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Natural History of Total Knee Arthroplasty Following Soft Tissue Defect Reconstruction with Flaps
Grzegorz J. Kwiecien, MD, Grigorios Lamaris, MD, PhD, Bahar Bassiri-Gharb, MD, PhD, Trevor Murray, MD, Mark F. Hendrickson, MD, James E. Zins, MD, Raymond Isakov, MD.
Cleveland Clinic, Cleveland, OH, USA.

PURPOSE:Insufficient soft-tissue coverage following total knee arthroplasty (TKA) jeopardizes prosthesis retention and may lead to significant complications. The aim of this study was to evaluate natural history of TKA following flap reconstruction of soft-tissue defects in a large cohort of patients.
METHODS:A retrospective review of patients treated with flaps after failed TKA between 1998 and 2014 was conducted. Patients requiring flap coverage of full-thickness defects were included into group 1. Patients with no full-thickness defects, but with extensive debridement during revision TKA requiring immediate flap reconstruction were included into group 2 and served as a control.
RESULTS:Fifty-eight patients in the group 1 were treated with 86 flaps, and 15 patients in the group 2 were treated with 17 flaps. Mean length of follow-up was 67.0 and 54.7 months, respectively (p=0.21). Flap related complications and number of subsequent flap revisions were comparable in both groups. Patients in the group 1 had a higher rate of implant reinfection (58%vs.27%; p<0.05), amputations (24%vs.0%; p<0.05), and number of subsequent prosthesis revisions (2.2vs.0.9; p<0.05). Functional joint was preserved in 58% and 80% of cases, respectively. Mean range of motion and quality of life were significantly better in the group 2 (p<0.05).
CONCLUSIONS:Flap reconstruction allowed achieving stable coverage of the prosthesis, but the reinfection rate was surprisingly high, patients needed multiple additional revisions and only 58% of functional implants were retained after 5 years. This should be taken into consideration while discussing different treatment options for soft-tissue defects around the knee prosthesis.


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