Medial gastrocnemius rotational flap for the reconstruction of extensor mechanism disruption in periprosthetic knee infections: a retrospective series with minimum two year follow-up.
Extensor mechanism disruption
Medial gastrocnemius flap
PJI
Periprosthetic knee infection
Two-stage knee revision
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
15
11
2022
accepted:
27
01
2023
pubmed:
9
2
2023
medline:
17
3
2023
entrez:
8
2
2023
Statut:
ppublish
Résumé
Extensor mechanism disruption following total knee arthroplasty has a prevalence ranging from 0.3 to 3%. Its management is challenging, especially in case of associated infection of the prosthetic implant. Surgical options are limited due to the septic process, and the use of allograft or synthetic mesh are not recommended. The aim of this study was to report clinical outcomes, complications, survival, and surgical technique of medial gastrocnemius flap for the treatment of extensor mechanism disruptions associated with periprosthetic knee infection. This is a retrospective study from a prospectively collected arthroplasty registry from 2012 to 2019. Patients who received the gastrocnemius flap in the setting of a two-stage knee replacement for periprosthetic infection were included. Results of physical examination, Knee Society Score, Oxford Knee Score, and measurement of the range of motion registered pre-operatively were compared to those obtained at last follow-up. Survival was analysed through Kaplan-Meier curve. A total of 15 patients were included, with a mean age of 63.4 years (range 36-77). The reconstruction of the extensor mechanism demonstrated a success rate of 73.3%. The mean extension lag at final follow-up was 7.5° (range, 0-30). The mean Knee Society Score and Oxford Knee Score improved from 29.0 (range, 21-36) and 17.5 (range, 13-22) respectively, to 82.9 (range, 74-89) and 36.0 (range, 33-39). Medial gastrocnemius rotational flap is a reliable option for joint and limb salvage in case of periprosthetic knee infection associated with wide soft tissue degeneration and extensor mechanism disruption. The technique and surgical protocol presented in this study are reproducible and guaranteed good clinical outcomes and infection control.
Identifiants
pubmed: 36752846
doi: 10.1007/s00264-023-05716-x
pii: 10.1007/s00264-023-05716-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
983-993Informations de copyright
© 2023. The Author(s) under exclusive licence to SICOT aisbl.
Références
Alexiades M, Sands A, Craig SM, Scott WN (1989) Management of selected problems in revision knee arthroplasty. Orthop Clin North Am 20(2):211–219
pubmed: 2646564
Galat DD, McGovern SC, Larson DR, Harrington JR, Hanssen AD, Clarke HD (2009) Surgical treatment of early wound complications following primary total knee arthroplasty. J Bone Joint Surg Am 91(1):48–54. https://doi.org/10.2106/JBJS.G.01371
doi: 10.2106/JBJS.G.01371
pubmed: 19122078
Tetreault MW, Della Valle CJ, Bohl DD, Lodha SJ, Biswas D, Wysocki RW (2016) What factors influence the success of medial gastrocnemius flaps in the treatment of infected tKAs? Clin Orthop Relat Res 474(3):752–763. https://doi.org/10.1007/s11999-015-4624-z
doi: 10.1007/s11999-015-4624-z
pubmed: 26573319
Conway JD (2020) Knee arthrodesis for recurrent periprosthetic knee infection. JBJS Essent Surg Tech 10(3). https://doi.org/10.2106/JBJS.ST.19.00027
Conway JD, Mont MA, Bezwada HP (2004) Arthrodesis of the knee. J Bone Joint Surg Am 86(4):835–848. https://doi.org/10.2106/00004623-200404000-00027
doi: 10.2106/00004623-200404000-00027
pubmed: 15069154
Hungerford DS (1994) Management of extensor mechanism complications in total knee arthroplasty. Orthopedics 17(9):843–844
doi: 10.3928/0147-7447-19940901-34
pubmed: 7800620
