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

Osinga, Rik; Eggimann, Maurice Michel; Lo, Steven John; Kühl, Richard; Lunger, Alexander; Ochsner, Peter Emil; Sendi, Parham; Clauss, Martin; Schaefer, Dirk Johannes (2020). Orthoplastics in Periprosthetic Joint Infection of the Knee: Treatment Concept for Composite Soft-tissue Defect with Extensor Apparatus Deficiency. Journal of bone and joint infection, 5(3), pp. 160-171. Ivyspring International Publisher 10.7150/jbji.47018

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases

UniBE Contributor:

Sendi, Parham

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

2206-3552

Publisher:

Ivyspring International Publisher

Language:

English

Submitter:

Parham Sendi

Date Deposited:

17 Aug 2020 10:57

Last Modified:

18 Aug 2020 22:31

Publisher DOI:

10.7150/jbji.47018

PubMed ID:

32566456

Uncontrolled Keywords:

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

BORIS DOI:

10.7892/boris.145936

URI:

https://boris.unibe.ch/id/eprint/145936

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