• Ashraf T Hantouly, Jad Lawand, Osama Alzobi, Amir Human Hoveidaei, Loay A Salman, Shamsi Hameed, Ghalib Ahmed, and Mustafa Citak.
• Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
• Arch Orthop Trauma Surg. 2024 Sep 26.

PurposeTo systematically review the literature on the outcomes of above knee amputation as a salvage procedure after periprosthetic joint infection in total knee arthroplasty.MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Scopus, Web of Science, and Embase electronic databases were utilized to identify all studies evaluating clinical outcomes of patients with above knee amputation following PJI from inception to June 24, 2023. Studies were excluded for failure to report functional outcomes specifically related to AKA in PJI following TKA, utilizing surgical interventions other than amputation, AKA indicated for other reasons than PJI, technical studies, conference abstracts, case reports and non-English language. The quality of studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria.ResultsSeven retrospective studies, categorized as Therapeutic Level III evidence, were analyzed, involving a total of 188 patients who underwent AKA following PJI after TKA. The findings consistently indicate that post-AKA, patients experienced a notable decline in their level of independence and reported worsening ambulatory status. Infection and wound complications were common post-AKA, leading to revision surgeries, while the mortality rate ranged from 9 to 50% in the included studies. Polymicrobial organisms were frequently found in pre-AKA PJI, with MRSA being a common causative organism.ConclusionsAKA due to PJI following TKA is associated with restricted mobility and high mortality rate. Polymicrobial infections and MRSA were identified as common infecting organisms, emphasizing the complexities and challenges associated with managing these infections. The reported functional outcomes, ambulatory status, complications, reoperations, and mortality rates highlight the importance of providing comprehensive, individualized care to these patients.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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