Quality of Life and Outcomes After Treatment Failure for Recurrent Periprosthetic Joint Infection of Total Knee Arthroplasty: A Multicenter Retrospective Comparison of Transfemoral Amputation, Arthrodesis, and Permanent Spacer.

Abstract

In cases of recurrent treatment failure for periprosthetic joint infections (PJI) of the knee, above-the-knee amputation (AKA), knee arthrodesis, or permanent spacers are viable. Given the limited comparative data on outcomes between AKA and knee arthrodesis, as well as the lack of data on a permanent spacer, we conducted a retrospective study to evaluate and compare the quality of life and postoperative outcomes. All patients who had an AKA, a permanent spacer, or knee arthrodesis for repeated TKA infections at the Bordeaux University Hospital and Nantes University Hospital between January 2013 and December 2024 were included. There were 43 patients in the permanent spacer group, 35 in the AKA group, and eight in the arthrodesis group. All patients underwent the SF36 (Short Form-36) score, VAS score (visual analog scale), DN4 score (Douleur Neuropathique 4 questionnaire), and functional assessment. The AKA group showed significantly better outcomes in SF-36 scores, including general health (48.8 ± 19.8; P = 0.014), role limitations due to physical health (26.7 ± 34.1; P = 0.002), and pain (51.6 ± 31.6; P = 0.088), compared to the permanent spacer and arthrodesis groups. The VAS and DN4 scores were significantly better in the AKA group (1.96 ± 1.26 and 1.78 ± 1.04) compared to the spacer group (VAS: 3.83 ± 1.98, DN4: 2.79 ± 1.18) and arthrodesis group (VAS: 3.67 ± 1.37, DN4: 2.33 ± 1.63) with P = 0.002 and 0.023, respectively. Our findings suggest that AKA provides better pain relief, fewer complications, and superior quality of life compared to a permanent spacer. These results support considering AKA not only as a last-resort option, but as a viable alternative in selected patients.