scholarly journals Modified Medial Gastrocnemius Myocutaneous Flap Technique for Knee Joint Coverage after Total Knee Arthroplasty

2021 ◽  
Vol 17 (1) ◽  
pp. 67-71
Author(s):  
Dongseok Kim ◽  
Junhyung Kim ◽  
Woonhyeok Jeong ◽  
Taehee Jo ◽  
Jaehoon Choi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Myocutaneous Flap ◽  
Perforator Flap ◽  
Medial Gastrocnemius ◽  
Soft Tissue Defects ◽  
Total Knee ◽  
Tissue Defects

While there are many reasons the medial gastrocnemius flap is often the favored treatment for soft tissue defects around the knee area, this flap has some disadvantages. Reduced volume at the distal part of the flap and a short reach complicate provision of sufficient coverage for soft tissue defects superior to the patella and the lateral knee. In order to overcome these shortcomings, we modified the typical surgical technique by combining a medial gastrocnemius muscle flap and a medial sural artery perforator flap. This approach was applied to four patients who had developed deep infections and skin and soft tissue defects around the knee joint after total knee arthroplasty. The surgeries were successful. Dead space was well-filled and wounds healed without complications in all patients. This modified medial gastrocnemius myocutaneous flap provides a new option for treating challenging skin and soft tissue defects caused by deep infection after total knee arthroplasty.

Angiographic findings in patients with postoperative soft tissue defects following total knee arthroplasty

2011 ◽  
Vol 19 (12) ◽  
pp. 2045-2049 ◽  
Author(s):  
Christian Herold ◽  
Andreas Steiert ◽  
Karsten Knobloch ◽  
Marc N. Busche ◽  
Mehmet A. Altintas ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissue Defects ◽  
Total Knee ◽  
Tissue Defects ◽  
Angiographic Findings

Reconstruction of soft tissue defects following total knee arthroplasty

The Knee ◽  
2002 ◽  
Vol 9 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Adnan Menderes ◽  
Cenk Demirdover ◽  
Mustafa Yilmaz ◽  
Haluk Vayvada ◽  
Ali Barutcu
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissue Defects ◽  
Total Knee ◽  
Tissue Defects

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

2017 ◽  
Vol 31 (08) ◽  
pp. 723-729
Author(s):  
Bishoy Gad ◽  
Joseph Styron ◽  
Mark Goergy ◽  
Alison Klika ◽  
Wael Barsoum ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Soft Tissue Defects ◽  
Patient Factors ◽  
Flap Coverage ◽  
History Of ◽  
Total Knee ◽  
Tissue Defects

AbstractRevision 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.

scholarly journals Soft-tissue Defects After Total Knee Arthroplasty

2016 ◽  
Vol 24 (11) ◽  
pp. 769-779 ◽  
Author(s):  
Daniel A. Osei ◽  
Kelsey A. Rebehn ◽  
Martin I. Boyer
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissue Defects ◽  
Total Knee ◽  
Tissue Defects

Soft Tissue Reconstruction for Deep Defects over a Complicated Total Knee Arthroplasty: A Systematic Review

2019 ◽  
Vol 33 (07) ◽  
pp. 732-744 ◽  
Author(s):  
Demetrius M. Coombs ◽  
Jessica Churchill ◽  
Paul Cartwright ◽  
Morad Chughtai ◽  
Assem A. Sultan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Flap Coverage ◽  
Tissue Reconstruction ◽  
Total Knee ◽  
Tissue Defects

AbstractDeep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed. Reports were only included if they (1) were case series, (2) were level III studies or above (including retrospective cohort studies and meta-analyses), (3) were in English, and (4) discussed the outcome of graft or flap coverage of soft tissue defects after total knee arthroplasty. A total of 28 case series and four retrospective comparative studies were retrieved. In 16 studies, 195 out of 241 patients who received gastrocnemius flaps (81%) experienced successful outcomes. In seven studies including 84 patients that underwent fasciocutaneous flap coverage, over 90% of patients experienced successful outcomes. In the four studies examining 144 patients with delayed versus prophylactic soft tissue reconstruction, up to 81% of patients experienced a successful outcome. Various factors must be taken into consideration when assessing full-thickness defects over a TKA and collaboration between plastic and orthopaedic surgeons is required to select the optimal approach.

scholarly journals Unilateral or bilateral V-Y fasciocutaneous flaps for the coverage of soft tissue defects following total knee arthroplasty

2010 ◽  
Vol 5 (1) ◽  
pp. 82 ◽  
Author(s):  
Konstantinos Papaioannou ◽  
Stergios Lallos ◽  
Andreas Mavrogenis ◽  
Elias Vasiliadis ◽  
Olga Savvidou ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissue Defects ◽  
Fasciocutaneous Flaps ◽  
Total Knee ◽  
Tissue Defects

