{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:47:53Z","timestamp":1777898873918,"version":"3.51.4"},"reference-count":18,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Peri-prosthetic joint infection (PJI) following total knee arthroplasty complicated by soft tissue compromise presents a major reconstructive challenge. Successful management requires the eradication of infection while restoring durable soft tissue coverage and limb function. This study reports the outcomes of a patient-specific, multidisciplinary orthoplastic approach to complex knee PJI. Methods: We retrospectively reviewed five patients with complex infected knee arthroplasty and associated soft tissue compromise managed at our institution between 2021 and 2025 by a single orthopaedic surgeon and two plastic reconstructive surgeons. All cases required personalized management, including the use of custom spacers, patient-specific orthopaedic reconstruction, and individualized soft tissue reconstruction techniques. Data collected included patient demographics, infection characteristics, reconstructive techniques, and functional outcomes. Results: All patients achieved durable soft tissue coverage and infection eradication at final follow-up. Of the five patients, one underwent primary closure of a persistent sinus, one required a local axial bi-pedicled flap for sinus control and soft tissue closure, two were managed with medial gastrocnemius flaps, and one complex case with an associated bone defect required a custom-designed spacer to achieve stability and dead-space management. Conclusions: In this retrospective case series, we aim to demonstrate that complex knee PJI with associated soft tissue defects may be successfully managed with an individualized, multidisciplinary strategy. We aim to demonstrate the feasibility of such an approach in a tertiary referral centre and to highlight the importance of customisation in achieving infection control and limb preservation.<\/jats:p>","DOI":"10.3390\/jpm16050238","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T10:47:28Z","timestamp":1777546048000},"page":"238","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Complex Peri-Prosthetic Joint Infection Following Total Knee Arthroplasty with Soft Tissue Defects: Case Series and Multidisciplinary Approach"],"prefix":"10.3390","volume":"16","author":[{"given":"Katelynn","family":"Murray Whelan","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University Hospital Galway, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerard Anthony","family":"Sheridan","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, University Hospital Galway, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Joyce","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, University Hospital Galway, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Hussey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Hospital Galway, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7065-0656","authenticated-orcid":false,"given":"Jason S.","family":"Hoellwarth","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justina","family":"Baltrunaite","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Hospital Galway, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s42836-023-00168-5","article-title":"Single-stage revision for chronic periprosthetic joint infection after knee and hip arthroplasties: Indications and treatments","volume":"5","author":"Mu","year":"2023","journal-title":"Arthroplasty"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/S0140-6736(14)61798-0","article-title":"Periprosthetic Joint Infection","volume":"387","author":"Kapadia","year":"2016","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1302\/2058-5241.4.180092","article-title":"Periprosthetic Joint Infection: Current concepts and outlook","volume":"4","author":"Izakovicova","year":"2019","journal-title":"EFORT Open. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e0033825","DOI":"10.1128\/aac.00338-25","article-title":"Advancing the management of prosthetic joint infections: A review of randomized controlled trials and emerging evidence","volume":"69","author":"Isler","year":"2025","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-1381.R1","article-title":"The EBJIS definition of periprosthetic joint infection","volume":"103-B","author":"McNally","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s42836-022-00134-7","article-title":"Evolving Etiologies and rates of revision total knee arthroplasty: A 10-year institutional report","volume":"4","author":"Brown","year":"2022","journal-title":"Arthroplasty"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1186\/s13018-024-05099-8","article-title":"Incidence of periprosthetic joint infection after primary total knee arthroplasty shows significant variation: A synthesis of meta-analysis and bibliometrics analysis","volume":"19","author":"Ma","year":"2024","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s42836-023-00205-3","article-title":"Management of soft tissues in patients with periprosthetic joint infection","volume":"5","author":"Shao","year":"2023","journal-title":"Arthroplasty"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3263","DOI":"10.1016\/j.arth.2018.05.021","article-title":"Treatment of Periprosthetic Knee Infection with Concurrent Rotational Muscle Flap Coverage Is Associated With High Failure Rates","volume":"33","author":"Warren","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s40634-021-00333-2","article-title":"Diagnosis and management of the infected total knee replacement: A practical surgical guide","volume":"8","author":"Zahar","year":"2021","journal-title":"J. Exp. Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1016\/j.arth.2025.06.036","article-title":"Management of Periprosthetic Joint Infections: Understanding the Numbers; 1-, 1.5-, and 2-stage revisions","volume":"40","author":"Scuderi","year":"2025","journal-title":"J. Arthroplast."},{"key":"ref_12","unstructured":"Ayoade, F., Li, D., Mabrouk, A., and Todd, J.R. (2025, November 18). Periprosthetic Joint Infection, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448131\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1302\/2046-3758.136.BJR-2023-0251.R1","article-title":"Prosthetic spacers in two-stage revision for knee periprosthetic joint infection achieve better function and similar infection control","volume":"13","author":"Wu","year":"2024","journal-title":"Bone Jt. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103453","DOI":"10.1016\/j.otsr.2022.103453","article-title":"One- or two-stage preimplantation for infected total knee prosthesis?","volume":"109","author":"Wignadasan","year":"2023","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s12178-015-9293-8","article-title":"The use of spacers (static and mobile) in infection knee arthroplasty","volume":"8","author":"Mazzzucchelli","year":"2015","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1055\/s-0045-1810090","article-title":"Orthoplastic Approach to Extremity Reconstruction: A Paradigm Shift in Integrated Limb Salvage","volume":"39","author":"Lin","year":"2025","journal-title":"Semin. Plast. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.idc.2017.01.009","article-title":"Management of Prosthetic Joint Infection","volume":"31","author":"Tande","year":"2017","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.1016\/j.arth.2025.05.123","article-title":"The Management of Chronic Periprosthetic Joint Infection: No Longer Is It \u2018One Size Fits All\u2019","volume":"40","author":"Hannon","year":"2025","journal-title":"J. Arthroplast."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/5\/238\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:43:47Z","timestamp":1777628627000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/5\/238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":18,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jpm16050238"],"URL":"https:\/\/doi.org\/10.3390\/jpm16050238","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}