title: Trends and Outcomes in the Treatment of Failed Septic Total Knee Arthroplasty: Comparing Arthrodesis and Above-Knee Amputation.
abstract: Options for treatment of a failed septic total knee arthroplasty (TKA) include arthrodesis and above-knee amputation (AKA). Little comparative data exist to help clinicians when considering these alternatives.
  
  
  
  A national database was queried for patients who underwent either knee arthrodesis or AKA for an infected TKA between 2005 and 2012. Procedure volumes, postoperative complications, hospital charges, length of stay, and 90-day readmission rates were evaluated.
  
  
  
  A total of 2634 patients underwent arthrodesis and 5001 patients underwent AKA for septic TKA. The percentage of total patients who underwent AKA increased significantly throughout the study period compared to knee arthrodesis. Patients who underwent AKA tended to be older and have more medical comorbidities. Arthrodesis patients had a significantly higher rate of postoperative infection (14.5% vs 8.3%, P < .0001) and transfusion (55.1% vs 46.8%, P < .0001), whereas AKA patients had a higher rate of systemic complications (31.5% vs 25.9%, P < .0001) and in-hospital mortality (3.7% vs 2.1%, P < .0001). The AKA cohort had lower hospital charges ($79,686 vs $84,747, P = .004), longer length of stay (11 vs 7 days, P < .0001), and higher 90-day readmission rate (19.4% vs 16.9%).
  
  
  
  Our data suggest that there is an increasing trend toward AKA for the treatment of a failed infected TKA when compared to arthrodesis. Comparative analysis of the outcomes of these procedures should help the clinician when weighing these alternatives.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: James B
authors.initials: JB
authors.lastname: Carr
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: James A
authors.initials: JA
authors.lastname: Browne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods* / Q000639:trends; D001174:Arthrodesis / Q000379:methods* / Q000639:trends; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000639:trends*; D016896:Treatment Outcome
keywords: above-knee amputation; knee arthrodesis; periprosthetic joint infection; septic TKA; total knee arthroplasty