Free Flap Coverage for Complex Primary and Revision Total Knee Arthroplasty

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Free flap coverage is infrequently required for total knee arthroplasty (TKA).
• Complex TKAs, including primary and revision surgeries, may necessitate free flaps for soft-tissue coverage.
• This study evaluates outcomes of free flap reconstruction in TKA patients.

Purpose of the Study:

• To assess the efficacy and outcomes of free flap coverage in patients undergoing complex total knee arthroplasty.
• To determine the complication rates and functional results associated with this reconstructive approach.

Main Methods:

• Retrospective review of a total joint registry (1994-2017).
• Identified 8 patients (0.02%) requiring free flaps out of 35,502 TKAs (primary and revision).
• Analysis of flap types, reoperations, limb salvage, and functional scores (Knee Society Score, range of motion).

Main Results:

• Common flap types included vertical rectus abdominis, anterior lateral thigh, and latissimus dorsi.
• No total flap losses occurred, but one patient needed skin grafting.
• Six patients required reoperation, including TKA revisions for infection or loosening; one patient underwent amputation.
• Significant improvement in median Knee Society Score (49 to 82, p=0.03).

Conclusions:

• Free flap coverage in TKA is associated with a high reoperation rate.
• Limb preservation was achieved in most cases.
• The procedure can lead to reasonable functional outcomes despite reconstructive challenges.