Extensive Femoral Bone Loss Following Two-Stage Periprosthetic Joint Infection Treatment: Persistent Challenges in...

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Biomedical Engineering

Background:

• Proximal femoral replacement (PFR) is increasingly used in non-oncological reconstructions.
• Literature on PFR for extensive bone defects after two-stage periprosthetic joint infection (PJI) treatment is limited.
• This study evaluates PFR outcomes in severe bone loss due to PJI.

Purpose of the Study:

• To assess clinical and functional outcomes of PFR in extensive proximal femoral bone defects following two-stage PJI treatment.
• To determine complication rates and prosthesis survivorship in this challenging patient cohort.
• To provide insights into the effectiveness and limitations of PFR in managing complex PJI cases.

Main Methods:

• Retrospective single-center study of patients undergoing PFR for Paprosky type 3B/4 proximal femoral bone loss post-PJI.
• Inclusion criteria: minimum 24-month follow-up.
• Functional outcomes assessed by Musculoskeletal Tumor Society (MSTS) score; prosthesis failure by Henderson's Classification; survival by Kaplan-Meier curves.

Main Results:

• Thirty-four patients (mean age 72.9) with a mean follow-up of 75 months were analyzed.
• Average 3.88 prior surgeries per patient.
• High complication rates: 20.6% mechanical, 23.5% non-mechanical.
• Mean MSTS score was 66.74%.
• Five-year all-cause complication-free survival was 52%; revision-free survival was 47%.

Conclusions:

• PFR can be effective for limb salvage in complex PJI cases with severe bone defects.
• High rates of mechanical and non-mechanical complications necessitate careful patient selection and surgical planning.
• Moderate to poor prosthesis survival rates highlight the persistent challenges of PJI management.
• Further research is needed to improve functional assessment tools and address infection recurrence.