From the Research
No, a total knee replacement is not an absolute contraindication to below-knee amputation (BKA). According to the most recent and highest quality study, a case report published in 2024 1, a patient with a BKA can undergo a total knee arthroplasty (TKA) in the same limb, and the procedure can be successful with proper planning and technique. The study highlights the importance of careful pre-operative planning, including positioning, alignment determination, surgical technique, and rehabilitation, to achieve the best outcome.
Key Considerations
- The presence of a knee prosthesis requires additional considerations during amputation surgery, and experienced surgeons can successfully perform a BKA on a patient with a previous total knee replacement.
- The level of amputation might need adjustment to ensure proper healing and future prosthetic fitting.
- Preoperative assessment should include detailed imaging of the knee replacement to understand its position and condition.
- Postoperative rehabilitation may require specialized protocols to account for both the knee replacement and the new amputation.
Decision-Making
The decision to proceed with BKA in a patient with a total knee replacement should be made after thorough evaluation of the patient's overall health, the condition of the knee prosthesis, and the specific indications for amputation, such as severe infection, trauma, or vascular compromise that cannot be managed by other means. As noted in a systematic review published in 2021 2, amputation is a real end result of knee replacements, and the prevalence of amputation as a complication of TKR can range from 0.1-10%. However, with proper planning and technique, a BKA can be a viable option for patients with a total knee replacement, as demonstrated in the case report published in 2024 1.