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Microbiological Characteristics and Clinical Outcomes of Periprosthetic Infections Following Oncologic Megaprosthetic
Vasileios Karampikas1, Stavros Goumenos2, Andreas G Tsantes3,4
1First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece.
Background:
Periprosthetic joint infection (PJI) is a severe complication following megaprosthetic reconstruction in musculoskeletal oncology. This study aimed to evaluate outcomes of different surgical strategies for PJI in lower-limb megaprostheses and identify factors associated with treatment failure.
Methods:
We performed a retrospective cohort study of 29 consecutive patients treated for PJI after oncologic megaprosthetic reconstruction. Reinfection was analyzed using cumulative incidence functions (CIFs) with death treated as a competing event. Overall survival was assessed using Kaplan-Meier analysis. Univariable cause-specific Cox regression was performed for exploratory risk-factor analysis.
Results:
Among 29 patients, coagulase-negative staphylococci and Staphylococcus aureus were the most frequently isolated pathogens, and difficult-to-treat organisms were identified in a substantial proportion of cases. In patients managed with two-stage revision, the cumulative incidence of reinfection was 15% (95% CI: 0-30%) at 1 year and 30% (95% CI: 10-50%) at 2 and 5 years. In the DAIR cohort, the cumulative incidence of reinfection was 25% (95% CI: 0-62.5%) at 1 and 2 years and 37.5% (95% CI: 12.2-75%) at 3 years. Positive reimplantation cultures occurred in 38% of cases and were strongly associated with subsequent treatment failure. Polymicrobial infections were present in 27.5% of cases. Amputation was required in 17.2% of patients, often due to multidrug-resistant organisms or poor soft tissue.
Conclusions:
Two-stage revision remains the most effective strategy for PJI management in megaprostheses. DAIR may control acute infection but is suboptimal for definitive treatment. Individualized, multidisciplinary approaches are essential to improve outcomes in this high-risk population.
Insights
Two-stage revision is the most effective treatment for periprosthetic joint infection (PJI) in lower-limb megaprostheses. While debridement, antibiotics, and implant retention (DAIR) can manage acute infection, it is suboptimal for long-term PJI control.
Area of Science:
- Musculoskeletal oncology
- Orthopedic surgery
- Infectious disease
Background:
- Periprosthetic joint infection (PJI) is a significant complication in patients with lower-limb megaprostheses used in musculoskeletal oncology.
- Effective management strategies for PJI in this high-risk population are crucial to improve patient outcomes.
Purpose of the Study:
- To evaluate the outcomes of different surgical strategies for treating PJI in lower-limb megaprostheses.
- To identify factors associated with treatment failure in PJI cases.
Main Methods:
- Retrospective cohort study of 29 patients with PJI after oncologic megaprosthetic reconstruction.
- Analysis of reinfection rates using cumulative incidence functions and overall survival via Kaplan-Meier analysis.
- Exploratory risk-factor analysis using univariable cause-specific Cox regression.
Main Results:
- Coagulase-negative staphylococci and Staphylococcus aureus were common pathogens; difficult-to-treat organisms were frequent.
- Two-stage revision showed a 1-year reinfection rate of 15% and a 2-5 year rate of 30%.
- DAIR had higher reinfection rates (25% at 1-2 years). Positive reimplantation cultures (38%) and polymicrobial infections (27.5%) were associated with treatment failure. Amputation was required in 17.2% of cases.
Conclusions:
- Two-stage revision is the most effective strategy for managing PJI in megaprostheses.
- DAIR is less effective for definitive PJI treatment compared to two-stage revision.
- Individualized, multidisciplinary approaches are essential for optimizing outcomes in this patient group.
