Soft-Tissue Defects After Total Knee Arthroplasty: Management and Reconstruction

Daniel A. Osei, MD, MSc; Kelsey A. Rebehn, MD; Martin I. Boyer, MD, MS


J Am Acad Orthop Surg. 2016;24(11):769-779. 

In This Article

Abstract and Introduction


Wound healing complications associated with total knee arthroplasty present a considerable challenge to the orthopaedic surgeon. To ensure preservation of a functional joint, the management of periprosthetic soft-tissue defects around the knee requires rapid assessment, early and aggressive débridement, and durable, contoured coverage. Several reconstructive options are available to tailor soft-tissue coverage to the location, size, and depth of the wound. Special consideration should be given to the timing of the intervention, management of infection, and prosthesis salvage. The merits of each reconstructive option, including perforator, fasciocutaneous, muscular, and free microvascular flaps, should be weighed to select the most appropriate option. The proposed approach can guide surgeons in treating patients with these complex soft-tissue defects.


Wound complications in patients who have undergone total knee arthroplasty (TKA) present a serious and common challenge for the orthopaedic surgeon. Infection, impaired wound healing, and soft-tissue compromise after TKA can result in devastating complications, including the need for removal of the prosthesis and/or loss of the limb.[1] Annually, >600,000 primary TKA procedures are performed in the United States. The utilization of primary TKA is projected to increase substantially, to >1.5 million procedures per year by 2020.[2] As the number of TKA procedures performed continues to increase, an associated increase in the overall number of complications is expected. In recent reports, the rate of infection or wound healing complications in patients who have undergone TKA ranges from 0.33% to 10.5%.[1,3]

Despite initial management, patients experiencing wound healing complications or infection are at increased risk of a subsequent deep wound infection and the need for additional surgical treatment within 2 years postoperatively, underscoring the negative effect of early wound healing complications on long-term outcomes.[1,3,4] To ensure effective treatment of this increasing patient population, a renewed emphasis on accurate identification, classification, and treatment of wound complications after TKA is essential. The approach to the treatment of wound healing complications after TKA presented here was developed on the basis of the literature and the collaborative expertise of surgeons specializing in extremity reconstruction and joint arthroplasty. Optimal treatment of these patients requires careful evaluation of the surgical site; early, cooperative management by the arthroplasty and surgical reconstruction teams; and the use of a graded approach to the management of these complex wounds.