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Soft Tissue Reconstruction Does Not Compromise Infection Control in Chronic Knee Periprosthetic Joint Infection
Carlos Mendoza Aguiló1, Matías Vicente1,2,3,4, Antonio Cano3,4
1Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
Microorganisms
|March 28, 2026
Summary
Soft tissue reconstruction (STR) in knee periprosthetic joint infection (PJI) management aids infection control. Despite higher baseline complexity, patients needing STR achieved superior outcomes, demonstrating its value in complex PJI cases.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Plastic and Reconstructive Surgery
Background:
- Knee periprosthetic joint infection (PJI) management often involves complex strategies.
- The role of soft tissue reconstruction (STR) in controlling knee PJI during two-stage exchange is debated.
Purpose of the Study:
- To evaluate the impact of flap-based soft tissue reconstruction versus primary closure on infection control in knee PJI treated with two-stage exchange.
- To compare outcomes and complications between different soft tissue reconstruction techniques.
Main Methods:
- Retrospective observational study of 118 patients with chronic knee PJI undergoing two-stage exchange (2010-2023).
- Comparison of outcomes between patients requiring soft tissue reconstruction (flap-based) and those with primary closure.
- Analysis of pedicled medial gastrocnemius flaps and anterolateral thigh (ALT) microsurgical free flaps.
Main Results:
- Patients requiring STR had higher baseline complexity (more prior surgeries, diabetes, sinus tracts).
- Infection control was superior in the STR group (100%) compared to non-reconstructed cases (88.5%).
- ALT flaps had higher complication rates (46.7%), notably partial flap necrosis, though both flap types achieved eradication.
Conclusions:
- Formal soft tissue reconstruction does not compromise, and may facilitate, infection control in knee PJI management.
- STR is a valuable adjunct in a multidisciplinary approach for complex knee PJI cases.
- While effective, microsurgical ALT flaps require careful consideration due to higher complication risks.
