Revision of total knee arthroplasty in a patient with contralateral transfemoral amputation

Abstract

Background: Knee arthroplasty is an efficient solution for osteoarthrosis in amputees. However, because of overload on the implant, it is apparently more subject to failure than in the non-amputated population. The aim of this case report is to show a failure of primary total knee arthroplasty contralateral to transfemoral amputation that required revision involving a tissue bank because of severely compromised knee bone. Surgical strategies, rehabilitation, and postoperative care for the operated limb and the contralateral prosthesis were demonstrated. Case description and methods: A 60-year-old patient with early failure of total knee arthroplasty contralateral to transfemoral amputation underwent arthroplasty revision in which a graft from a tissue bank was used. After the revision, prosthesis length adjustment and exercise therapy were fundamental to the rehabilitation. Findings and outcomes: The patient progressed well after the revision of the arthroplasty, with increases on the Knee Society Score and 36-Item Short Form Health Survey scales. Conclusion: Knee arthroplasty in amputees should be planned differently to that of the general population. For the procedure to be successful, there should be greater attention to implant stability, equalization of leg length, and a postoperative regimen including muscle strengthening and range of motion exercises to achieve the required knee flexion. Clinical relevanceThis case report is important because it presents a challenging case of a unilateral transfemoral amputee with failed arthroplasty over the years in the contralateral limb. To our knowledge, such a case has not been described in the scientific literature. It would be helpful for surgeons and rehabilitation professionals to chart out a treatment protocol and also to prevent premature failure of the joint.

Total Knee Arthroplasty After Ipsilateral Below-knee Amputation: A Review of the Literature and Surgical Techniques

“…Ipsilateral knee replacement of below-knee amputees is extremely uncommon, with most of the literature describing degenerative changes necessitating TKA on the contralateral side [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. This is likely due to stresses on the contralateral limb from altered gait mechanics with a prosthesis [ 12 ].…”