THE OUTCOME OF PATIENTS WITH COMPLEX WOUNDS ASSOCIATED WITH AN INFECTED TOTAL KNEE ARTHROPLASTY

Abstract

Purpose: To assess the outcome of patients with an infected TKA who developed complex wounds requiring surgical intervention in our institution.

Methods: The computerised local database was searched for patients recorded as having complex knee wounds associated with an infected TKA. Fifteen patients operated on between 1997 and 2007 were retrospectively reviewed. Data including the limb salvage rate, type of soft tissue surgery performed, local wound complications, and re-implantation rate were recorded. Average follow up was 3.2 years. Three patients had died at the time of review.

Results: Eleven out of 15 patients had been referred to our centre from other hospitals with an infected TKA. Fourteen patients were treated with two stage revision surgery. The remaining patient had direct exchange of the infected implant. Mean age at the time of surgery to address the soft tissue defect was 69.6 years.

Nine patients required a medial gastrocnemius flap. Three patients received fasciocutaneous flaps (one bipedicle); one patient was managed with a tissue expander pre-operatively; one with a split skin graft, and one patient required perforating skin incisions in order to close the wound. 60% of patients developed local wound complications and 27% required further soft tissue procedures.

The overall limb salvage rate was 73.3% (four patients required an above knee amputation for persistent infection). Five patients had successful re-implantation surgery. Four patients had arthrodesis surgery with successful eradication of infection. Two patients developed chronic infection.

Conclusions: Intensive specialist input from plastic and orthopaedic surgeons is required with such difficult cases. Contrary to recent literature, the risk of failure may be higher than previously thought. Patients should be fully counselled pre-operatively about the risks of such procedures.