Prosthesis-related Indications for Transfemoral Amputation after Total Knee Arthroplasty

Objective: Few studies have described the complications leading to transfemoral amputation after total knee arthroplasty. The aim of this study was to demonstrate which long term prosthesis-related complications can lead to the loss of a limb after knee joint replacement and to provide clinical guidance regarding the situations that generate an increased likelihood of a patient requiring above knee amputation after total knee arthroplasty. Methods: All patients who received above knee amputations between 2005 and 2015 at our clinic due to prosthesis-related complications after total knee arthroplasty were included in this retrospective study. We analyzed the frequencies of various reasons for above knee amputation as well as their influence on the decision to amputate. Results: Sixteen patients received a transfemoral amputation after total knee arthroplasty at our clinic during the study period. Joint infection was the principal reason for above knee amputation in all patients, and at least two additional factors that influenced the decision to amputate were present in each presented case. Conclusions: The indication leading to transfemoral amputation after total knee arthroplasty is always multifactorial. An infection is present in most cases as the main contributing factor and is usually accompanied by at least two other factors. In some cases of recurrent persistent periprothetic joint infections, transfemoral amputation remains the only salvage procedure in order to control the infection, and in some cases, it is a life-saving procedure.