ReviewJournal of experimental orthopaedics2026
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.
Review in Journal of experimental orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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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; 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.
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