Preliminary outcomes of proximal femur megaspacers

Abstract

There are very few therapeutic alternatives for patients with proximal femoral epiphyseal bone deficit combined with a fracture at another level and signs of infection. This combination can be successfully managed with a proximal femur megaspacer. This article is intended to review our variation of this technique and to show the initial results obtained from 11 cases. Of these 11 cases, there were 6 women and 5 men. The mean age was 66 years. The average number of previous surgeries was 3. Definitive prosthetic reconstructive treatment was achieved in 7 of these 11 subjects. The average time to reimplantation was 11.7 months. Fractures or nonunion healed uneventfully. Bone union and infection control were achieved in 10 of the 11 patients.

Outcomes after antibiotic megaspacer implantation in patients with severe chronic periprosthetic infections

“…There are only a few case series in the orthopedic literature that have described the use of antibiotic megaspacers to salvage chronically infected joints 4–6 . Alternative treatments for PJI include debridement and implant retention, exchange of modular components, and single‐stage revision arthroplasty.…”

“…However, both of these studies involved the use of modular megaspacers, whereas the megaspacers described in our investigation were custom‐made by the orthopedic oncology surgeons intraoperatively. A preliminary study by Sancineto et al 4 described the technique and complications associated with the use of custom‐made femoral megaspacer in a series of 11 patients but only 7 patients had undergone Stage 2 of revision.…”

“…There are only a few case series in the orthopedic literature that have described the use of antibiotic megaspacers to salvage chronically infected joints. [4][5][6] Alternative treatments for PJI include debridement and implant retention, exchange of modular components, and single-stage revision arthroplasty. According to the majority of literature on PJI developing in primary arthroplasty components, infection eradication rates are maximized by a two-stage exchange paradigm (although this has recently been challenged by Pangaud et al 9 ).…”

“…Periprosthetic joint infection (PJI) is a known postoperative complication of total hip and knee arthroplasty. Two‐stage revision remains the gold standard treatment in the United States, with infection eradication rates ranging from 72% to 95% 1–6 . Unfortunately, those patients who cannot successfully eradicate their infection on the first attempt may undergo multiple surgeries, with increasing amount of bone loss and soft tissue compromise 2,5,6 .…”

“…Two-stage revision remains the gold standard treatment in the United States, with infection eradication rates ranging from 72% to 95%. [1][2][3][4][5][6] Unfortunately, those patients who cannot successfully eradicate their infection on the first attempt may undergo multiple surgeries, with increasing amount of bone loss and soft tissue compromise. 2,5,6 Those who are not able to eradicate the infection can be left with the option to live without a joint (hip girdlestone) or amputation (above knee or hip disarticulation).…”