Related Experiment Video
Updated: Jun 17, 2026
Prospective, Randomized, and Controlled Study of a Human Umbilical Cord Mesenchymal Stem Cell Injection for Treating Diabetic Foot Ulcers
Published on: March 3, 2023
Two-stage revision for infection of oncological megaprostheses : a multicentre EMSOS study
Andrea Sambri1, Domenico A Campanacci2, Elisa Pala3
1Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy.
Aims:
The aim of this study was to assess the incidence of reinfection in patients after two-stage revision of an infected megaprosthesis (MPR) implanted after resection of a bone tumour.
Methods:
A retrospective study was carried out of 186 patients from 16 bone sarcoma centres treated between January 2010 and December 2020. The median age at the time of tumour diagnosis was 26 years (IQR 17 to 33); 69 (37.1%) patients were female, and 117 (62.9%) were male.
Results:
A total of 186 patients with chronic MPR infections were included. Median follow-up was 68 months (IQR 31 to 105). The most represented sites of MPR were distal femur in 93 cases (50.0%) and proximal tibia in 53 cases (28.5%). Polymicrobial infections were seen in 34 cases (18.3%). The most frequent isolated pathogens were staphylococci. Difficult-to-treat (DTT) pathogens were isolated in 50 cases (26.9%). The estimated infection recurrence (IR) rate was 39.1% at five years and 50.0% at ten years. A higher IR rate was found in DTT PJI compared to non-DTT infections (p = 0.019). Polymicrobial infections also showed a higher rate of infection recurrence (p = 0.046).
Conclusion:
This study suggests that an infected MPR treated by two-stage revision and ultimately reimplantation with a MPR can be successful, but the surgeon must be aware of a high recurrence rate compared to those seen with infected conventional implants.
Insights
Revising infected bone tumour megaprostheses (MPR) via two-stage surgery shows success but carries a high infection recurrence rate, especially with difficult-to-treat pathogens. Surgeons must carefully consider these risks.
Area of Science:
- Orthopedic Surgery
- Oncology
- Infectious Diseases
Background:
- Bone tumours often require megaprosthesis (MPR) implantation.
- Infection after MPR implantation is a significant complication, necessitating complex management.
- Two-stage revision is a common strategy for managing infected MPRs.
Purpose of the Study:
- To evaluate the incidence of reinfection after two-stage revision of infected megaprostheses (MPR) in bone tumour patients.
- To identify factors associated with infection recurrence in this patient population.
Main Methods:
- Retrospective study of 186 patients undergoing two-stage revision for infected MPRs between 2010-2020.
- Data collected from 16 bone sarcoma centers.
- Analysis of infection recurrence rates, pathogen types, and anatomical locations.
Main Results:
- The 5-year infection recurrence rate was 39.1%, reaching 50.0% at 10 years.
- Difficult-to-treat (DTT) pathogens and polymicrobial infections were associated with significantly higher recurrence rates (p=0.019 and p=0.046, respectively).
- Distal femur and proximal tibia were the most common sites for MPRs.
Conclusions:
- Two-stage revision and reimplantation of MPRs for bone tumour patients can be successful.
- A high infection recurrence rate, exceeding that of infected conventional implants, must be anticipated.
- Awareness of DTT pathogens and polymicrobial infections is crucial for managing outcomes.
