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

Document Type : RESEARCH PAPER


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


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


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