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Total hip and knee arthroplasty after lower extremity amputation in a military population
  1. Alexander Dan-Fong Li1,
  2. C T Eccleston2,
  3. V Abraham1,
  4. G C Balazs1,3 and
  5. A H Goldman1,3
  1. 1Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  2. 2School of Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
  3. 3Uniformed Services University of Health Sciences, Bethesda, MD, USA
  1. Correspondence to Dr A H Goldman, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA; ashton.goldman{at}


Introduction The military includes lower extremity amputees requiring arthroplasty; however, there is little literature on this population. The primary aim of this study was to report demographics and clinical factors in amputees who undergo total hip or knee arthroplasty (THA/TKA) in the Military Health System (MHS). Second, patient-reported outcome measures (PROMs) are reported.

Methods The Military Data Repository was queried for patients with lower extremity amputations and TKA or THA between 1 October 2014 and 12 October 2020. The medical records were reviewed and patients were contacted to complete PROMs. Mean follow-up for TKA and THA was 5.5 and 2.5 years, respectively.

Results Nineteen TKAs (76%) and eight THAs (28%) were performed in 25 patients. Mean age of TKA and THA patients at the time of arthroplasty was 57 years old. A majority of TKA (68%) and THA (57%) patients underwent amputations secondary to trauma. Nearly all TKAs were performed on the contralateral side to the amputation (95%), while half of THAs were performed on the ipsilateral side (50%). Two THAs (29%) were revised due to periprosthetic fractures, whereas six TKAs (32%) were revised or reoperated on due to infection. Ten TKA patients completed PROMs. The mean score on Knee Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) was 41.8 and Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) was 41.6 (Global Physical Health) and 49.6 (Global Mental Health).

Conclusions Most TKAs were performed on the contralateral limb, suggesting increased demand on the joint. The most common indication for amputation and post-TKA complication was trauma and infection, respectively. KOOS JR may not accurately capture the outcomes of this population, or they simply do worse. However, PROMIS-10 scores were similar to the non-amputee population, suggesting that the PROMIS-10 may be more useful than the KOOS JR.

  • hip
  • knee
  • orthopaedic & trauma surgery
  • trauma management
  • adult orthopaedics
  • limb reconstruction

Data availability statement

Data are available upon request.

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  • Contributors AD-FL planned the study, wrote and submitted the IRB, performed data collection and analysis, wrote and edited the manuscript, and submitted the study. CTE assisted in performing data collection and analysis and edited the manuscript. VA contributed to data analysis and editing the manuscript. GCB collected patient data using the military data repository to obtain initial cohort of patients and contributed data analysis and editing the manuscript. AHG was the principal investigator for the study and planned the study, edited the IRB, assisted in data collection and analysis and edited the manuscript. AHG was the guarantor of the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.