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Published on: August 4, 2022
Megaprostheses for the revision of infected hip arthroplasties with severe bone loss
Nicola Logoluso1, Francesca Alice Pedrini2, Ilaria Morelli3
1IRCCS Istituto Ortopedico Galeazzi, Centre for Reconstructive Surgery and Osteoarticular Infections (C.R.I.O. Unit), via Riccardo Galeazzi 4, 20161, Milan, Italy.
Background:
Periprosthetic hip infections with severe proximal femoral bone loss may require the use of limb salvage techniques, but no agreement exists in literature regarding the most effective treatment. Aim of this study is to analyze the infection eradication rate and implant survival at medium-term follow-up in patients treated with megaprostheses for periprosthetic hip infections with severe bone loss.
Methods:
Twenty-one consecutive patients were retrospectively reviewed at a mean 64-month follow-up (24-120). Functional and pain scores, microbiological, radiological and intraoperative findings were registered. Kaplan Meier survival analysis and log rank test were used for infection free survival and implant survival analyses.
Results:
The infection eradication rate was 90.5%, with an infection free survival of 95.2% at 2 years (95%CI 70.7-99.3) and 89.6%(95%CI 64.3-97.3) at 5 years. Only two patients required major implant revisions for aseptic implant loosening. The most frequent complication was dislocation (38.1%). The major revision-free survival of implants was 95.2% (95%CI 70.7-99.3) at 2 years and 89.6% (95%CI 64.3-97.3) at 5 years. The overall implant survival was 83.35% (CI95% 50.7-93.94) at 2 and 5 years. Subgroup analyses (cemented versus cementless MPs, coated versus uncoated MPs) revealed no significant differences at log rank test, but its reliability was limited by the small number of patients included.
Conclusions:
Proximal femoral arthroplasty is useful to treat periprosthetic hip infections with severe bone loss, providing good functional results with high infection eradication rates and rare major revisions at medium-term follow-up. No conclusions can be drawn on the role of cement and coatings.
Insights
Proximal femoral arthroplasty effectively treats severe hip infections with bone loss, achieving high infection eradication and implant survival rates. This limb salvage technique offers good functional outcomes at medium-term follow-up.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Biomaterials Science
Background:
- Periprosthetic hip infections with significant proximal femoral bone loss present complex treatment challenges.
- Limb salvage techniques are employed, but optimal strategies remain debated in scientific literature.
Purpose of the Study:
- To evaluate infection eradication rates and implant survival following megaprosthesis use for periprosthetic hip infections with severe bone loss.
- To assess functional outcomes and complication rates in this patient cohort.
Main Methods:
- Retrospective review of 21 consecutive patients with a mean follow-up of 64 months.
- Data collected included functional/pain scores, microbiology, radiology, and intraoperative findings.
- Kaplan-Meier survival analysis and log-rank tests were used for survival assessments.
Main Results:
- High infection eradication rate of 90.5% and infection-free survival of 89.6% at 5 years.
- Major implant revisions were infrequent (2 patients for aseptic loosening).
- Dislocation was the most common complication (38.1%); overall implant survival was 83.35% at 5 years.
Conclusions:
- Proximal femoral arthroplasty is a viable option for periprosthetic hip infections with severe bone loss, yielding good function and high infection control.
- The study indicates rare major revisions are needed, but further research is required to determine the impact of cement and coatings.
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