Journal cover Journal topic
Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
Journal topic
Volume 5, issue 3
J. Bone Joint Infect., 5, 160–171, 2020
https://doi.org/10.7150/jbji.47018
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 5, 160–171, 2020
https://doi.org/10.7150/jbji.47018
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 18 May 2020

Original full-length article | 18 May 2020

Orthoplastics in Periprosthetic Joint Infection of the Knee: Treatment Concept for Composite Soft-tissue Defect with Extensor Apparatus Deficiency

Rik Osinga1,2,3, Maurice Michel Eggimann1, Steven John Lo3,4, Richard Kühl5, Alexander Lunger2, Peter Emil Ochsner6, Parham Sendi1,5,7,8, Martin Clauss1,6,8, and Dirk Johannes Schaefer1,2 Rik Osinga et al.
  • 1Centre for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland
  • 2Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
  • 3Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, United Kingdom
  • 4Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 5Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
  • 6Clinic for Orthopedics and Trauma Surgery and Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal, Switzerland
  • 7Institute for Infectious Diseases, University of Bern, Bern, Switzerland
  • 8Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland

Keywords: Knee, TKA, PJI, infected arthroplasty, soft-tissue defect, deficient extensor apparatus, orthoplastic, surgical concept

Abstract. Introduction: Reconstruction of composite soft-tissue defects with extensor apparatus deficiency in patients with periprosthetic joint infection (PJI) of the knee is challenging. We present a single-centre multidisciplinary orthoplastic treatment concept based on a retrospective outcome analysis over 20 years.

Methods and Results: One-hundred sixty patients had PJI after total knee arthroplasty. Plastic surgical reconstruction of a concomitant perigenicular soft-tissue defect was indicated in 47 patients. Of these, six presented with extensor apparatus deficiency. One patient underwent primary arthrodesis and five patients underwent reconstruction of the extensor apparatus. The principle to reconstruct missing tissue 'like with like' was thereby favoured: Two patients with a wide soft-tissue defect received a free anterolateral thigh flap with fascia lata; one patient with a smaller soft-tissue defect received a free sensate, extended lateral arm flap with triceps tendon; and two patients who did not qualify for free flap surgery received a pedicled medial sural artery perforator gastrocnemius flap. Despite good functional results 1 year later, long-term follow-up revealed that two patients had to undergo arthrodesis because of recurrent infection and one patient was lost to follow-up.

Conclusion: These results show that PJI of the knee and extensor apparatus deficiency is a dreaded combination with a poor long-term outcome. Standardization of surgical techniques for a defined PJI problem and consensus on study variables may facilitate interinstitutional comparisons of outcome data, and hence, improvement of treatment concepts.

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