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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Wolters Kluwer
2021
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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) |
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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 |
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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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