walking ability, only one (25%) of the amputees was able to walk, as opposed to 100% in the non-amputee groups. CONCLUSION: Twenty-five percent of the amputee patients continued to be able to walk. The functional outcome of non-amputee patients was better, with 100% being able to walk, though with limitations. CLINICAL RELEVANCE: This is the first study evaluating patients who refused the amputation procedure and remained with the spacer. Despite the fact that this option is not recommended by the medical community, we believe that these data are useful when discussing, with a patient, quality of life after amputation.

Revision of total knee arthroplasty in a patient with contralateral transfemoral amputation: case report.

BACKGROUND: Knee arthroplasty is an efficient solution for osteoarthrosis in amputees. However, because of overload on the implant, it is apparently more subject to failure than in the non-amputated population. The aim of this case report is to show a failure of primary total knee arthroplasty contralateral to transfemoral amputation that required revision involving a tissue bank because of severely compromised knee bone. Surgical strategies, rehabilitation, and postoperative care for the operated limb and the contralateral prosthesis were demonstrated. CASE DESCRIPTION AND METHODS: A 60-year-old patient with early failure of total knee arthroplasty contralateral to transfemoral amputation underwent arthroplasty revision in which a graft from a tissue bank was used. After the revision, prosthesis length adjustment and exercise therapy were fundamental to the rehabilitation. FINDINGS AND OUTCOMES: The patient progressed well after the revision of the arthroplasty, with increases on the Knee Society Score and 36-Item Short Form Health Survey scales. CONCLUSION: Knee arthroplasty in amputees should be planned differently to that of the general population. For the procedure to be successful, there should be greater attention to implant stability, equalization of leg length, and a postoperative regimen including muscle strengthening and range of motion exercises to achieve the required knee flexion. CLINICAL RELEVANCE: This case report is important because it presents a challenging case of a unilateral transfemoral amputee with failed arthroplasty over the years in the contralateral limb. To our knowledge, such a case has not been described in the scientific literature. It would be helpful for surgeons and rehabilitation professionals to chart out a treatment protocol and also to prevent premature failure of the joint.