The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction

Background:. A megaprosthesis may be used for reconstruction in patients with massive bone loss or a periprosthetic fracture. Periprosthetic joint infection (PJI) may occur after a megaprosthesis reconstruction and may pose a major challenge. The outcomes of managing PJI in patients with a megaprost...

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Autores principales: Kamolsak Sukhonthamarn, MD, Timothy L. Tan, MD, John Strony, BS, Scot Brown, MD, David Nazarian, MD, Javad Parvizi, MD, FRCS
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Lenguaje:EN
Publicado: Wolters Kluwer 2021
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Acceso en línea:https://doaj.org/article/bd21057151194a1eaa4d6b61136c88da
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spelling oai:doaj.org-article:bd21057151194a1eaa4d6b61136c88da2021-11-25T07:59:02ZThe Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction2472-724510.2106/JBJS.OA.21.00003https://doaj.org/article/bd21057151194a1eaa4d6b61136c88da2021-12-01T00:00:00Zhttp://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.21.00003https://doaj.org/toc/2472-7245Background:. A megaprosthesis may be used for reconstruction in patients with massive bone loss or a periprosthetic fracture. Periprosthetic joint infection (PJI) may occur after a megaprosthesis reconstruction and may pose a major challenge. The outcomes of managing PJI in patients with a megaprosthesis is relatively unclear. The aim of this study was to investigate the clinical course and outcomes of PJI in patients with a megaprosthesis in place. Methods:. From a total of 219 patients who underwent megaprosthesis replacement for non-oncologic conditions, 38 (17.4%) developed subsequent PJI. A retrospective review of the medical record was performed to ascertain the course of the PJI and treatment outcomes. Kaplan-Meier analysis was performed to evaluate the survival function, and the log-rank test was used to assess differences in outcome measures. Results:. The surgical management of 33 patients with PJI included debridement, antibiotics, and implant retention (DAIR) (82%), consisting of DAIR with modular component exchange (19 patients) and DAIR without component exchange (8 patients); 2-stage exchange arthroplasty (9%); resection arthroplasty (6%); and a single-stage revision arthroplasty (3%). The Kaplan-Meier survivorship analysis demonstrated that the overall survival rate was 65.1% at 2 years. The mortality rate was 15%, with many patients undergoing salvage procedures including amputation (18%), arthrodesis (6%), and resection arthroplasty (6%). Conclusions:. The rate of PJI after megaprosthesis reconstruction, 17% in this study, appears to be very high. The management of PJI in these patients is challenging, with 1 of 3 patients undergoing failed treatment. Despite the limited options available, DAIR seems to be an appropriate treatment strategy for some of these patients. Further data on a larger cohort are needed to assess the success of various surgical procedures and predictors of failure in this challenging patient population. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.Kamolsak Sukhonthamarn, MDTimothy L. Tan, MDJohn Strony, BSScot Brown, MDDavid Nazarian, MDJavad Parvizi, MD, FRCSWolters KluwerarticleOrthopedic surgeryRD701-811ENJBJS Open Access, Vol 6, Iss 4 (2021)
institution DOAJ
collection DOAJ
language EN
topic Orthopedic surgery
RD701-811
spellingShingle Orthopedic surgery
RD701-811
Kamolsak Sukhonthamarn, MD
Timothy L. Tan, MD
John Strony, BS
Scot Brown, MD
David Nazarian, MD
Javad Parvizi, MD, FRCS
The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction
description Background:. A megaprosthesis may be used for reconstruction in patients with massive bone loss or a periprosthetic fracture. Periprosthetic joint infection (PJI) may occur after a megaprosthesis reconstruction and may pose a major challenge. The outcomes of managing PJI in patients with a megaprosthesis is relatively unclear. The aim of this study was to investigate the clinical course and outcomes of PJI in patients with a megaprosthesis in place. Methods:. From a total of 219 patients who underwent megaprosthesis replacement for non-oncologic conditions, 38 (17.4%) developed subsequent PJI. A retrospective review of the medical record was performed to ascertain the course of the PJI and treatment outcomes. Kaplan-Meier analysis was performed to evaluate the survival function, and the log-rank test was used to assess differences in outcome measures. Results:. The surgical management of 33 patients with PJI included debridement, antibiotics, and implant retention (DAIR) (82%), consisting of DAIR with modular component exchange (19 patients) and DAIR without component exchange (8 patients); 2-stage exchange arthroplasty (9%); resection arthroplasty (6%); and a single-stage revision arthroplasty (3%). The Kaplan-Meier survivorship analysis demonstrated that the overall survival rate was 65.1% at 2 years. The mortality rate was 15%, with many patients undergoing salvage procedures including amputation (18%), arthrodesis (6%), and resection arthroplasty (6%). Conclusions:. The rate of PJI after megaprosthesis reconstruction, 17% in this study, appears to be very high. The management of PJI in these patients is challenging, with 1 of 3 patients undergoing failed treatment. Despite the limited options available, DAIR seems to be an appropriate treatment strategy for some of these patients. Further data on a larger cohort are needed to assess the success of various surgical procedures and predictors of failure in this challenging patient population. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
format article
author Kamolsak Sukhonthamarn, MD
Timothy L. Tan, MD
John Strony, BS
Scot Brown, MD
David Nazarian, MD
Javad Parvizi, MD, FRCS
author_facet Kamolsak Sukhonthamarn, MD
Timothy L. Tan, MD
John Strony, BS
Scot Brown, MD
David Nazarian, MD
Javad Parvizi, MD, FRCS
author_sort Kamolsak Sukhonthamarn, MD
title The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction
title_short The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction
title_full The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction
title_fullStr The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction
title_full_unstemmed The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction
title_sort fate of periprosthetic joint infection following megaprosthesis reconstruction
publisher Wolters Kluwer
publishDate 2021
url https://doaj.org/article/bd21057151194a1eaa4d6b61136c88da
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