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Several patient factors increased revision, amputation risk after gastrocnemius flap use in TKA
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Although use of a gastrocnemius flap in complex knee reconstruction reliably provided component coverage, results published in The Journal of Bone and Joint Surgery showed an increased risk of revision and amputation among patients with a history of multiple surgical procedures on the knee and larger, soft tissue defects.
Researchers followed 83 patients who received a gastrocnemius flap to cover the site of a primary or revision total knee arthroplasty to the time of implant or flap revision, amputation or death for a minimum of 2 years. Researchers assessed clinical outcomes using the Knee Society Score for pain and function. Patients had a mean age of 65 years, a mean BMI of 32.6 kg/m2 and a mean wound size of 49 cm2.
Following gastrocnemius flap coverage, results showed patients had a 10-year revision- and amputation-free survival rate of 68% and 79%, respectively. Researchers found morbid obesity and five or more prior surgical procedures on the knee increased the risk of implant failure, while five or more prior surgical procedures, an age of 65 years or older and a wound size of 50 cm2 or greater increased the risk of amputation. Patients experienced a significant improvement in Knee Society Scores for pain from 46 preoperatively to 78 postoperative and for function from 28 preoperatively to 43 postoperatively at the time of follow-up, according to results. Researchers noted at least one postoperative complication in 71% of patients and multiple complications in 39% of patients.
“We advocate early flap coverage in patients with soft tissues at risk for complications,” the authors wrote. “Patients with a history of multiple surgical procedures on the knee and larger, soft tissue defects should be cautioned about their increased risk of revision TKA and subsequent amputation.” – by Casey Tingle
Disclosures: Houdek reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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