Maffulli N, Spiezia F, La Verde L, Rosa MA, Franceschi F (2017) The management of extensor mechanism disruption after total knee arthroplasty: a systematic review. Sports Med Arthrosc Rev 25(1):41–50. https://doi.org/10.1097/JSA.0000000000000139
doi: 10.1097/JSA.0000000000000139
pubmed: 28045873
Vajapey SP, Blackwell RE, Maki AJ, Miller TL (2019) Treatment of extensor tendon disruption after total knee arthroplasty: a systematic review. J Arthroplasty 34(6):1279–1286. https://doi.org/10.1016/j.arth.2019.02.046
doi: 10.1016/j.arth.2019.02.046
pubmed: 30902501
Lim CT, Amanatullah DF, Huddleston JI 3rd, Harris AHS, Hwang KL, Maloney WJ, Goodman SB (2017) Reconstruction of disrupted extensor mechanism after total knee arthroplasty. J Arthroplasty 32(10):3134–3140. https://doi.org/10.1016/j.arth.2017.05.005
doi: 10.1016/j.arth.2017.05.005
pubmed: 28634096
Llombart Blanco R, Valenti A, Diaz de Rada P, Mora G, Valenti JR (2014) Reconstruction of the extensor mechanism with fresh-frozen tendon allograft in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(11):2771–2775. https://doi.org/10.1007/s00167-013-2688-4
doi: 10.1007/s00167-013-2688-4
pubmed: 24051508
Sapino G, Zaugg P, Cherix S, Borens O, Lo SJ, Raffoul W, di Summa PG (2019) ALT flap with vascularized fascia lata for one-stage functional patellar tendon reconstruction. J Plast Reconstr Aesthet Surg 72(3):467–476. https://doi.org/10.1016/j.bjps.2018.11.002
doi: 10.1016/j.bjps.2018.11.002
pubmed: 30579912
Wood TJ, Leighton J, Backstein DJ, Marsh JD, Howard JL, McCalden RW, MacDonald SJ, Lanting BA (2019) Synthetic graft compared with allograft reconstruction for extensor mechanism disruption in total knee arthroplasty: a multicenter cohort study. J Am Acad Orthop Surg 27(12):451–457. https://doi.org/10.5435/JAAOS-D-18-00393
doi: 10.5435/JAAOS-D-18-00393
pubmed: 30379759
Ries MD, Bozic KJ (2006) Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res 446:186–192. https://doi.org/10.1097/01.blo.0000218723.21720.51
doi: 10.1097/01.blo.0000218723.21720.51
pubmed: 16672887
Walton Z, Armstrong M, Traven S, Leddy L (2017) Pedicled rotational medial and lateral gastrocnemius flaps: surgical technique. J Am Acad Orthop Surg 25(11):744–751. https://doi.org/10.5435/JAAOS-D-15-00722
doi: 10.5435/JAAOS-D-15-00722
pubmed: 29059111
Panni AS, Vasso M, Cerciello S, Salgarello M (2011) Wound complications in total knee arthroplasty. Which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc 19(7):1060–1068. https://doi.org/10.1007/s00167-010-1328-5
doi: 10.1007/s00167-010-1328-5
pubmed: 21161178
Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466(7):1710–1715. https://doi.org/10.1007/s11999-008-0209-4
doi: 10.1007/s11999-008-0209-4
pubmed: 18421542
pmcid: 2505241
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785. https://doi.org/10.2106/JBJS.F.00222
doi: 10.2106/JBJS.F.00222
pubmed: 17403800
Menderes A, Demirdover C, Yilmaz M, Vayvada H, Barutcu A (2002) Reconstruction of soft tissue defects following total knee arthroplasty. Knee 9(3):215–219. https://doi.org/10.1016/s0968-0160(02)00010-8
doi: 10.1016/s0968-0160(02)00010-8
pubmed: 12126680
Coombs DM, Churchill J, Cartwright P, Chughtai M, Sultan AA, Samuel LT, Moskal JT, Hendrickson MF, Mont MA (2020) Soft tissue reconstruction for deep defects over a complicated total knee arthroplasty: a systematic review. J Knee Surg 33(7):732–744. https://doi.org/10.1055/s-0039-1684012
doi: 10.1055/s-0039-1684012
pubmed: 30959536
Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469(11):2992–2994. https://doi.org/10.1007/s11999-011-2102-9
doi: 10.1007/s11999-011-2102-9
pubmed: 21938532
pmcid: 3183178
Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint I (2014) Definition of periprosthetic joint infection. J Arthroplasty 29(7):1331. https://doi.org/10.1016/j.arth.2014.03.009
