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

Dong, Katherine; Cohen-Rosenblum, Anna; Hartzler, Molly

doi:10.1016/j.artd.2022.03.020

Cited by 5 publications

(9 citation statements)

References 28 publications

(34 reference statements)

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“…For TKR in amputees, the medial para-patellar approach remained the standard surgical approach. However, Dong et al [ 24 ] described placing the skin incision more medially, to avoid the tibial tuberosity and reduce potential problems associated with prosthetic loading over the scar. The reporting of implants used was poor, with a combination of cruciate retaining, posterior stabilised, highly constrained and hinged components reported [ 22 , 24 – 28 , 31 , 47 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

Hip and knee replacement in lower limb amputees: a scoping review

Walton,

Chatterton,

Goodwin

2024

BMC Musculoskelet Disord

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Background There are many consequences of lower limb amputation, including altered biomechanics of gait. It has previously been shown that these can lead to increased rates of osteoarthritis (OA). A common and successful treatment for severe OA is joint replacement. However, it is unclear whether amputees undergoing this surgery can expect the same outcomes or complication profile compared with non-amputees. Furthermore, there are key technical challenges associated with hip or knee replacement in lower limb amputees. This scoping review aimed to identify and summarise the existing evidence base. Methods This was a systematic scoping review performed according to PRISMA guidelines. An electronic database search of MEDLINE (PubMed), Cochrane Library, EMBASE and CINAHL was completed from the date of inception to 1st April 2023. All peer reviewed literature related to hip or knee replacement among lower limb amputees was included. Results Of the 931 records identified, 40 studies were included in this study. The available literature consisted primarily of case reports and case series, with generally low level of evidence. In total, there were 265 patients of which 195 received total hip replacement (THR), 51 received total knee replacement (TKR) and 21 received hip hemiarthroplasty. The most common reason for amputation was trauma (34.2%), and the main indication for joint replacement was OA (77.1%), occurring more frequently in the contralateral limb (66.7%). The outcomes reported varied widely between studies, with most suggesting good functional status post-operatively. A variety of technical tips were reported, primarily concerned with intra-operative control of the residual limb. Conclusion There is a need for more observational studies to clearly define the association between amputation and subsequent need for joint replacement. Furthermore, comparative studies are needed to identify whether amputees can be expected to achieve similar functional outcomes after surgery, and if they are at higher risk of certain complications.

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Section: Resultsmentioning

confidence: 99%

Hip and knee replacement in lower limb amputees: a scoping review

Walton,

Chatterton,

Goodwin

2024

BMC Musculoskelet Disord

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“…Rehabilitation is a key aspect of quality of life and functionality following TKA and BKA, but it is especially important for patients who undergo both procedures ipsilaterally. BKA is preferred over above-knee amputation due to its association with improved functional outcomes [ 7 ]. The use of an anti-gravity treadmill is one specific rehabilitation modality that has been found to be useful in achieving maximum prosthetic functionality after BKA [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…A successful result in a TKA in a below-knee amputee has previously been achieved using navigation assistance [ 22 ]. Similar to other cases, special consideration was given towards positioning techniques, alignment of implants, and the rehabilitation plan to maximize exposure, ensure stability, and achieve a successful outcome to satisfy the patient [ 7 , 22 - 24 ]. In patients who undergo TKA after ipsilateral BKA, the timeline between the operation and weight-bearing varies case by case [ 7 , 22 - 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similar to other cases, special consideration was given towards positioning techniques, alignment of implants, and the rehabilitation plan to maximize exposure, ensure stability, and achieve a successful outcome to satisfy the patient [ 7 , 22 - 24 ]. In patients who undergo TKA after ipsilateral BKA, the timeline between the operation and weight-bearing varies case by case [ 7 , 22 - 24 ]. This patient was allowed to immediately weight-bear using his BKA prosthesis.…”

Section: Discussionmentioning

confidence: 99%

“…While ipsilateral amputation is not a contraindication for TKA, it presents orthopedic surgeons with a unique challenge. Focus on pre-operative planning, proper positioning, alignment techniques, and rehabilitation are crucial to obtaining the best outcome [ 7 ]. This case report presents a below-knee amputee who underwent an ipsilateral TKA.…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Total Knee Arthroplasty in Ipsilateral Below-Knee Amputee

Marrero,

Willard

2024

jocr

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Introduction: Total knee arthroplasty (TKA) has the highest annual incidence among all joint replacement surgeries. Below-knee amputation (BKA) is another common procedure to treat lower-limb-threatening pathologies. These two procedures are commonly performed individually, but an ipsilateral TKA performed on a BKA patient is rare. While ipsilateral amputation is not a contraindication for TKA, it presents orthopaedic surgeons with a unique case and necessitates thoughtful pre-operative planning regarding proper positioning, alignment determination, surgical technique, and rehabilitation for the best outcome. Objectives: We present a case of a patient with a BKA who underwent ipsilateral TKA. Case Report: This patient has a history of osteoarthritis (OA) of the right knee and diabetic neuropathy and underwent a right BKA after sustaining second-degree thermal burns to the bilateral forefeet. The patient was scheduled to undergo elective TKA prior to these injuries but was forced to postpone due to their severity. Following the BKA, the patient regained his ability to ambulate independently with prosthesis but continued to suffer from OA symptoms. The patient was then scheduled for surgery, and a TKA was performed. Results: The patient underwent a TKA and tolerated the surgery well without complications. Appropriate positioning was achieved using a popliteal post. Alignment and tibial cut were checked using fluoroscopy. All components were cemented into position, and the patella was resurfaced. The patient did well postoperatively and was using his prosthesis and ambulating independently at the final follow-up. Keywords: Below-knee amputation, total knee arthroplasty, osteoarthritis.

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