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. 2011:11:e45.
Epub 2011 Nov 21.

Arthrodesis using pedicled fibular flap after failed infected knee arthroplasty

Steve C Minear, Gordon Lee, David Kahn, Stuart Goodman

Arthrodesis using pedicled fibular flap after failed infected knee arthroplasty

Steve C Minear et al. Eplasty. 2011.

Abstract

Objective: Severe bone loss associated with failed revision total knee arthroplasty is a challenging scenario. The pedicled fibular flap is a method to obtain vascularized bone for use in knee arthrodesis after failure of a total knee arthroplasty, with substantial loss of bone.

Methods: We report 2 successful knee arthrodeses using this method in patients with infected, failed multiply revised total knee arthroplasties. The failed prosthesis was removed, and the bones were aligned and stabilized. The fibular flap was then harvested, fed through a subcutaneous tunnel, and placed within the medullary canal at the arthrodesis site. The soft tissue was closed over the grafts and flaps.

Results: Two elderly women presented with pain and drainage from previous total knee arthroplasties after multiple revisions. Arthrodeses were performed as described, and both patients were pain-free with the knee fused at 1 year.

Conclusions: Thus, pedicled vascularized flaps are a viable alternative in the treatment of failed revision arthroplasty with large segmental bone loss.

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Figures

Figure 1
Figure 1
Intraoperative photographic documentation of case 1. (a) The pedicled fibular flap is bisected into a “double-barrel” configuration and fed through the subcutaneous tunnel. (b) The vascular pedicle is presented. (c) The flap is fitted into the arthrodesis site. (d) An additional free fibular graft is prepared to fit into the medial aspect of the arthrodesis site. (e) The flap and graft are fitted into the arthrodesis site. (f) The ipsilateral fibula harvest site is closed and the arthrodesis is completed.
Figure 2
Figure 2
Radiographic documentation of cases. (a) Preoperative AP roentogram of infected knee joint of case 1. (b) Preoperative lateral roentogram of infected knee joint of case 1. (c) Postoperative AP. (d) lateral roentogram of case 1 at 7 weeks. (e) Preoperative AP roentogram of infected knee joint of case 2. (f) Preoperative lateral roentogram of infected knee joint of case 2. (g) Postoperative AP. (h) lateral roentogram of case 2 at 5 months.
See this image and copyright information in PMC

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