Dataset Information

Osseointegration Following Transfemoral Amputation After Infected Total Knee Replacement: A Case Series of 10 Patients With a Mean Follow-up of 5 Years.

ABSTRACT:

Background

Management of total knee replacement (TKR) infection may sometimes prompt knee fusion (KF) or transfemoral amputation (TFA), both associated with low mobility and quality of life (QOL). Transcutaneous osseointegration for amputees provides superior mobility and QOL vs traditional socket prostheses but has not been studied for patients with a history of infected TKR. This study investigates the following hypothesis: Patients who have had TFA or KF following infected TKR achieve better mobility and QOL following transfemoral osseointegration.

Material and methods

A retrospective evaluation of the prospectively maintained registry identified 10 patients who had prior infected TKR. The mobility assessments (patient daily prosthesis wear time, K-level, Timed Up and Go, 6-Minute Walk Test) and QOL surveys (Questionnaire for Persons with a Transfemoral Amputation Global, Mobility, and Problem scores) were compared preoperatively and after at least 2 years. Complications requiring an additional surgery were also evaluated.

Results

Daily wear hours, K-level, and 6-Minute Walk Test and Questionnaire for Persons with a Transfemoral Amputation Global and Problem scores significantly improved (P < .05). Through 1 year, 4 patients (40%) had additional surgeries. After several years, 7 patients (70%) had at least 1 additional surgery, and 5 (50%) had multiple, for an average of 1 debridement and 1.3 soft-tissue refashionings per patient. One patient died of newly diagnosed cancer 1 year after transcutaneous osseointegration for amputees.

Conclusion

Transfemoral osseointegration confers significantly better mobility and QOL vs KF or a TFA with traditional socket prostheses following infected TKR. Technique improvements to prevent subsequent surgeries may provide an increasingly streamlined experience.

SUBMITTER: Akhtar MA

PROVIDER: S-EPMC9126745 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

Osseointegration Following Transfemoral Amputation After Infected Total Knee Replacement: A Case Series of 10 Patients With a Mean Follow-up of 5 Years.

Akhtar Muhammad Adeel MA Hoellwarth Jason Shih JS Tetsworth Kevin K Oomatia Atiya A Al Muderis Munjed M

Arthroplasty today 20220521

<h4>Background</h4>Management of total knee replacement (TKR) infection may sometimes prompt knee fusion (KF) or transfemoral amputation (TFA), both associated with low mobility and quality of life (QOL). Transcutaneous osseointegration for amputees provides superior mobility and QOL vs traditional socket prostheses but has not been studied for patients with a history of infected TKR. This study investigates the following hypothesis: Patients who have had TFA or KF following infected TKR achieve ...[more]

PMID: 35620587

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Project description:ObjectiveThe purpose of this study was to qualitatively assess the first-hand lived experiences of patients with amputation who had transitioned from a traditional socket (TS) to Osseointegration (OI) to impact their overall quality of life (QOL) and function.MethodsThis was a qualitative phenomenological study. Participants who had a unilateral transfemoral amputation and fit the study's inclusion criteria were interviewed in a semi-structured format regarding their quality of life and function before and after transitioning from a traditional socket (TS) to Osseointegration (OI). Responses were then analyzed through line-by-line coding to determine themes that were relevant to QOL outcomes for this study.ResultsEleven participants were interviewed in this study. The qualitative analysis demonstrated an emergence of 6 main themes consisting of "Improved Quality of Life," "Supportive Community," "Previous Ill-fitting Socket," "Greater Function," "Improved Osseo-perception," and "Promotion of Community Accessibility". Strengths included the use of an OI-specific quality of life assessment with adapted questions from validated outcome measures, international participants, and use of thematic analysis for data analysis. Weaknesses included sample size, niche participant population, and OI as a revision procedure only. More research is still necessary to explore/determine the benefits and detriments of Osseointegration as an alternative to traditional sockets for prosthetic devices.ConclusionIndividuals who have undergone Osseointegration procedure discuss being more satisfied with their prosthesis and quality of life when compared to their previous experience of a traditional socket.Impact statementThis is a first of its kind study reporting on the lived experiences of those who have undergone OI. The field of amputation rehabilitation is expanding rapidly and knowing how this procedure impacts quality of life is important for healthcare professionals to understand as new frontiers are explored in this field.

