Hungerer S, et al. - Patients treated with modular knee-arthrodesis (MKA) or above-the-knee amputation (AKA) after septic failure of total knee arthroplasty (TKA), were compared, focusing on specific complications, functional outcome and quality of life. Findings demonstrated that although various factors determined the treatment decisions for desolate situations of septic failures following revision knee arthroplasty, it was recommended to consider amputation in patients with a good physical and mental condition.

Methods

• This cohort study included 81 patients treated with MKA and 32 patients treated with AKA after septic failure of TKA between 2003 and 2012.
• Researchers recorded demographic data, comorbidities, pathogens and complications such as re-infection, implant-failure or revision surgeries in 55MKA and 20AKA patients.
• After a mean interval of 55 months, they recorded functional outcome with use of the Lower-Extremity-Functional-Score (LEFS) and the patients reported general health status (SF-12-questionnaire).

Results

• Following MKA and AKA, occurrence of a major complication was reported in more than one-third of the cases, whereas recurrence of infection (the most common complication ) was with 22% after MKA and 35% after AKA.
• A comparable functional outcome was seen among patients with AKA and MKA, with a mean LEFS score of 37 and 28 respectively (p=0.181).
• Correspondingly, researchers noted a comparable physical quality of life with a mean physical SF-12 of 36 for AKA patients and a mean score of 30 for MKA patients (p=0.080).
• Notably, in comparison to other amputee patients (p < 0.01) or MKA patients (p < 0.01), 10 AKA patients that could be fitted with a microprocessor-controlled-knee-joint demonstrated with a mean LEFS of 56, a significantly better functional outcome.