Harna Bushu, Arya Shivali, Arora Anil
Consultant Joint Replacement and Sports Medicine, Indus International Hospital, Derrabassi, Panjab, India.
Government Medical College and Hospital, Chandigarh, India.
Arch Bone Jt Surg. 2025;13(4):188-195. doi: 10.22038/ABJS.2024.80181.3659.
The study assessed the clinical and functional outcomes of transfemoral amputations following TKA complications, shedding light on a procedure often considered in extreme cases.
In this retrospective study, six patients undergoing above-knee amputation due to TKA complications were analysed. Diagnosis of periprosthetic joint infection relied on clinical presentation and the Musculoskeletal Infection Society Definition (2011). Patient demographics, comorbidities, and surgical interventions were meticulously recorded. The study aimed to contribute valuable insights into the intricacies of managing complications post-TKA.
The study cohort, constituting 0.002% of total TKA cases, exhibited a mean age of 78.8 years. Comorbidities, predominantly diabetes, were prevalent. The duration between TKA and amputation averaged 6.3 years. Surgical interventions, including revisions, debridements, and aspirations, were numerous, reflecting the complexity of managing complications. All patients underwent above-knee amputation using a single-stage approach, with careful consideration of the surgical site's condition. Post-amputation care, including stump care and prosthetic leg options, was tailored to individual patients' needs. Patients were diligently followed for a minimum of 12 months. Stump wounds healed without requiring revisions, and prosthetic limbs were successfully applied to three patients. Mobility status and disability scores, evaluated through the Sickness Impact Profile (SIP), showed significant improvement.
The study highlights periprosthetic joint infection as the primary cause of multiple failed procedures leading to amputation. Microbiological findings identified common pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa. Challenges posed by biofilm formation underscored the complexities of antibiotic treatment. Transfemoral amputation emerges as a feasible option for patients with multiple failed TKAs, particularly in cases of persistent infection. The decision-making process should encompass a thorough consideration of the number of failed procedures, cost-benefit analysis, and various psychosocial and economic factors. Further research and extensive multicentric studies are imperative to validate and expand upon these findings.
本研究评估了全膝关节置换术（TKA）并发症后经股截肢的临床和功能结局，为极端情况下常考虑的一种手术提供了见解。
在这项回顾性研究中，分析了6例因TKA并发症而接受膝上截肢的患者。假体周围关节感染的诊断依据临床表现和肌肉骨骼感染学会定义（2011年）。详细记录了患者的人口统计学特征、合并症和手术干预情况。该研究旨在为TKA术后并发症管理的复杂性提供有价值的见解。
该研究队列占TKA总病例的0.002%，平均年龄为78.8岁。合并症以糖尿病为主，较为普遍。TKA与截肢之间的平均间隔时间为6.3年。包括翻修、清创和穿刺抽吸在内的手术干预次数众多，反映了并发症管理的复杂性。所有患者均采用单阶段方法进行膝上截肢，并仔细考虑了手术部位的情况。截肢后护理，包括残端护理和假肢选择，根据个体患者的需求进行定制。对患者进行了至少12个月的密切随访。残端伤口愈合良好，无需翻修，3例患者成功安装了假肢。通过疾病影响量表（SIP）评估的活动状态和残疾评分显示有显著改善。
该研究强调假体周围关节感染是导致多次手术失败并最终截肢的主要原因。微生物学检查发现了常见病原体，包括金黄色葡萄球菌和铜绿假单胞菌。生物膜形成带来的挑战凸显了抗生素治疗的复杂性。对于多次TKA手术失败的患者，经股截肢是一种可行的选择，尤其是在持续感染的情况下。决策过程应全面考虑手术失败的次数、成本效益分析以及各种心理社会和经济因素。进一步的研究和广泛的多中心研究对于验证和扩展这些发现至关重要。