doi: 10.1016/j.arth.2014.03.009
Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 33(5):1309–1314 e1302. https://doi.org/10.1016/j.arth.2018.02.078
doi: 10.1016/j.arth.2018.02.078
pubmed: 29551303
Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12
doi: 10.1097/00003086-198911000-00003
Roidis N, Varitimidis S, Poultsides L, Liakou P, Karachalios T, Malizos K (2008) A “biologic technique” for the treatment of a disruption of the extensor mechanism after revision total knee arthroplasty: a case report. Knee Surg Sports Traumatol Arthrosc 16(7):661–665. https://doi.org/10.1007/s00167-008-0533-y
doi: 10.1007/s00167-008-0533-y
pubmed: 18418573
Russo A, Cavagnaro L, Chiarlone F, Alessio-Mazzola M, Felli L, Burastero G (2021) Predictors of failure of two-stage revision in periprosthetic knee infection: a retrospective cohort study with a minimum two-year follow-up. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-04265-5
Faschingbauer M, Bieger R, Kappe T, Weiner C, Freitag T, Reichel H (2020) Difficult to treat: are there organism-dependent differences and overall risk factors in success rates for two-stage knee revision? Arch Orthop Trauma Surg 140(11):1595–1602. https://doi.org/10.1007/s00402-020-03335-4
doi: 10.1007/s00402-020-03335-4
pubmed: 31960169
Fehring KA, Abdel MP, Ollivier M, Mabry TM, Hanssen AD (2017) Repeat two-stage exchange arthroplasty for periprosthetic knee infection is dependent on host grade. J Bone Joint Surg Am 99(1):19–24. https://doi.org/10.2106/JBJS.16.00075
doi: 10.2106/JBJS.16.00075
pubmed: 28060229
Russo A, Cavagnaro L, Chiarlone F, Clemente A, Romagnoli S, Burastero G (2021) Clinical outcomes and survivorship of two-stage total hip or knee arthroplasty in septic arthritis: a retrospective analysis with a minimum five-year follow-up. Int Orthop 45:1683–1691. https://doi.org/10.1007/s00264-021-05013-5
doi: 10.1007/s00264-021-05013-5
pubmed: 33774699
Sierra RJ, Trousdale RT, Pagnano MW (2003) Above-the-knee amputation after a total knee replacement: prevalence, etiology, and functional outcome. J Bone Joint Surg Am 85(6):1000–1004. https://doi.org/10.2106/00004623-200306000-00003
doi: 10.2106/00004623-200306000-00003
pubmed: 12783994
Alessio-Mazzola M, Repetto I, Russo A, Clemente A, Ventura N, Formica M, Burastero G, Felli L (2020) Permanent spacers are a reliable solution for peri-prosthetic shoulder infection: a systematic review. HSS J 16(3):272–279. https://doi.org/10.1007/s11420-020-09755-7
doi: 10.1007/s11420-020-09755-7
pubmed: 33082722
pmcid: 7534885
Gad BV, Styron JF, Goergy MA, Klika AK, Barsoum WK, Higuera CA (2018) Patient factors associated with failure of flap coverage used during revision total knee arthroplasty. J Knee Surg 31(8):723–729. https://doi.org/10.1055/s-0037-1607060
doi: 10.1055/s-0037-1607060
pubmed: 29017218
McPherson EJ, Patzakis MJ, Gross JE, Holtom PD, Song M, Dorr LD (1997) Infected total knee arthroplasty. Two-stage reimplantation with a gastrocnemius rotational flap. Clin Orthop Relat Res 341:73–81
doi: 10.1097/00003086-199708000-00013
Papp A, Kettunen J, Miettinen H (2003) Pedicled gastrocnemius flap in complicated total knee arthroplasty. Scand J Surg 92(2):156–159. https://doi.org/10.1177/145749690309200208
doi: 10.1177/145749690309200208
pubmed: 12841557
Burnett RS, Butler RA, Barrack RL (2006) Extensor mechanism allograft reconstruction in TKA at a mean of 56 months. Clin Orthop Relat Res 452:159–165. https://doi.org/10.1097/01.blo.0000238818.25530.2b
doi: 10.1097/01.blo.0000238818.25530.2b
pubmed: 16967038
McCulloch RA, Adlan A, Evans S, Parry M, Stevenson J, Jeys L (2021) Outcomes of the gastrocnemius flap performed by orthopaedic surgeons in salvage revision knee arthroplasty. J Bone Joint Infect 6(9):425–432. https://doi.org/10.5194/jbji-6-425-2021
doi: 10.5194/jbji-6-425-2021