Abstract
Purpose: Wound defects management during or after a total knee arthroplasty is a challenging clinical situation which raises the risk of implant exposure and infection with subsequent removal and poor functional outcome. The clinical course of the tissue loss is unpredictable leading to retarded curative treatment.
Material and Methods: We report a consecutive retrospective series of 39 knee prostheses implanted from 1990 to 2007 where a wound defect occured during or after implantation of a total knee arthroplasty. Salvage surgery have included a flap with different way of treatment for the knee prosthesis. We studied time to onset of tissue loss, wound border vitality, presence or absence of implant exposure, type of cover flap distinguishing faciocutaneous and muscle flaps, retention or not of the implant, and time of secondary reconstruction.
Results: In 34 of the 39 prostheses, the implant use of the cover flap enabled saving the implant and proper wound healing. In 2 additional cases, wound closure using a flap enabled a reimplantation of a knee prosthesis. The joint remained functional but only 20 knees recovered flexion greater than 90°. In three cases, the implant had to be removed and a knee arthrodesis was done, in all cases due to infection with resistant bacteria (staphylococcus, serratia). Prognositic factors identified included: time from tissue loss to its treatment, usefulness of a cover flap to save the implant, or usefulness of two-procedure reconstruction in case of implant infection.
Discussion: We compared our therapeutic methods with the propositions in the Laing classification and preferred to distinguish a simplified three-step tactic based on time of exposure for determining the theraputic strategy for cutaneous tissue loss in knee prosthesis patients.
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