Pablo S Corona1, Matias Vicente2, Mireia Lalanza3, Carles Amat1, Luis Carrera1. 1. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain. 2. Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig Vall d'Hebron 119-129, 08029, Barcelona, Spain. matias.vicente@vhebron.net. 3. Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig Vall d'Hebron 119-129, 08029, Barcelona, Spain.
Abstract
BACKGROUND: Bone loss is a common problem in periprosthetic joint infection (PJI) scenarios. Modular megaprosthesis (MP) could offer a limb salvage solution in such situations. Concerns about risk of infection relapse, reinfection and implant longevity exist regarding MP use in cases of chronic PJI, rather than standard implants. We therefore sought to analyze our results with MP use in chronic PJI cases. METHODS: We performed a retrospective analysis of 29 MP patients. Inclusion criteria were the use of this type of modular megaimplant for reconstruction of segmental bone defects in chronically infected lower-extremity arthroplasties (hip or knee) and a minimum follow-up of 18 months. We evaluated the primary outcome of infection control or recurrence. The MPs were classified into 3 groups, according the bone segment replaced (proximal femur, distal femur or total femur). We further analyzed complications, pain, patient satisfaction and functional results. RESULTS: Mean age was 75 years; mean follow-up was 48 months (range 18-82). The most frequently involved pathogens were coagulase-negative staphylococci (62%). Polymicrobial infection was detected in 7 patients. Twenty-eight patients were managed with a two-stage approach. The infection-free rate at the end of follow-up was 82.8% (24 of 29 patients). Aside from infection relapse, the most frequent complication was dislocation. Final-point survival rate was 91.2% (CI 68.1-97.8). Clinical outcome data and satisfaction results were acceptable. CONCLUSION: According our data, MP is a useful tool in treating end-stage PJI cases, achieving acceptable eradication, satisfaction and implant survivorship rates.
BACKGROUND: Bone loss is a common problem in periprosthetic joint infection (PJI) scenarios. Modular megaprosthesis (MP) could offer a limb salvage solution in such situations. Concerns about risk of infection relapse, reinfection and implant longevity exist regarding MP use in cases of chronic PJI, rather than standard implants. We therefore sought to analyze our results with MP use in chronic PJI cases. METHODS: We performed a retrospective analysis of 29 MP patients. Inclusion criteria were the use of this type of modular megaimplant for reconstruction of segmental bone defects in chronically infected lower-extremity arthroplasties (hip or knee) and a minimum follow-up of 18 months. We evaluated the primary outcome of infection control or recurrence. The MPs were classified into 3 groups, according the bone segment replaced (proximal femur, distal femur or total femur). We further analyzed complications, pain, patient satisfaction and functional results. RESULTS: Mean age was 75 years; mean follow-up was 48 months (range 18-82). The most frequently involved pathogens were coagulase-negative staphylococci (62%). Polymicrobial infection was detected in 7 patients. Twenty-eight patients were managed with a two-stage approach. The infection-free rate at the end of follow-up was 82.8% (24 of 29 patients). Aside from infection relapse, the most frequent complication was dislocation. Final-point survival rate was 91.2% (CI 68.1-97.8). Clinical outcome data and satisfaction results were acceptable. CONCLUSION: According our data, MP is a useful tool in treating end-stage PJI cases, achieving acceptable eradication, satisfaction and implant survivorship rates.
Authors: Christopher L Peters; Joshua M Hickman; Jill Erickson; Adolph V Lombardi; Keith R Berend; Thomas H Mallory Journal: J Arthroplasty Date: 2006-01 Impact factor: 4.757
Authors: C M Brandt; W W Sistrunk; M C Duffy; A D Hanssen; J M Steckelberg; D M Ilstrup; D R Osmon Journal: Clin Infect Dis Date: 1997-05 Impact factor: 9.079
Authors: Eric R Henderson; John S Groundland; Elisa Pala; Jeremy A Dennis; Rebecca Wooten; David Cheong; Reinhard Windhager; Rainer I Kotz; Mario Mercuri; Philipp T Funovics; Francis J Hornicek; H Thomas Temple; Pietro Ruggieri; G Douglas Letson Journal: J Bone Joint Surg Am Date: 2011-03-02 Impact factor: 5.284
Authors: Nicola Logoluso; Francesca Alice Pedrini; Carlo Luca Romanò; Antonio Virgilio Pellegrini; Ilaria Morelli; Elena De Vecchi Journal: BMC Surg Date: 2022-02-25 Impact factor: 2.102
Authors: Alberto Di Martino; Davide Pederiva; Barbara Bordini; Gabriele Di Carlo; Alessandro Panciera; Giuseppe Geraci; Niccolò Stefanini; Cesare Faldini Journal: J Orthop Traumatol Date: 2022-03-29
Authors: Benjamin Davies; Rajiv Kaila; Loukas Andritsos; Christian Gray Stephens; Gordon W Blunn; Craig Gerrand; Panagiotis Gikas; Andrew Johnston Journal: Bone Jt Open Date: 2021-06