Management strategies for complex wounds following total knee arthroplasty

Complex wounds following total knee arthroplasty can result in loss of the prosthesis or limb. We report our experience with 32 patients (33 knees) with complex wounds following total knee arthroplasty. Wound assessment includes size, location, depth, presence of infection, quality of tissue, and exposure of bone or prosthetic components. Management options include debridement and closure, local wound care, skin graft, fasciocutaneous flap, local muscle flap, and free tissue transfer. Postoperative outcome is based on complications and clinical evaluation using the Knee Society Score. Successful salvage of the total knee prosthesis was obtained in 28 of 33 knees (85%). Secondary procedures were necessary in ten knees and consisted of soft tissue revision in six knees, removal of prosthetic components in three knees, and both soft tissue revision and removal of prosthetic components in one knee. Our algorithm for management includes early plastic surgery consultation, control of infection, aggressive debridement, and early soft tissue coverage.