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Periprosthetic Joint Infection after Endoprosthetic Reconstruction: Saving the Limb-Salvage

Wylie Lopez1, Kayoumars Azizpour2, Kevin Raskin3

  • 1Department of Orthopaedic Surgery, Massachusetts General Hospital, MA, USA.

The Archives of Bone and Joint Surgery
|February 2, 2022
PubMed
Abstract

Insights

Mega-endoprosthetic survival after revision for periprosthetic joint infection (PJI) is viable, with a 73.7% limb salvage rate. Spacer length did not impact repeat surgeries, but complications remain high.

Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Infectious Diseases

Background:

  • Periprosthetic joint infection (PJI) is a severe complication following joint replacement surgery, occurring in 2-10% of patients.
  • PJI often necessitates revision surgery, amputation, or can be fatal.
  • Mega-endoprosthetics provide a limb salvage option, but data on their survival after PJI revision is limited.

Purpose of the Study:

  • To evaluate the survival rate of mega-endoprostheses after two-stage revision for PJI.
  • To assess the impact of cement spacer length on prosthesis survival and complication rates.
  • To report institutional experience with mega-endoprosthetic reconstruction following PJI.

Main Methods:

  • Retrospective chart review of patients undergoing two-stage revision for PJI with mega-endoprosthesis.
  • Analysis of variables including diagnosis, complications, cement spacer length, and number of surgeries.
  • Statistical analysis using Fisher's exact test and Kaplan-Meier method for prosthesis survival.

Main Results:

  • No statistically significant correlation was found between cement spacer length and the need for repeat surgery (p = 0.245).
  • The study observed a 63.2% complication rate and a 26.3% amputation rate after two-stage revision and mega-prosthesis insertion.
  • Kaplan-Meier analysis indicated a 73.7% probability of limb salvage in the studied cohort.

Conclusions:

  • Mega-endoprostheses demonstrate long-term viability following two-stage revision for PJI.
  • Despite a high complication rate, mega-endoprosthetic reconstruction offers a significant limb salvage option for patients with PJI.
Keywords:
Limb salvageMega-endoprosthesisPeriprosthetic joint infectionTwo-stage revision

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