Outcomes of Total Knee Arthroplasty with a Prior Contralateral Above-Knee Amputation: A Report of 10 Cases

BACKGROUND: Total knee arthroplasty (TKA) in the setting of a prior contralateral above-knee amputation (AKA) represents a rare scenario with limited reported outcomes. As such, it is difficult for surgeons to effectively counsel these patients relative to risks and expected outcomes after TKA. We report outcomes for a series of 10 such patients. METHODS: We retrospectively reviewed all patients at our institution from 2005 to 2018 who underwent a primary TKA and prior contralateral AKA and had a minimum 12-month follow-up. Data regarding complications, ambulatory status, reported pain, patient demographics, length of follow-up, and comorbidities were obtained. RESULTS: Ten patients met criteria. Follow-up ranged from 1 to 8 years. Six reported no pain or improved pain with weight-bearing. Ambulatory status worsened for 5 patients, remained unchanged for 3, and improved for 2. Five patients had significant postoperative complications: infection requiring repeat surgery (3), quadriceps tendon rupture (1), and revision for implant failure and instability (1). Patients in this cohort had a median of 3 medical comorbidities known to affect postoperative outcomes and complication rates. CONCLUSIONS: While a contralateral AKA is not an absolute contraindication to TKA, these results should influence patient counseling. Most of our cohort benefited from improved pain, but only 2 of 10 had improved ambulation and half had significant complications. Medical comorbidities may have contributed to these complications. Surgeons contemplating TKA in this situation might consider modified postoperative recovery protocols and aggressive preoperative optimization of medical comorbidities to lower the risk of complication in this high-risk population.