Project description:ObjectivesThe main objective was to investigate 5-year outcomes in patients with knee osteoarthritis, randomised to one of two non-surgical treatments.SettingTwo outpatient clinics.ParticipantsAt baseline, 100 patients with radiographic and symptomatic knee osteoarthritis not found eligible for knee replacement (KR) were included. Main exclusion criteria were average score above 75 of the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, function of daily living and quality of life; KOOS4 and average knee pain the previous week greater than 60 mm on a 100 mm visual analogue scale.InterventionsPatients were randomised to supervised non-surgical treatment consisting of patient education, supervised exercise, weight loss, insoles, and pain medication (the MEDIC treatment) or written advice. The 12-week MEDIC treatment included patient education, neuromuscular exercise, insoles and a dietary weight loss programme and/or pain medication if needed and written advice consisted of two leaflets.Primary and secondary outcome measuresPrimary outcome was 5-year mean change for KOOS4. Secondary outcomes included KOOS subscales, self-reported health, usage of pain medication and self-reported physical activity.ResultsThirty-nine (78%) and 36 (72%) from the MEDIC and written advice groups responded at 5 years. There were no between-group differences in KOOS4 (difference 5.3 (95% CI -1.5 to 12.1) or any secondary outcomes. However, the 95% CI included the minimal clinically important difference for the main outcome.Seventy-six percent of the MEDIC group and 66% of the written advice group experienced clinically important improvements in KOOS4.Fifteen patients (30%) from the MEDIC group and 17 (34%) from the written advice group received KR in the index knee. Undergoing KR did not result in a statistically significant greater improvement in KOOS4 (difference 6.1 (95% CI -1.1 to 13.4).ConclusionsNo statistically significant differences between supervised non-surgical treatment and written advice were demonstrated at 5 years. Most patients experienced clinically important improvements, irrespective of initial treatment strategy or KR.Trial registration numberNCT01535001; ClinicalTrials.gov.

Project description:IntroductionThe aim of this work is to compare in a retrospective study, the radiological results of three series of different total knee replacements performed using Orthopilot computer-based alignment system (Group A, 31 patients), a totally intramedullary alignment system (Group B, 34 patients) and a totally extramedullary alignment system (Group C, 32 patients).Materials and methodsAt a medium follow-up of 15 years, all patients underwent call interview for clinical update. Of the 115 patients initially enrolled in the study, only 97 were available for radiological assessment. Both standing long-leg antero-posterior radiographs and lateral radiographs of the knee had been taken for every patient at 1 year-follow-up and at the last follow-up.ResultsAt the last follow-up, the mean hip-knee-ankle angle (HKA) was 179.1° (range: 176°-184°) for group A, 178.6° (range: 173°-186°) for group B and 177.8° (range: 172°-186°) for group C with no statistically significant difference among the 3 groups. The mean frontal femoral component angle (FFC) was 90.5° (range: 87°-94°) for group A, 91.05° (range: 85°-95°) for group B and 91.19° (range: 85°-96°) for group C and there was no statistically significant difference among the three groups. The mean frontal tibial component angle (FTC) was 89.9° (range: 83°-97°) for group A, 90.6° (range: 87°-95°) for group B and 90.8° (range: 86°-95°) for group C and there was no statistically significant difference among the three groups. The mean tibial component inclination in the sagittal plane was 1° (range: 3°-0°) for group A, 3.6° (range: 7°-0°) for group B and 3.1° (range: 6°-0°) for group C.Discussion and conclusionOur results demonstrated statistically significant differences between computer-assisted and extramedullary group, in favour of navigated group in terms of implant position and mechanical alignment. Computer-assisted group showed superior but not statistically significant differences compared to intramedullary alignment system in terms of implant position and mechanical alignment. We advocate the use of computer-assisted system routinely in total knee replacement. As an alternative, we suggest the use of intramedullary system.

Dataset Information

Osseointegration Following Transfemoral Amputation After Infected Total Knee Replacement: A Case Series of 10 Patients With a Mean Follow-up of 5 Years.

Background

Material and methods

Results

Conclusion

Publications

Osseointegration Following Transfemoral Amputation After Infected Total Knee Replacement: A Case Series of 10 Patients With a Mean Follow-up of 5 Years.

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