JOA - 2026-05-22 - Journal Article
One-Stage Revision Total Knee Arthroplasty for Chronic Periprosthetic Joint Infection Requiring Gastrocnemius Flap Reconstruction: A Feasibility Study Using Propensity Score Matching.
Gresle G, Bouché PA, Villain B, Mouchantaf M, Bauer T, Pioger C
Topics
Key Takeaway
One-stage revision TKA with gastrocnemius flap reconstruction achieved 72.5% reinfection-free survival at two years, statistically equivalent to one-stage revision without flap coverage (P=0.56).
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Summary
This single-center study asked whether gastrocnemius flap reconstruction compromises infection eradication in one-stage revision TKA for chronic PJI. Propensity score matching compared 41 flap patients to 41 non-flap controls; reinfection-free (72.5% at 2 years), relapse-free, and new-infection-free survivals did not differ significantly between groups. All 49 flaps remained viable with zero flap-related reoperations, and polymicrobial infections were more prevalent in the flap cohort (19.5% vs. 9.8%).
Key Limitation
Single specialized center with dedicated flap reconstruction capability; results are not transferable to institutions without integrated plastic surgery support, and the study is underpowered to detect moderate differences in infection outcomes given the sample size.
Original Abstract
BACKGROUND
A one-stage revision total knee arthroplasty (TKA) has been increasingly adopted for the treatment of chronic periprosthetic joint infection (PJI) in specialized centers. However, patients who require soft-tissue reconstruction with a gastrocnemius flap are often excluded from one-stage strategies because soft-tissue deficiency is considered a marker of advanced disease. Data evaluating the impact of flap reconstruction within a one-stage revision strategy remain limited.
METHODS
This single-center retrospective study analyzed prospectively collected data from patients undergoing one-stage revision TKA for chronic PJI between 2018 and 2023. Patients treated with gastrocnemius flap reconstruction were compared with those who did not undergo flap coverage. A propensity score-matched analysis was performed to contextualize outcomes between groups. The primary outcome was treatment failure, defined as relapse, new infection, or infection-related reoperation. Secondary outcomes included flap-related complications. A total of 116 patients were included, of whom 49 underwent gastrocnemius flap reconstruction. After propensity score matching, 41 matched pairs were analyzed.
RESULTS
Reinfection-free (P = 0.56), relapse-free (P = 0.37), and new-infection-free (P = 0.19) survivals did not differ significantly between groups. Reinfection-free survival in the matched cohort was 72.5% at two years. Polymicrobial infections were more frequent in the flap group (9.8 versus 19.5%). All gastrocnemius flaps remained viable, and no flap-related surgical revisions were required.
CONCLUSION
In this propensity score-matched cohort of patients undergoing one-stage revision TKA for chronic PJI, the addition of gastrocnemius flap reconstruction was feasible in cases of severe soft-tissue compromise and was not associated with an obvious additional deterioration in infection-related outcomes. These findings suggest that, in specialized centers, the need for gastrocnemius flap reconstruction should not automatically preclude consideration of a one-stage revision strategy.