Periprosthetic Joint Infection after Endoprosthetic Reconstruction: Saving the Limb-Salvage

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, Massachusetts General Hospital, MA, USA

2 Harvard Medical School, Boston MA, USA

3 Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

4 Massachusetts General Hospital, Boston, MA, USA

Abstract

Background: This study evaluates mega-endoprosthetic survival after revision for periprosthetic joint infection (PJI)
and two-staged reconstruction using a cement spacer. Mega-endoprosthetics offer patients an important treatment
option for limb salvage. However, PJI is a devastating complication which affects between 2-10% of patients. It
commonly results in revisions, amputation, and sometimes death. Literature in terms of success rates, limb salvage
and Megaprostheses survival after revision for infection is limited. We present here our experience and the impact of
length of the spacer in prostheses survival.
Methods: A retrospective chart review was implemented using Fisher’s exact test for categorical data and the Kaplan-
Meier method for prosthesis survival. Patient information was acquired through our institution’s electronic medical
records. Variables such as diagnosis, complications, length of cement spacer, and number of surgeries were recorded.
We analyzed spacer length and prosthesis survival based on these variables.
Results: Fisher’s Exact test showed no correlation between length of spacer and amount of repeat surgery (P = 0.245).
After two-stage revision and mega-prosthesis insertion, there was a 63.2% chance of complication and a 26.3% chance
of amputation. This indicates a 73.7% probability for limb salvage in this sample (Kaplan-Meier).
Conclusion: These data suggest long-term viability of mega-endoprostheses after two-stage revision despite a high
complication rate.
Level of evidence: IV

Keywords

References

1. Enneking WF. An Abbreviated History of Orthopaedic
Oncology in North America. Clin Orthop Relat Res.
2000; 374:115–24.
2. Kini SG, Gabr A, Das R, Sukeik M, Haddad FS. Twostage
Revision for Periprosthetic Hip and Knee
Joint Infections. Open Orthop J. 2016 ;10(Suppl-2,
M2):579–88.
3. Mankin HJ. The changes in major limb reconstruction
as a result of the development of allografts. Chir
Organi Mov. 2003; 88(2):101–13.
4. Wagels M, Rowe D, Senewiratne S, Theile DR. History
of lower limb reconstruction after trauma. ANZ J
Surg. 2012 ;83(5):348–53.
5. Adeli B, Parvizi J. Strategies for the prevention of
periprosthetic joint infection. J Bone Joint Surg Br.
2012 ;94-B(11_Supple_A):42–6.
6. Healey JH. CORR Insights™: High Infection Rate Outcomes in Long-bone Tumor Surgery with
Endoprosthetic Reconstruction in Adults: A
Systematic Review. Clin Orthop Relat Res. 2013
;471(6):2028–9.
7. Kühne CA, Taeger G, Nast-Kolb D, Ruchholtz S. Knee
arthrodesis after infected tumor mega prosthesis
of the knee using an intramedullary nail for
callus distraction. Langenbecks Arch Surg. 2003
;388(1):56–9.
8. Costerton JW. Biofilm Theory Can Guide the
Treatment of Device-Related Orthopaedic Infections.
Clin Orthop Relat Res. 2005; 437:7–11.
9. Stoodley P, Ehrlich GD, Sedghizadeh PP, Hall-Stoodley
L, Baratz ME, Altman DT, et al. Orthopaedic biofilm
infections. Curr Orthop Pract. 2011 ;22(6):558–63.
10. Illingworth KD, Mihalko WM, Parvizi J, Sculco T,
Mcarthur B, Bitar YE, et al. How to Minimize Infection and Thereby Maximize Patient Outcomes in Total
Joint Arthroplasty. J Bone Joint Surg Am. 2013 ;95(8).
11. Fink B. Revision of late periprosthetic infections of
total hip endoprostheses: pros and cons of different
concepts. Int J Med Sci. 2009 ;6(5):287–95.
12. Parvizi J, Adeli B, Zmistowski B, Restrepo C,
Greenwald AS. Management of Periprosthetic Joint
Infection: The Current Knowledge. J Bone Joint Surg
Am. 2012; 94(14):e104.
13. Kalore NV, Gioe TJ, Singh JA. Diagnosis and
management of infected total knee arthroplasty.
Open Orthop J. 2011 ;5:86–91.
14. Cuckler JM. The infected total knee: management
options. J Arthroplasty. 2005 ;20(4 Suppl 2):33–6.
15. Haddad FS, Masri BA, Campbell D, McGraw RW,
Beauchamp CP, Duncan CP. The PROSTALAC functional
spacer in two-stage revision for infected knee
replacements. Prosthesis of antibiotic-loaded acrylic
cement. J Bone Joint Surg Br. 2000 ;82(6):807-12.
The Archives of Bone and Joint Surgery
Volume 9, Issue 6
November 2021
Pages 677-685

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History

  • Receive Date: 08 December 2020
  • Revise Date: 04 February 2021
  • Accept Date: 23 February 2021

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