Abstract
TKA (Total Knee Arthroplasty) is a successful operation. Soft tissue problems with TKA are difficult to treat. Flap surgery is successful in treating this problem and salvaging the prostheses. We present results of flap surgery for complicated TKAs over a ten year period, performed by a single surgeon.
Between 1996 and 2005, 31 patients (32 knees) underwent flap surgeries for TKAs. Four of these procedures were done prophylactically in patients with previous knee surgeries. Gastrocnemius, medial fasciocutaneous and anterior compartment flaps were used either solely or in combination based on the size of the defect. The data was collected retrospectively from case-notes and correspondence from the treating orthopaedic surgeons. All the knees included in the study had a minimum follow up of 6 months.
The patients were aged between 50 and 94 years. Indication for primary TKA was osteoarthritis in 26 patients and rheumatoid arthritis in 5. The index orthopaedic surgery was a primary knee arthroplasty in 14 and revision in 13. The average duration between the TKA and flap surgery was 11 weeks (range 1 – 52). Gastrocnemius was the most commonly used local flap (17 cases). Anterior compartment flap was used in 5 cases and in the rest combination of flaps was used. Coagulase -ve Staph. aureus was the most commonly isolated organism from the perioperative wound swabs. Successful soft tissue cover was achieved in 29 of 32 knees (92%). Overall, TKA was salvaged in 23 of 32 knees (72%) and 3 knees (9.7%) underwent arthrodesis. Three (9.7%) patients had above knee amputation, two of these had post op MRSA infection. We could not use a functional knee scoring system due to inadequate information available.
We conclude local flap surgery is a viable and successful procedure for providing soft tissue cover for complicated TKAs with good results.
