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The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction
Kamolsak Sukhonthamarn1,2, Timothy L Tan1, John Strony1
1Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Background:
A megaprosthesis may be used for reconstruction in patients with massive bone loss or a periprosthetic fracture. Periprosthetic joint infection (PJI) may occur after a megaprosthesis reconstruction and may pose a major challenge. The outcomes of managing PJI in patients with a megaprosthesis is relatively unclear. The aim of this study was to investigate the clinical course and outcomes of PJI in patients with a megaprosthesis in place.
Methods:
From a total of 219 patients who underwent megaprosthesis replacement for non-oncologic conditions, 38 (17.4%) developed subsequent PJI. A retrospective review of the medical record was performed to ascertain the course of the PJI and treatment outcomes. Kaplan-Meier analysis was performed to evaluate the survival function, and the log-rank test was used to assess differences in outcome measures.
Results:
The surgical management of 33 patients with PJI included debridement, antibiotics, and implant retention (DAIR) (82%), consisting of DAIR with modular component exchange (19 patients) and DAIR without component exchange (8 patients); 2-stage exchange arthroplasty (9%); resection arthroplasty (6%); and a single-stage revision arthroplasty (3%). The Kaplan-Meier survivorship analysis demonstrated that the overall survival rate was 65.1% at 2 years. The mortality rate was 15%, with many patients undergoing salvage procedures including amputation (18%), arthrodesis (6%), and resection arthroplasty (6%).
Conclusions:
The rate of PJI after megaprosthesis reconstruction, 17% in this study, appears to be very high. The management of PJI in these patients is challenging, with 1 of 3 patients undergoing failed treatment. Despite the limited options available, DAIR seems to be an appropriate treatment strategy for some of these patients. Further data on a larger cohort are needed to assess the success of various surgical procedures and predictors of failure in this challenging patient population.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Insights
Periprosthetic joint infection (PJI) rates are high after megaprosthesis reconstruction, with a significant portion of patients experiencing treatment failure. Debridement, antibiotics, and implant retention (DAIR) may be a viable option for some, but further research is needed.
Area of Science:
- Orthopedic surgery
- Infectious disease
Background:
- Megaprostheses are used for massive bone loss or periprosthetic fractures.
- Periprosthetic joint infection (PJI) is a challenging complication following megaprosthesis reconstruction.
- Outcomes of PJI management in megaprosthesis patients are not well-defined.
Purpose of the Study:
- To investigate the clinical course and outcomes of PJI in patients with megaprostheses.
- To identify challenges and success rates of different management strategies for PJI in this population.
Main Methods:
- Retrospective review of 219 patients undergoing non-oncologic megaprosthesis replacement.
- Analysis of 38 patients (17.4%) who developed PJI.
- Kaplan-Meier survival analysis and log-rank testing were used to evaluate outcomes.
Main Results:
- The overall survival rate at 2 years post-PJI was 65.1%.
- Mortality rate was 15%, with high rates of salvage procedures including amputation (18%).
- Debridement, antibiotics, and implant retention (DAIR) was the primary surgical approach (82%).
Conclusions:
- PJI occurs at a high rate (17%) after megaprosthesis reconstruction.
- PJI management in these patients is difficult, with a 1 in 3 treatment failure rate.
- DAIR may be a suitable strategy for some patients, but larger cohorts are needed to determine predictors of failure.
