Ej. Mcpherson et al., INFECTED TOTAL KNEE ARTHROPLASTY - 2-STAGE REIMPLANTATION WITH A GASTROCNEMIUS ROTATIONAL FLAP, Clinical orthopaedics and related research, (341), 1997, pp. 73-81
This study reviews a consecutive series of 21 patients undergoing two-
stage reimplantation total knee arthroplasty for late chronic infectio
n. All 21 patients had late chronic infections, and 20 of 21 patients
were compromised hosts. Seven different organisms were isolated at the
time of prosthetic resection. Staphylococcus coagulase negative speci
es was the most frequently isolated organism. At the time of reimplant
ation, a medial gastrocnemius rotational flap was rotated over the pro
ximal tibia and knee for wound closure. The average explantation time
was 25 weeks (range, 7-76 weeks), and no methylmethacrylate spacers we
re used. At an average 17-month followup (range, 5.1-33.1 months) all
reimplanted total knee replacements remained in place with one patient
having recurrent infection. At reimplantation, 11 patients had positi
ve bacterial cultures from tissue specimens, Sixteen of the 33 (40%) p
ositive cultures were from specimens taken from the medullary canal, A
t followup, the average Knee Society Score was 77.4 (range, 40-100). T
he lack of a methylmethacrylate spacer and a long explantation time we
re considered important factors in diminishing functional performance
and determining the need for a gastrocnemius flap, A medial gastrocnem
ius rotational flap should be considered at the time of reimplantation
total knee arthroplasty if the soft tissue envelope about the knee is
compromised and cannot be closed without undue tension.