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24.01.2018 | Original Article • HIP - ARTHROPLASTY | Ausgabe 4/2018

European Journal of Orthopaedic Surgery & Traumatology 4/2018

Use of modular megaprosthesis in managing chronic end-stage periprosthetic hip and knee infections: Is there an increase in relapse rate?

Zeitschrift:
European Journal of Orthopaedic Surgery & Traumatology > Ausgabe 4/2018
Autoren:
Pablo S. Corona, Matias Vicente, Mireia Lalanza, Carles Amat, Luis Carrera
Wichtige Hinweise
Pablo S. Corona and Matias Vicente have contributed equally to this work.

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.

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