Transfemoral amputation versus knee arthrodesis for failed total knee replacement: A systematic review of outcomes
Background: The options available to salvage a failed total knee replacement (TKR) include transfemoral amputation (TFA) and knee arthrodesis (KA). This systematic review aims to evaluate outcomes following either TFA or KA, comparing ambulatory status, additional subsequent surgery, postoperative i...
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| Veröffentlicht in: | The knee 2024-03, Vol.47, p.63-80 |
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| creator | Low, Juin Hoellwarth, Jason Shih Akhtar, Muhammad Adeel Tetsworth, Kevin Al-Muderis, Munjed |
| description | Background: The options available to salvage a failed total knee replacement (TKR) include transfemoral amputation (TFA) and knee arthrodesis (KA). This systematic review aims to evaluate outcomes following either TFA or KA, comparing ambulatory status, additional subsequent surgery, postoperative infection, pain, health-related quality of life (HRQoL), and mortality rate.
A literature search was conducted in EMBASE, Ovid Medline, and PubMed. Only primary research studies were included and data were independently extracted using a standardized form. The methodological quality of the studies was evaluated using Newcastle-Ottawa Scale.
Forty-four papers were included, comprising 470 TFA and 1034 KA patients. The methodological quality of the studies was moderate. No TFA versus KA randomized controlled trials could be identified. Pooled data totals via subgroup analyses were performed, owing to inconsistent reporting methods in the included studies. Prosthesis use rate by TFA patients was 157/316 = 49.7%. Significant differences included that TFA patients had lower rates of ambulatory capacity than KA patients (139/294 = 45.6% versus 248/287 = 86.4%, p |
| doi_str_mv | 10.1016/j.knee.2023.12.012 |
| format | Article |
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A literature search was conducted in EMBASE, Ovid Medline, and PubMed. Only primary research studies were included and data were independently extracted using a standardized form. The methodological quality of the studies was evaluated using Newcastle-Ottawa Scale.
Forty-four papers were included, comprising 470 TFA and 1034 KA patients. The methodological quality of the studies was moderate. No TFA versus KA randomized controlled trials could be identified. Pooled data totals via subgroup analyses were performed, owing to inconsistent reporting methods in the included studies. Prosthesis use rate by TFA patients was 157/316 = 49.7%. Significant differences included that TFA patients had lower rates of ambulatory capacity than KA patients (139/294 = 45.6% versus 248/287 = 86.4%, p < 0.001), TFA ambulators were less likely to use an ambulatory aid (55/135 = 40.7% versus 167/232 = 72.0%, p < 0.001), and TFA was associated with a greater postoperative infection rate than KA (29/118 = 24.6% versus 129/650 = 17.2%, p = 0.054). There was a similar rate of revision surgery between TFA and KA (37/183 = 20.2% versus 145/780 = 18.6%, p = 0.612). Data on HRQoL for both TFA and KA were limited, contradictory, and heterogeneous.
No randomized controlled trials comparing TFA versus KA exist;therefore, current data likely reflects substantial selection bias. The currently available evidence suggests that KA patients are significantly more likely to achieve independent bipedal ambulation than TFA patients. In both treatment cohorts, subsequent infection and revision surgery remain a relatively common occurrence.</description><identifier>ISSN: 0968-0160</identifier><identifier>ISSN: 1873-5800</identifier><identifier>EISSN: 1873-5800</identifier><identifier>DOI: 10.1016/j.knee.2023.12.012</identifier><identifier>PMID: 38245922</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Failed Total Knee Replacement ; Knee Arthrodesis ; Knee Arthroplasty ; Outcomes ; Transfemoral Amputation</subject><ispartof>The knee, 2024-03, Vol.47, p.63-80</ispartof><rights>2023</rights><rights>Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c307t-db13900b2f261710beeb3abf8b546439abf255af9243c0637d7a8491862b27893</cites><orcidid>0000-0002-6890-6883</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.knee.2023.12.012$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38245922$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Low, Juin</creatorcontrib><creatorcontrib>Hoellwarth, Jason Shih</creatorcontrib><creatorcontrib>Akhtar, Muhammad Adeel</creatorcontrib><creatorcontrib>Tetsworth, Kevin</creatorcontrib><creatorcontrib>Al-Muderis, Munjed</creatorcontrib><title>Transfemoral amputation versus knee arthrodesis for failed total knee replacement: A systematic review of outcomes</title><title>The knee</title><addtitle>Knee</addtitle><description>Background: The options available to salvage a failed total knee replacement (TKR) include transfemoral amputation (TFA) and knee arthrodesis (KA). This systematic review aims to evaluate outcomes following either TFA or KA, comparing ambulatory status, additional subsequent surgery, postoperative infection, pain, health-related quality of life (HRQoL), and mortality rate.
