High Risk for Persistent Peri-Prosthetic Infection and Amputation in Mega-Prosthesis Reconstruction

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Oncology

Background:

• Deep peri-prosthetic joint infection is a serious complication following mega-prosthesis reconstruction for large bone defects.
• These infections can significantly impact patient outcomes, necessitating further interventions.

Purpose of the Study:

• To investigate the outcomes of patients with mega-prostheses who develop deep peri-prosthetic joint infections.
• To analyze re-operation rates, persistent infection risk, arthrodesis, and amputation following infection.

Main Methods:

• Retrospective evaluation of 114 patients (116 prostheses) who underwent mega-prosthesis reconstruction for sarcoma, metastasis, or trauma.
• Analysis of infection details, treatment modalities, bacterial strains, and patient outcomes at a median follow-up of 7.6 years.

Main Results:

• 30% of patients required re-operation due to peri-prosthetic infection.
• Infected patients had a 51% chance of retaining the prosthesis, 37% underwent amputation, and 9% had arthrodesis.
• Persistent infection occurred in 26% of infected cases. Coagulase-negative staphylococci and Staphylococcus aureus were the most common pathogens.

Conclusions:

• Mega-prostheses are associated with a substantial risk of peri-prosthetic infection.
• Infections frequently lead to challenging outcomes, including persistent infection or limb amputation, highlighting the need for effective prevention and treatment strategies.