NEW ORLEANS — The risk of limb loss in patients with compromised soft tissue envelopes after total knee arthroplasty decreased with early, proactive soft tissue management and plastic surgery reconstruction, according to a presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
“Our results support early intervention by plastic surgeons in light of soft tissue breakdown,” Martin Carney, BS, said during his presentation. “Drainage in a draining sinus track for TKA should be assumed as communicating with the wound until proven otherwise in the OR. Gram-negative culture positive wounds seem to fare poorly in our patient population. Employing an orthoplastic approach for complex patients can help improve outcomes.”
Carney and colleagues retrospectively reviewed 71 consecutive TKAs that needed soft tissue coverage between 2008 and 2016. Mean follow-up was 2 years, with one patient lost to follow-up. As part of the definitive wound management, investigators performed 16 local fasciocutaneous flaps; 33 medial gastrocnemius flaps; 13 free flaps; and primary closures. They also analyzed TKAs with regard to patient demographics, surgical history, operative course and functional outcomes. Factors that impacted successful prosthetic salvage vs. knee arthrodesis or amputation were determined with logistic regression analysis.
Results showed 45 knee prostheses overall were successfully salvaged. Investigators noted a negative correlation between successful prosthesis retention and the total number of knee surgeries before plastic surgery intervention. They saw a trend toward decreasing success with increasing days from diagnosis of soft tissue compromise before plastic surgery intervention and an increased number of debridements before definitive reconstruction.
The risk for TKA salvage decreased, whereas the risk for amputation increased, with each additional surgery needed before plastic surgery intervention. The risk of subsequent failure also increased with a positive culture at the time of definitive wound management due to the presence of gram-negative organisms having the lowest success rates. – by Monica Jaramillo
Colen D, et al. Paper #128. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 6-10, 2018; New Orleans.
Disclosure: Carney reports no relevant financial disclosures.