Studies Show Increased Risk of Catastrophic Amputation After Knee Joint Replacement in Low-Income Patients

 In Blog

Every surgical procedure has its risks and although rare, a risk of total knee arthroplasty is the possibility of above-knee amputation (AKA). AKA is sometimes the result of a prosthetic joint infection (PJI) after undergoing a total knee replacement surgery. In a small number of PJI cases, the treatment is unsuccessful in which case it is necessary for the surgeon to remove the limb above the knee. The complication is incredibly rare, however, a recent study in Clinical Orthopaedics and Related Research® (CORR®) led by Shyam Brahmabhatt, MD, of Rothman Orthopaedic Institute, Philadelphia, found that often low-income patients are at a higher risk of getting PJI and possibly requiring an additional procedure. After using data from a nationally representative hospital database (Nationwide Inpatient Sample), the researchers identified approximately 33,000 patients diagnosed with PJI after knee joint replacement surgery between 2010 and 2014.1 According to the research, race and sex do not affect the risk of AKA after PJI, however, income and insurance status do.

The research found that socioeconomic factors were significantly related to AKA risk, even after adjustment for the patients’ health status and other characteristics. Patients living in areas (based on ZIP code) in the lowest one-fourth of income were 58 percent more likely to sustain an AKA, compared to those living in the highest-income areas.1 The study also found that patients with public insurance were at a higher risk. Compared to those with private insurance, the odds of AKA were 94 percent higher for Medicare patients and 86 percent higher for Medicaid patients.1 When comparing African American and Caucasian patients, the research found that the risk of AKA was not significantly different which is important to note because previous research has suggested that race may have an impact on AKA risk after knee replacement surgery. The study also found that the risk for AKA following PJI was similar for both men and women.

This research is important because it suggests that where patients live has an impact on AKA risk. Dr. Brahmabhatt noted that “while ZIP code may not be a perfect measure of socioeconomic status, it is associated with the level of resources that may be available to people living in that area.”2 These findings call for the consideration of the importance of reducing inequalities in healthcare. Dr. Brahmabhatt expressed that after reviewing his findings “the message that [he] would impart is that upholding the principles of equity, social justice, and ensuring community health are important for all physicians.”2 In the future, utilization of new technology like TracPatch may be a useful tool in helping physicians and patients stay connected throughout the recovery process, while collecting the important data needed to help physicians care for each individual patient more effectively. For more information about TracPatch contact us today.


  1. Anderton, K. (2019, June 20). Low-income patients at increased risk of catastrophic amputation after knee joint replacement. Retrieved August 7, 2019, from
  2. Low Income Is a Risk Factor for ‘Catastrophic’ Amputation after Knee Joint Replacement. Retrieved from


Recommended Posts