Above-knee amputation after recurrent dislocations of total knee arthroplasty.

Amputation after total knee arthroplasty (TKA) is an extremely rare but disastrous complication. Most of the reported cases resulted from refractory deep joint sepsis or perioperative vascular complications. We present a case of above-knee amputation resulting from vascular complications after recurrent dislocations of a TKA in a patient with underlying end-stage renal disease. The possible association between certain metabolic diseases and instability of TKA is discussed. In contrast to the high incidence of vascular complications after traumatic knee dislocation, popliteal artery injury after TKA dislocation is seldom encountered. The importance of careful evaluation and serial physical examinations to exclude the possibility cannot be overemphasized, however. When compromise of the circulation was recognized, emergent exploration of the popliteal fossa for repair of the vascular injury presented the best chance to save the limb.