Comparable reinfection rates between one‐stage and two‐stage revision total knee arthroplasty with gastrocnemius flap reconstruction for periprosthetic joint infection: A systematic review and meta‐analysis
Sina J., Schrednitzki D., Ting A., Addai D., Azam B., Saha P., Meissner N., Halder AM., Dietrich M., Price AJ., Alvand A., Maslaris A.
Abstract Purpose Gastrocnemius flap coverage is a widely used technique for soft‐tissue reconstruction in complex revision total knee arthroplasty (rTKA) for periprosthetic joint infection (PJI). However, clinical outcomes following one‐stage and two‐stage revision strategies in this context are poorly defined. The purpose of this meta‐analysis was to synthesize, critically appraise, systematically review and compare reinfection rates and complication profiles between one‐ and two‐stage septic rTKA for PJI using a gastrocnemius flap for reconstruction. Methods A systematic review and meta‐analysis based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines was conducted. MEDLINE, Embase, Cochrane Library and Web of Science were searched from inception to 6 April 2025 for studies on patients undergoing rTKA for PJI with soft tissue reconstruction using a gastrocnemius flap. Outcomes of interest included reinfection rates, any complications and flap‐related complications. A pooled meta‐analysis at group level was performed to compare interventions. Results There were 11 studies reporting on 271 rTKAs involving gastrocnemius flap reconstruction for PJI that met inclusion criteria. Of these, 56 were one‐stage rTKAs, while 215 were two‐stage rTKAs. PJI eradication rate was 66.1% in the one‐stage group versus 54.4% in the two‐stage group. There were no statistically significant differences between groups for reinfection (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.33–1.13; p = 0.12), any complications (OR: 1.59; 95% CI: 0.71–3.54; p = 0.26) or flap‐related complications (OR: 1.03; 95% CI: 0.43–2.47; p = 0.94). Conclusion It was found that one‐stage and two‐stage rTKA using a gastrocnemius flap showed comparable rates of reinfection, any complication and flap‐related complication with the data available for this meta‐analysis. Findings suggest that one‐stage revision may be a viable treatment option for suitable patients. However, higher‐quality studies are warranted to identify potential true differences within this high‐risk group. Level of Evidence Level IV.