A literature search was conducted in EMBASE, Ovid Medline, and PubMed. Only primary research studies were included and data were independently extracted using a standardized form. The methodological quality of the studies was evaluated using Newcastle-Ottawa Scale.
Forty-four papers were included, comprising 470 TFA and 1034 KA patients. The methodological quality of the studies was moderate. No TFA versus KA randomized controlled trials could be identified. Pooled data totals via subgroup analyses were performed, owing to inconsistent reporting methods in the included studies. Prosthesis use rate by TFA patients was 157/316 = 49.7%. Significant differences included that TFA patients had lower rates of ambulatory capacity than KA patients (139/294 = 45.6% versus 248/287 = 86.4%, p < 0.001), TFA ambulators were less likely to use an ambulatory aid (55/135 = 40.7% versus 167/232 = 72.0%, p < 0.001), and TFA was associated with a greater postoperative infection rate than KA (29/118 = 24.6% versus 129/650 = 17.2%, p = 0.054). There was a similar rate of revision surgery between TFA and KA (37/183 = 20.2% versus 145/780 = 18.6%, p = 0.612). Data on HRQoL for both TFA and KA were limited, contradictory, and heterogeneous.
No randomized controlled trials comparing TFA versus KA exist;therefore, current data likely reflects substantial selection bias. The currently available evidence suggests that KA patients are significantly more likely to achieve independent bipedal ambulation than TFA patients. In both treatment cohorts, subsequent infection and revision surgery remain a relatively common occurrence.</description><subject>Failed Total Knee Replacement</subject><subject>Knee Arthrodesis</subject><subject>Knee Arthroplasty</subject><subject>Outcomes</subject><subject>Transfemoral Amputation</subject><issn>0968-0160</issn><issn>1873-5800</issn><issn>1873-5800</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kE1v1DAQhq2Kii6FP8AB-cglYWzny4hLVfElVeqlnC3HGateknjxOK367_GyhSMnj-TnfUfzMPZWQC1AdB_29c8VsZYgVS1kDUKesZ0YelW1A8ALtgPdDVUh4YK9ItoDQKeb9iW7UINsWi3ljqW7ZFfyuMRkZ26Xw5ZtDnHlD5hoI37cwG3K9ylOSIG4j4l7G2aceI65ZP4QCQ-zdbjgmj_yK05PlHEpRa78PAR85NHzuGUXF6TX7NzbmfDN83vJfnz5fHf9rbq5_fr9-uqmcgr6XE2jUBpglF52ohcwIo7Kjn4Y26ZrlC6jbFvrtWyUg071U2-HRouhk6PsB60u2ftT7yHFXxtSNksgh_NsV4wbGalF37ay01BQeUJdikQJvTmksNj0ZASYo2uzN8c7zdG1EdIU1yX07rl_Gxec_kX-yi3ApxOA5cpiIRlyAVeHU0jospli-F__b-bjkZ0</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Low, Juin</creator><creator>Hoellwarth, Jason Shih</creator><creator>Akhtar, Muhammad Adeel</creator><creator>Tetsworth, Kevin</creator><creator>Al-Muderis, Munjed</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6890-6883</orcidid></search><sort><creationdate>20240301</creationdate><title>Transfemoral amputation versus knee arthrodesis for failed total knee replacement: A systematic review of outcomes</title><author>Low, Juin ; Hoellwarth, Jason Shih ; Akhtar, Muhammad Adeel ; Tetsworth, Kevin ; Al-Muderis, Munjed</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-db13900b2f261710beeb3abf8b546439abf255af9243c0637d7a8491862b27893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Failed Total Knee Replacement</topic><topic>Knee Arthrodesis</topic><topic>Knee Arthroplasty</topic><topic>Outcomes</topic><topic>Transfemoral Amputation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Low, Juin</creatorcontrib><creatorcontrib>Hoellwarth, Jason