Surgical and patient-reported outcomes after total knee arthroplasty requiring soft tissue flap reconstruction – A 12-year experience from high-volume arthroplasty hospital

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This study investigates the outcomes of complex knee joint reconstructions performed by an orthoplastic surgery team at a tertiary referral hospital. Retrospective review of all the total knee arthroplasty (TKA)/revision TKA (rTKA) procedures with soft tissue flap reconstruction performed between 2008 and 2019 was conducted. Patients were stratified into two groups according to the urgency of surgery: scheduled non-complicated (SNC) and emergent complicated (EC). The whole study cohort was also categorized into non-infected and infected groups. Of 20,184 TKAs operated, 58 patients required flap reconstruction (SNC group n=27; EC group n=31). The most common reconstruction was medial gastrocnemius flap (74%). Mean follow-up time was 31.9 months. Functional knee joint salvage was achieved in 96.3% the SNC group and in 80.6% the EC group patients (p=0.07). Transfemoral amputation rates were 3.7% in the SNC group vs. 6.5% in the EC group (p=0.36). Oxford Knee Score was 34.5vs. 25.5 (p=0.21), and range of motion was 100⁰ vs. 93⁰ (p=0.37) in the SNC and EC groups, respectively. Superior functional knee joint salvage rates were achieved in the non-infected group compared to the infected group (97.1% vs. 75.0%, p=0.004). However, the transfemoral amputation rate was nearly three-fold in the infected group (8.3% vs. 2.9%, p=0.36). Estimated five-year survival with functional knee joint was higher in the non-infected group (p=0.03). Both the SNC and EC groups had similar acceptable limb salvage rates, and functional and PROM outcomes. Infection reduces the probability of a functional knee joint after TKA and flap reconstruction.