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Archive for January 24th, 2012

2012 Pac Rim Meeting - A Pacific Forum for Physical Rehab

 

The United States Chapter of the International Society of Prosthetics and Orthotics held its bi-annual meeting in Honolulu this week.  Dr. Frank Gottschalk presented a half hour lecture titled, “Amputation Following Failed Infected Knee Arthroplasty”.  Dr. Gottschalk stressed the fact that total knee arthroplasty is a safe and common procedure, and explained that only less than 1% of patients succumb to infections.  However he believes that this problem could become more prevalent by 2030.

Dr. Gottschalk quoted statistics that there are approximately 500,000 knee replacements performed in the United States each year.  That number will swell to 3.5 million annual surgeries by 2030.  His research indicates that there are specific risk factors that lead to infections post surgery.  Diabetes, morbid obesity, smoking, rheumatoid arthritis, steroids, and revision surgeries are the primary culprits. Knee replacement surgeries for these osteoarthritis patients are usually a last resort.

The infections are of the staph, MRSA, and Gram Negative varieties.  Approximately 90% of the patients who succumb to infection post knee replacement surgery are treated successfully, but some conditions will deteriorate to the point where a limb will have to be amputated.  Dr. Gottschalk informed the audience of prosthetists about what types of patients will be successful candidates for prosthetic restoration.  He stressed that when a patient is motivated they can have the potential to accomplish anything.

His statistics show that younger patients who lose limbs following an infected knee replacement will have a good chance of becoming active community ambulators.  Dr. Gottschalk explained that elderly and morbidly obese patients will often times not be candidates for artificial legs and will most likely be confined to wheelchairs.  He concluded by saying that the more surgery a patient is exposed to, the more scar tissue will develop.  Scar tissue decreases functionality.  So it is in the patient’s best interest to keep the revisions to a minimum.

Frank Gottschalk, M.D. is a professor at the Department of Orthopaedic Surgery at the University of Texas Southwestern Medical Center at Dallas.  Dr. Gottschalk serves on the Board of United States Member Society, International Society of Prosthetics & Orthotics.