title: Long-Term Outcomes of Total Knee Arthroplasty following Soft-Tissue Defect Reconstruction with Muscle and Fasciocutaneous Flaps.
abstract: BACKGROUND
  Insufficient soft-tissue coverage following total knee arthroplasty jeopardizes prosthesis retention and may lead to significant complications. The aim of this study was to evaluate the natural history of total knee arthroplasty following flap reconstruction of soft-tissue defects.
  
  
  METHODS
  A retrospective review of patients treated with flaps after failed total knee arthroplasty between 1998 and 2013 was conducted. Patients with preexisting soft-tissue defects who required reactive flap reconstruction were included in group 1. Patients with no preexisting soft-tissue defects, but with extensive débridement during revision total knee arthroplasty requiring immediate proactive flap coverage, were included in group 2.
  
  
  RESULTS
  Fifty-eight patients in group 1 were treated with 86 flaps, and 15 patients in group 2 were treated with 17 flaps. Mean length of follow-up was 67.0 and 54.7 months, respectively (p = 0.21). Flap-related complications and number of subsequent flap revisions were comparable in both groups. Patients in group 1 had a higher rate of implant reinfection (58 percent versus 27 percent; p < 0.05), amputations (25 percent versus 0 percent; p < 0.05), and subsequent prosthesis revisions (2.2 versus 0.9; p < 0.05). Functional joint was preserved in 54 percent and 80 percent of cases, respectively. Mean gain in range of motion and quality of life were significantly better in group 2 (p < 0.05).
  
  
  CONCLUSIONS
  Early proactive soft-tissue coverage of total-knee arthroplasty is critical to long-term success. In cases where reactive treatment is required, significantly worse outcomes and a high rate of complications should be expected.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Cleveland, Ohio From the Departments of Plastic Surgery and Orthopaedic Surgery, Cleveland Clinic.
authors.forename: Grzegorz J
authors.initials: GJ
authors.lastname: Kwiecien
authors.forename: Gregory
authors.initials: G
authors.lastname: Lamaris
authors.forename: Bahar Bassiri
authors.initials: BB
authors.lastname: Gharb
authors.forename: Trevor
authors.initials: T
authors.lastname: Murray
authors.forename: Mark F
authors.initials: MF
authors.lastname: Hendrickson
authors.forename: James E
authors.initials: JE
authors.lastname: Zins
authors.forename: Raymond
authors.initials: R
authors.lastname: Isakov
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000150:complications / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors