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

Abstract

According our data, MP is a useful tool in treating end-stage PJI cases, achieving acceptable eradication, satisfaction and implant survivorship rates.

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

“…Although a majority of patients in this study had improvement in limb functionality after two‐stage revision, the procedure was not without its complications. The most common complication following both megaspacer and megaprosthesis implantation was dislocation, which is similar to other studies evaluating outcomes after two‐stage revision 6,14,15 . We reported a total of six incidences of dislocation, of which five involved the hip.…”

“…We report on the surgical pathology and functionality of patients who undergo this procedure, which has not previously been documented. Another strength of our study relates to the severity of the cases included: no other study of megaspacers has reported on a cohort of PJI patients with such an extensive surgical history, persistence of infection despite prior spacer and antibiotic treatments, and high CCI as we describe here 5,6 . Additionally, all patients in our study were operated on by only two surgeons over the course of 3 years, which allowed for consistency in technique in contrast to Alvand et al 5 whose study consisted of 69 patients operated on by nine surgeons over the course of 7 years.…”

“…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.…”

“…There are few studies comparing the effectiveness of these techniques in megaprosthetic infection. Alvand et al 5 and Corona et al 6 have reported on the clinical outcomes and complications associated with megaprosthesis of the hip and knee after one‐ and two‐stage revision. 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.…”

“…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).…”