J Bone Jt Infect 2020; 5(3):160-171. doi:10.7150/jbji.47018

Research Paper

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#, Dirk Johannes Schaefer1,2#

1. Centre for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland
2. Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
3. Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, United Kingdom
4. Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
5. Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
6. Clinic for Orthopedics and Trauma Surgery and Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal, Switzerland
7. Institute for Infectious Diseases, University of Bern, Bern, Switzerland
8. Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
*these authors contributed equally to the manuscript and are shared first authors
#these authors share senior authorship

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Citation:
Osinga R, Eggimann MM, Lo SJ, Kühl R, Lunger A, Ochsner PE, Sendi P, Clauss M, Schaefer DJ. Orthoplastics in Periprosthetic Joint Infection of the Knee: Treatment Concept for Composite Soft-tissue Defect with Extensor Apparatus Deficiency. J Bone Jt Infect 2020; 5(3):160-171. doi:10.7150/jbji.47018. Available from http://www.jbji.net/v05p0160.htm

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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.

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