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Use of modular megaprosthesis in managing chronic end-stage periprosthetic hip and knee infections: Is there an increase in relapse rate?
Corona, Pablo S; Vicente, Matias; Lalanza, Mireia; Amat, Carles; Carrera, Luis.
Afiliación
  • Corona PS; Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
  • Vicente M; 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.
  • Lalanza M; Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig Vall d'Hebron 119-129, 08029, Barcelona, Spain.
  • Amat C; Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
  • Carrera L; Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
Eur J Orthop Surg Traumatol ; 28(4): 627-636, 2018 May.
Article en En | MEDLINE | ID: mdl-29368238
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones Relacionadas con Prótesis / Prótesis de Cadera / Prótesis de la Rodilla Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged80 Idioma: En Revista: Eur J Orthop Surg Traumatol Año: 2018 Tipo del documento: Article País de afiliación: España Pais de publicación: Francia
Texto completo
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Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones Relacionadas con Prótesis / Prótesis de Cadera / Prótesis de la Rodilla Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged80 Idioma: En Revista: Eur J Orthop Surg Traumatol Año: 2018 Tipo del documento: Article País de afiliación: España Pais de publicación: Francia