Lateral Gastrocnemius Flaps in Infected Revision Total Knee Arthroplasty Have Increased Reoperation Rates at One Year Compared to Other Flap Choices

ABSTRACT

INTRODUCTION

Periprosthetic joint infection (PJI) is a severe complication following total knee arthroplasty (TKA), occurring in 0.5-2% of cases, and accounts for 20-25% of total knee arthroplasty revisions. When periarticular soft tissue is compromised, muscle flaps may be required to restore durable coverage, obliterate dead space, and enhance vascularity. 

 

METHODS

This retrospective study analyzed 140 infected TKA cases between January 2018 and February 2025, performed by three fellowship-trained orthopaedic surgeons in collaboration with two plastic surgeons. Patients underwent free, rotational, or combined flap reconstruction. Flaps included rectus abdominus, anterolateral thigh (ALT), latissimus dorsi, medial gastrocnemius, the lateral gastrocnemius, the vastus medialis, and the vastus lateralis. Outcomes examined for flap failure, reinfection, and reoperation examined up to 1 year.

 

RESULTS

The cohort included 140 revision TKAs with a mean age of 66 years, a mean BMI of 30.81, 42% smokers, and 28% with diabetes mellitus. 40% were males and 60% were females. Of those, 54 had static spacers, 6 had articulating spacers, and the remaining 80 had final revision components. At 1 year, lateral gastrocnemius flaps had an increased risk of flap failure and reoperation, p = 0.0004 and 0.005, respectively. The latissimus dorsi flaps had the lowest reinfection rates, p = 0.012. Anterolateral thigh (ALT) and vastus medialis flaps both had an increased risk of reinfection, p = 0.044 and 0.023, respectively.

CONCLUSION

Lateral gastrocnemius flaps may not be the ideal first flap choice if other flaps are available. Latissimus dorsi flaps are a viable option in reconstruction after infected TKA.

Level of Evidence: IV

KEYWORDS: Prosthetic joint infection, total knee arthroplasty, lateral gastrocnemius flap, vastus medialis flap, anterolateral thigh flap, latissimus dorsi flap