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Treatment solutions are unclear for perimegaprosthetic infections
Lisa B Ercolano1, Tyson Christensen, Richard McGough
1Department of Orthopaedics, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA, ercolanolb@upmc.edu.
Background:
Infection about a megaprosthesis is a dreaded complication. Treatment options vary from débridement alone to staged revisions, arthrodesis, and amputation. Indications for how to treat this complication are unclear.
Questions/Purposes:
We therefore determined (1) the incidence of perimegaprosthetic infections, (2) the methods of treatment, (3) the number of patients who failed their original treatment plan, and (4) the characteristics of the infection.
Methods:
We retrospectively identified 291 patients who had megaprostheses implanted between 2001 and 2011 and identified all those surgically treated for a perimegaprosthetic infection during that time. We defined a treatment failure as any unplanned reoperation or death due to uncontrolled infection. All patients with failure had a minimum followup of 1 year (mean, 3.3 years; range, 1-8 years).
Results:
Of the 291 patients, 31 (11%) had subsequent infections. Surgical management varied among irrigation and débridement (n=15), single-stage revisions (n=11), two-stage revisions (n=4), and amputations (n=1). Sixteen patients failed their original treatment plan: 13 required additional surgery and three died. Infections were mostly chronic and single organism with five being methicillin-resistant Staphylococcus aureus.
Conclusions:
An 11% incidence of perimegaprosthetic infections is consistent with the increased risk of infection seen in other studies. A variety of surgical methods were employed at our institution and by those contributing to the literature without clear evidence of superiority of one method over another. Given the complicated medical and surgical histories of these patients, individualization in decision making is necessary.
Level Of Evidence:
Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Insights
Periprosthetic infections after megaprosthesis surgery occur in 11% of cases. Treatment outcomes vary, and individualized patient care is essential due to complex factors and lack of a superior surgical method.
Area of Science:
- Orthopedic surgery
- Infectious disease
- Biomaterials science
Background:
- Periprosthetic infections are a significant complication following megaprosthesis implantation.
- Current treatment strategies, including débridement, staged revisions, arthrodesis, and amputation, lack clear indications.
- The optimal management approach for these infections remains undefined.
Purpose of the Study:
- To determine the incidence of perimegaprosthetic infections.
- To analyze the treatment methods employed for these infections.
- To assess treatment failure rates and identify characteristics of periprosthetic infections.
Main Methods:
- Retrospective review of 291 patients who underwent megaprosthesis implantation between 2001 and 2011.
- Identification of patients surgically treated for periprosthetic infections.
- Definition of treatment failure as unplanned reoperation or death from infection, with a minimum 1-year follow-up for failed cases.
Main Results:
- A 11% incidence (31 of 291 patients) of periprosthetic infections was observed.
- Surgical interventions included irrigation and débridement (n=15), single-stage revisions (n=11), two-stage revisions (n=4), and amputation (n=1).
- Sixteen patients experienced treatment failure, requiring further surgery (n=13) or resulting in death (n=3); infections were typically chronic, single-organism, with five cases of methicillin-resistant Staphylococcus aureus.
Conclusions:
- The 11% infection rate aligns with increased risks reported in similar studies.
- No single surgical method demonstrated clear superiority for treating periprosthetic infections.
- Individualized treatment decisions are crucial given the complex patient profiles and surgical histories.
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