Russo Antonio, Clemente Antonio, Massè Alessandro, Burastero Giorgio
Department of Surgical Sciences, University of Turin, Corso Dogliotti 24, 10126, Turin, Italy.
IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy.
Int Orthop. 2023 Apr;47(4):983-993. doi: 10.1007/s00264-023-05716-x. Epub 2023 Feb 8.
Extensor mechanism disruption following total knee arthroplasty has a prevalence ranging from 0.3 to 3%. Its management is challenging, especially in case of associated infection of the prosthetic implant. Surgical options are limited due to the septic process, and the use of allograft or synthetic mesh are not recommended. The aim of this study was to report clinical outcomes, complications, survival, and surgical technique of medial gastrocnemius flap for the treatment of extensor mechanism disruptions associated with periprosthetic knee infection.
This is a retrospective study from a prospectively collected arthroplasty registry from 2012 to 2019. Patients who received the gastrocnemius flap in the setting of a two-stage knee replacement for periprosthetic infection were included. Results of physical examination, Knee Society Score, Oxford Knee Score, and measurement of the range of motion registered pre-operatively were compared to those obtained at last follow-up. Survival was analysed through Kaplan-Meier curve.
A total of 15 patients were included, with a mean age of 63.4 years (range 36-77). The reconstruction of the extensor mechanism demonstrated a success rate of 73.3%. The mean extension lag at final follow-up was 7.5° (range, 0-30). The mean Knee Society Score and Oxford Knee Score improved from 29.0 (range, 21-36) and 17.5 (range, 13-22) respectively, to 82.9 (range, 74-89) and 36.0 (range, 33-39).
Medial gastrocnemius rotational flap is a reliable option for joint and limb salvage in case of periprosthetic knee infection associated with wide soft tissue degeneration and extensor mechanism disruption. The technique and surgical protocol presented in this study are reproducible and guaranteed good clinical outcomes and infection control.
全膝关节置换术后伸肌机制破坏的发生率为0.3%至3%。其治疗具有挑战性，尤其是在假体植入物伴有感染的情况下。由于感染过程，手术选择有限，不建议使用同种异体移植物或合成网片。本研究的目的是报告内侧腓肠肌瓣治疗与人工膝关节周围感染相关的伸肌机制破坏的临床结果、并发症、生存率和手术技术。
这是一项回顾性研究，数据来自2012年至2019年前瞻性收集的关节置换登记处。纳入在两阶段膝关节置换治疗人工关节周围感染时接受腓肠肌瓣手术的患者。将术前体格检查结果、膝关节协会评分、牛津膝关节评分和活动范围测量结果与最后一次随访时获得的结果进行比较。通过Kaplan-Meier曲线分析生存率。
共纳入15例患者，平均年龄63.4岁（范围36 - 77岁）。伸肌机制重建成功率为73.3%。最后一次随访时的平均伸直滞后为7.5°（范围0 - 30°）。膝关节协会评分和牛津膝关节评分分别从术前的29.0（范围21 - 36）和17.5（范围13 - 22）提高到82.9（范围74 - 89）和36.0（范围33 - 39）。
对于与广泛软组织退变和伸肌机制破坏相关的人工膝关节周围感染，内侧腓肠肌旋转瓣是挽救关节和肢体的可靠选择。本研究中介绍的技术和手术方案具有可重复性，并保证了良好的临床结果和感染控制。
