J Knee Surg 2018; 31(08): 723-729
DOI: 10.1055/s-0037-1607060
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient Factors Associated with Failure of Flap Coverage Used during Revision Total Knee Arthroplasty

Bishoy V. Gad
1  Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Joseph F. Styron
1  Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Mark A. Goergy
1  Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Alison K. Klika
1  Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Wael K. Barsoum
1  Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Carlos A. Higuera
1  Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

03 March 2017

25 August 2017

Publication Date:
10 October 2017 (eFirst)

Abstract

Revision total knee arthroplasty (rTKA) is a challenging problem in the setting of soft tissue defects. The purpose of this study was to evaluate patients who underwent rTKA requiring flap coverage and determine patient factors that predisposed them to failure. Forty-three consecutive patients (mean follow-up, 46.5 months) who underwent rTKA requiring flap coverage were retrospectively reviewed between January 1, 2000 and December 31, 2010. Sixteen of 43 patients experienced failure requiring either flap revision (n = 2) or above the knee amputation (n = 14). Patients with heart failure (p = 0.008), cancer (p = 0.049), or infection with Klebsiella pneumoniae (p = 0.002) had greater rates of failure. Smoking (p = 0.287), diabetes (p = 0.631), and flap type (p = 0.634, p = 0.801) were not associated with increased failure. Mean survival was 46.4 months. Survival of patients with a history of cancer (34.3 months) was less (p = 0.033) than those without (49.2 months). Flap coverage in rTKA is a viable limb salvage option for patients with soft tissue defects; however, failure rates are much higher than in patients not requiring flap coverage.