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Above Knee Amputation in the Treatment of Failed Septic Total Knee Arthroplasty

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The Infected Total Knee Arthroplasty

Abstract

This chapter will review current concepts on above knee amputation (AKA) in the treatment of failed septic total knee arthroplasty (TKA). Most patients are satisfied with their AKA, insomuch as they would have taken an amputation earlier. However, their functional level following AKA for infection is low, with only half of patients managing to walk. More than six previous procedures attempting limb salvage and failed gastrocnemius flap are possible poor prognostic factors. A substantial percentage of patients fail to have a prosthetic limb fitted, and those who do seldom obtain functional independence. Knee fusion (KF) in treatment of recurrent infection after TKA has a better functional and ambulatory result compared to patients receiving AKA. KF patients have significantly higher rates of postoperative infection (14.5% versus 8.3%) and transfusion (55.1% versus 46.8%), whereas AKA patients have a higher rate of systemic complications (31.5% versus 25.9%) and in-hospital mortality (3.7% versus 2.1%). AKA patients have lower hospital charges ($79,686 versus $84,747), longer length of stay (11 versus 7 days), and higher 90-day readmission rate (19.4% versus 16.9%). KF is therefore preferable to AKA for patients who have persistent infected TKA after a failed two-stage reimplantation procedure.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, “La Paz” University Hospital-IdiPaz Paseo de la Castellana 261, 28046, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. Department of Physical Medicine and Rehabilitation, “La Paz” University Hospital-IdiPaz Paseo de la Castellana 261, 28046, Madrid, Spain

    Hortensia de la Corte-Rodriguez

  3. Department of Physical Medicine and Rehabilitation, Hospital Central de la Cruz Roja San José y Santa Adela, Avenida Reina Victoria 22-26, 28003, Madrid, Spain

    Juan M. Román-Belmonte

Authors
  1. E. Carlos Rodríguez-Merchán
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  2. Hortensia de la Corte-Rodriguez
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  3. Juan M. Román-Belmonte
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Correspondence to E. Carlos Rodríguez-Merchán .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London Hospitals , London, United Kingdom

    Sam Oussedik

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Rodríguez-Merchán, E.C., de la Corte-Rodriguez, H., Román-Belmonte, J.M. (2018). Above Knee Amputation in the Treatment of Failed Septic Total Knee Arthroplasty. In: Rodríguez-Merchán, E., Oussedik, S. (eds) The Infected Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-66730-0_21

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  • DOI: https://doi.org/10.1007/978-3-319-66730-0_21

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-66729-4

  • Online ISBN: 978-3-319-66730-0

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