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One-Stage Revision Total Knee Arthroplasty for Chronic Periprosthetic Joint Infection Requiring Gastrocnemius Flap
Gauthier Gresle1, Pierre-Alban Bouché2, Benoit Villain3
1Department of Orthopaedic Surgery, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France.
Background:
A one-stage revision total knee arthroplasty (TKA) has been increasingly adopted for the treatment of chronic periprosthetic joint infection (PJI) in specialized centers. However, patients who require soft-tissue reconstruction with a gastrocnemius flap are often excluded from one-stage strategies because soft-tissue deficiency is considered a marker of advanced disease. Data evaluating the impact of flap reconstruction within a one-stage revision strategy remain limited.
Methods:
This single-center retrospective study analyzed prospectively collected data from patients undergoing one-stage revision TKA for chronic PJI between 2018 and 2023. Patients treated with gastrocnemius flap reconstruction were compared with those who did not undergo flap coverage. A propensity score-matched analysis was performed to contextualize outcomes between groups. The primary outcome was treatment failure, defined as relapse, new infection, or infection-related reoperation. Secondary outcomes included flap-related complications. A total of 116 patients were included, of whom 49 underwent gastrocnemius flap reconstruction. After propensity score matching, 41 matched pairs were analyzed.
Results:
Reinfection-free (P = 0.56), relapse-free (P = 0.37), and new-infection-free (P = 0.19) survivals did not differ significantly between groups. Reinfection-free survival in the matched cohort was 72.5% at two years. Polymicrobial infections were more frequent in the flap group (9.8 versus 19.5%). All gastrocnemius flaps remained viable, and no flap-related surgical revisions were required.
Conclusions:
In this propensity score-matched cohort of patients undergoing one-stage revision TKA for chronic PJI, the addition of gastrocnemius flap reconstruction was feasible in cases of severe soft-tissue compromise and was not associated with an obvious additional deterioration in infection-related outcomes. These findings suggest that, in specialized centers, the need for gastrocnemius flap reconstruction should not automatically preclude consideration of a one-stage revision strategy.
Level Of Evidence:
III.