The Impact of Intraoperative Gap Difference Between Extension and Flexion on Perception of Joint Function After Total Knee Arthroplasty: a Comparative Retrospective Study

2021 ◽  
Author(s):  
Tomohiro Okayoshi ◽  
Yoshinori Okamoto ◽  
Hitoshi Wakama ◽  
Shuhei Otsuki ◽  
Masashi Neo
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Soft Tissue ◽  
Knee Joint ◽  
Predictive Factors ◽  
Knee Arthroplasty ◽  
Difference Threshold ◽  
Joint Function ◽  
Flexion Gap ◽  
Total Knee

Abstract Background: The argument presupposes that intra-operative soft tissue balance is associated with patient-reported outcome measures after total knee arthroplasty (TKA). Our aim was to assess the association between the extension-to-flexion gap and patients’ reported perception of knee joint function.Methods: This was a retrospective study of 60 cases of primary cruciate-retaining TKAs performed for the treatment of medial-compartment knee osteoarthritis, at a mean follow-up of 2.6 (range, 2.0–5.2) years. Knee perception was evaluated by asking patients whether they considered their knee joint as “natural” (grade I) or “artificial”, with or without restrictions (grades II–V). The following factors were compared between the two groups: age, sex, and the extension-to-flexion gap difference. A multiple logistic regression analysis was used to identify predictive factors of an artificial knee joint perception. A receiver operating characteristic curve analysis was used to identify cut-off values of predictive factors. Result: Compared to a natural knee joint perception (26 knees, 43%), an artificial perception (34 knees, 57%) was associated with a smaller gap difference at the distraction force of 20 lbf (p < .001), 30 lbf (p = .022), and 40 lbf (p = .038), a lower EuroQol 5-Dimension score (p = .029), and self-reported joint health (Knee injury and Osteoarthritis Outcome Score-Joint Replacement [KOOS-JR], p = .032). A gap difference <1.0 mm was a predictive of an artificial perception (odds ratio, 1.63; 95% confidence interval, 1.33–4.54; p < .001). A cut-off gap difference of 0.99 mm at 20 lbf predicted an artificial perception with a sensitivity of 81.5% and a specificity of 87.9%. Post-operative satisfaction (p < .001), KOOS-JR (p < .001), patient’s joint perception (p = .006), pain (p = .015), and EuroQol 5-Dimension (p = .032) differed between the two groups when the gap difference threshold was set to 1.0 mm.Conclusion: Careful balancing of soft tissue during TKA to achieve an extension-to-flexion gap ≥ 1.0 mm can improve patients’ perception of knee joint function and quality of life.

scholarly journals Functional Correctability of the Knee Joint using 3D-to-2D Registration of X-Ray Imaging in Stressed Positions

10.29007/g7l8 ◽  
2020 ◽  
Author(s):  
Jialong Li ◽  
David Liu ◽  
Stephen McMahon ◽  
Jonathan Baré ◽  
Andrew Shimmin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Ct Scans ◽  
Patient Specific ◽  
Anatomical Landmarks ◽  
X Ray ◽  
Total Knee ◽  
Tissue Structures

Correcting the knee joint to accommodate the pre-existing soft tissue structures is a major aim in total knee arthroplasty. 3D-to-2D registration of segmented boney geometry obtained from computer tomography (CT) scans to functionally stressed positions in X-Ray (XR) imaging can be a more accurate method of obtaining the laxity envelop. From which, a more patient specific limit for the correctability of the knee joint can be found. Supine CT scans were segmented, and 3D bone models and anatomical landmarks were registered to 2D functional stressed XR imaging. The functional position of the patient femoral and tibial bone is then used to calculate the varus and valgus extent of the patient’s knee joint laxity. 103 preoperative knees undergoing primary total knee arthroplasty identified from six different surgeons. The range of patients who are correctable back to within 3 degrees when a force is applied is 52%. 65% of patients who were within 3 degrees varus/valgus for tibia varus were correctable, while 41% of patients who were within 3 degrees varus/valgus for femoral valgus were correctable. 26% of patients were correctable when the LDFA is outside the threshold and MPTA is not, while 56% of patients were correctable when the MPTA is outside the threshold and LDFA is not. This study demonstrates the complexity of soft tissue structures of the knee joint. The main finding of this study is that correctability is more sensitive to the proximal tibial than the distal and posterior femoral articulating geometry. A lack of dependency between correctability of the knee joint and anatomical measures specific to flexion of the knee is seen. Careful consideration should be made intraoperatively when balancing the knee joint flexion gaps surrounding the soft tissue structures.

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