Strategies for Soft-Tissue Management of Complex Joint Revision Arthroplasty: A 10-Year Experience.

Background: Approximately 160,000 joint replacements are performed each year in the United Kingdom. After multiple revisions, soft tissues become suboptimal and chronic wounds develop, causing infection or metalwork extrusion. The authors present their experience with 155 patients at a tertiary orthopedic hospital.

Methods: A chart review of patients who required reconstruction as a result of complex joint revision surgery was performed between January of 2006 and January of 2015. All primary joint replacements were excluded.

Results: One hundred nineteen flaps were performed, 28 were managed conservatively, and eight were treated with primary amputations. Eighty-four of the patients (71 percent) who had soft-tissue reconstruction were healed at 1-year follow-up. Seven primary free flap failures occurred (11 percent); of these, four of seven patients underwent a second successful free flap reconstruction. A further 12 patients underwent secondary amputation as a result of persistent periprosthetic infection, and 11 patients were managed with long-term oral antimicrobial therapy after declining amputation.

Conclusions: The best results are achieved using a combined approach with multidisciplinary input from orthopedic and plastic surgeons with constant specialist clinical microbiology input. All patients had deep tissue samples taken, a long line inserted and, according to microbiology advice, a tailored 6-week regimen of intravenous antibiotics. The data support that early plastic surgery involvement achieved better patient outcomes.

Clinical Question/level Of Evidence: Therapeutic, IV.