TY - JOUR

T1 - Transfemoral Amputation After Failure of Knee Arthroplasty

T2 - A Nationwide Register-Based Study

AU - Gottfriedsen, Tinne B

AU - Schrøder, Henrik M

AU - Odgaard, Anders

PY - 2016/12/7

Y1 - 2016/12/7

N2 - BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty in a nationwide population.METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258 were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test.RESULTS: A total of 115 amputations were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed from 2008 to 2013 (p = 0.06). The causes of the amputation were periprosthetic infection in 95 cases (83%), soft-tissue deficiency in 26 (23%), severe bone loss in 21 (18%), extensor mechanism disruption in 11 (10%), intractable pain in 11 (10%), periprosthetic fracture in 10 (9%), and vascular complications in 9 (8%). In 92 (80%) of the cases, there were ≥2 indications for amputation.CONCLUSIONS: The cumulative incidence of amputation within 15 years after primary knee arthroplasty was 0.32%, with a tendency toward a decreasing incidence in the last part of the study period.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty in a nationwide population.METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258 were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test.RESULTS: A total of 115 amputations were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed from 2008 to 2013 (p = 0.06). The causes of the amputation were periprosthetic infection in 95 cases (83%), soft-tissue deficiency in 26 (23%), severe bone loss in 21 (18%), extensor mechanism disruption in 11 (10%), intractable pain in 11 (10%), periprosthetic fracture in 10 (9%), and vascular complications in 9 (8%). In 92 (80%) of the cases, there were ≥2 indications for amputation.CONCLUSIONS: The cumulative incidence of amputation within 15 years after primary knee arthroplasty was 0.32%, with a tendency toward a decreasing incidence in the last part of the study period.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Amputation

KW - Arthritis

KW - Arthroplasty, Replacement, Knee

KW - Denmark

KW - Female

KW - Femur

KW - Humans

KW - Male

KW - Middle Aged

KW - Prosthesis Failure

KW - Prosthesis-Related Infections

KW - Registries

KW - Reoperation

KW - Retrospective Studies

KW - Risk Factors

KW - Young Adult

KW - Journal Article

U2 - 10.2106/JBJS.15.01362

DO - 10.2106/JBJS.15.01362

M3 - Journal article

C2 - 27926677

VL - 98

SP - 1962

EP - 1969

JO - Journal of Bone and Joint Surgery - Series A

JF - Journal of Bone and Joint Surgery - Series A

SN - 0021-9355

IS - 23

ER -