Shih</creatorcontrib><creatorcontrib>Akhtar, Muhammad Adeel</creatorcontrib><creatorcontrib>Tetsworth, Kevin</creatorcontrib><creatorcontrib>Al-Muderis, Munjed</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The knee</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Low, Juin</au><au>Hoellwarth, Jason Shih</au><au>Akhtar, Muhammad Adeel</au><au>Tetsworth, Kevin</au><au>Al-Muderis, Munjed</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transfemoral amputation versus knee arthrodesis for failed total knee replacement: A systematic review of outcomes</atitle><jtitle>The knee</jtitle><addtitle>Knee</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>47</volume><spage>63</spage><epage>80</epage><pages>63-80</pages><issn>0968-0160</issn><issn>1873-5800</issn><eissn>1873-5800</eissn><abstract>Background: The options available to salvage a failed total knee replacement (TKR) include transfemoral amputation (TFA) and knee arthrodesis (KA). This systematic review aims to evaluate outcomes following either TFA or KA, comparing ambulatory status, additional subsequent surgery, postoperative infection, pain, health-related quality of life (HRQoL), and mortality rate.
A literature search was conducted in EMBASE, Ovid Medline, and PubMed. Only primary research studies were included and data were independently extracted using a standardized form. The methodological quality of the studies was evaluated using Newcastle-Ottawa Scale.
Forty-four papers were included, comprising 470 TFA and 1034 KA patients. The methodological quality of the studies was moderate. No TFA versus KA randomized controlled trials could be identified. Pooled data totals via subgroup analyses were performed, owing to inconsistent reporting methods in the included studies. Prosthesis use rate by TFA patients was 157/316 = 49.7%. Significant differences included that TFA patients had lower rates of ambulatory capacity than KA patients (139/294 = 45.6% versus 248/287 = 86.4%, p < 0.001), TFA ambulators were less likely to use an ambulatory aid (55/135 = 40.7% versus 167/232 = 72.0%, p < 0.001), and TFA was associated with a greater postoperative infection rate than KA (29/118 = 24.6% versus 129/650 = 17.2%, p = 0.054). There was a similar rate of revision surgery between TFA and KA (37/183 = 20.2% versus 145/780 = 18.6%, p = 0.612). Data on HRQoL for both TFA and KA were limited, contradictory, and heterogeneous.
No randomized controlled trials comparing TFA versus KA exist;therefore, current data likely reflects substantial selection bias. The currently available evidence suggests that KA patients are significantly more likely to achieve independent bipedal ambulation than TFA patients. In both treatment cohorts, subsequent infection and revision surgery remain a relatively common occurrence.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>38245922</pmid><doi>10.1016/j.knee.2023.12.012</doi><tpages>18</tpages><orcidid>https://orcid.org/0000-0002-6890-6883</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | Failed Total Knee Replacement Knee Arthrodesis Knee Arthroplasty Outcomes Transfemoral Amputation |
| title | Transfemoral amputation versus knee arthrodesis for failed total knee replacement: A systematic review of outcomes |
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