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Use of modular megaprosthesis in managing chronic end-stage periprosthetic hip and knee infections: Is there an increase in relapse rate?

  • Original Article • HIP - ARTHROPLASTY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Bone loss is a common problem in periprosthetic joint infection (PJI) scenarios. Modular megaprosthesis (MP) could offer a limb salvage solution in such situations. Concerns about risk of infection relapse, reinfection and implant longevity exist regarding MP use in cases of chronic PJI, rather than standard implants. We therefore sought to analyze our results with MP use in chronic PJI cases.

Methods

We performed a retrospective analysis of 29 MP patients. Inclusion criteria were the use of this type of modular megaimplant for reconstruction of segmental bone defects in chronically infected lower-extremity arthroplasties (hip or knee) and a minimum follow-up of 18 months. We evaluated the primary outcome of infection control or recurrence. The MPs were classified into 3 groups, according the bone segment replaced (proximal femur, distal femur or total femur). We further analyzed complications, pain, patient satisfaction and functional results.

Results

Mean age was 75 years; mean follow-up was 48 months (range 18–82). The most frequently involved pathogens were coagulase-negative staphylococci (62%). Polymicrobial infection was detected in 7 patients. Twenty-eight patients were managed with a two-stage approach. The infection-free rate at the end of follow-up was 82.8% (24 of 29 patients). Aside from infection relapse, the most frequent complication was dislocation. Final-point survival rate was 91.2% (CI 68.1–97.8). Clinical outcome data and satisfaction results were acceptable.

Conclusion

According our data, MP is a useful tool in treating end-stage PJI cases, achieving acceptable eradication, satisfaction and implant survivorship rates.

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References

  1. Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654. https://doi.org/10.1056/NEJMra040181

    Article  CAS  PubMed  Google Scholar 

  2. Tsukayama DT, Goldberg VM, Kyle R (2003) Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg Am 85A(Suppl 1):S75–S80

    Article  Google Scholar 

  3. Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785. https://doi.org/10.2106/JBJS.F.00222

    PubMed  Google Scholar 

  4. Beck RT, Illingworth KD, Saleh KJ (2012) Review of periprosthetic osteolysis in total joint arthroplasty: an emphasis on host factors and future directions. J Orthop Res Off Publ Orthop Res Soc 30:541–546. https://doi.org/10.1002/jor.21554

    Article  Google Scholar 

  5. Sheth NP, Bonadio MB, Demange MK (2017) Bone loss in revision total knee arthroplasty: evaluation and management. J Am Acad Orthop Surg 25:348–357. https://doi.org/10.5435/JAAOS-D-15-00660

    Article  PubMed  Google Scholar 

  6. Calori GM, Colombo M, Malagoli E et al (2014) Megaprosthesis in post-traumatic and periprosthetic large bone defects: issues to consider. Injury 45(Suppl 6):S105–S110. https://doi.org/10.1016/j.injury.2014.10.032

    Article  PubMed  Google Scholar 

  7. Pala E, Trovarelli G, Calabrò T et al (2015) Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop 473:891–899. https://doi.org/10.1007/s11999-014-3699-2

    Article  PubMed  Google Scholar 

  8. Kapoor SK, Thiyam R (2015) Management of infection following reconstruction in bone tumors. J Clin Orthop Trauma 6:244–251. https://doi.org/10.1016/j.jcot.2015.04.005

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ercolano LB, Christensen T, McGough R, Weiss K (2013) Treatment solutions are unclear for perimegaprosthetic infections. Clin Orthop 471:3204–3213. https://doi.org/10.1007/s11999-013-2852-7

    Article  PubMed  PubMed Central  Google Scholar 

  10. Henderson ER, Groundland JS, Pala E et al (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93:418–429. https://doi.org/10.2106/JBJS.J.00834

    Article  PubMed  Google Scholar 

  11. Artiaco S, Boggio F, Colzani G et al (2015) Megaprostheses in the revision of infected total hip arthroplasty: clinical series and literature review. Bull Hosp Jt Dis 73:229–232

    Google Scholar 

  12. Osmon DR, Berbari EF, Berendt AR et al (2013) Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am 56:1–10. https://doi.org/10.1093/cid/cis966

    Article  Google Scholar 

  13. Corona PS, Barro V, Mendez M et al (2014) Industrially prefabricated cement spacers: do vancomycin- and gentamicin-impregnated spacers offer any advantage? Clin Orthop 472:923–932. https://doi.org/10.1007/s11999-013-3342-7

    Article  PubMed  Google Scholar 

  14. Ariza J, Cobo J, Baraia-Etxaburu J et al (2017) Executive summary of management of prosthetic joint infections. Clinical practice guidelines by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Enferm Infecc Microbiol Clin 35:189–195. https://doi.org/10.1016/j.eimc.2016.08.012

    Article  PubMed  Google Scholar 

  15. Diaz-Ledezma C, Higuera CA, Parvizi J (2013) Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus. Clin Orthop 471:2374–2382. https://doi.org/10.1007/s11999-013-2866-1

    Article  PubMed  PubMed Central  Google Scholar 

  16. Brandt CM, Sistrunk WW, Duffy MC et al (1997) Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis Off Publ Infect Dis Soc Am 24:914–919

    Article  CAS  Google Scholar 

  17. Brokelman RBG, Haverkamp D, van Loon C et al (2012) The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty. Eur Orthop Traumatol 3:101–105. https://doi.org/10.1007/s12570-012-0100-3

    Article  PubMed  PubMed Central  Google Scholar 

  18. Saleh KJ, Mulhall KJ, Bershadsky B et al (2005) Development and validation of a lower-extremity activity scale. Use for patients treated with revision total knee arthroplasty. J Bone Joint Surg Am 87:1985–1994. https://doi.org/10.2106/JBJS.D.02564

    Article  PubMed  Google Scholar 

  19. Mahomed N, Gandhi R, Daltroy L, Katz JN (2011) The self-administered patient satisfaction scale for primary hip and knee arthroplasty. Arthritis 2011:591253. https://doi.org/10.1155/2011/591253

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Osmon DR, Berbari EF, Berendt AR et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:e1–e25. https://doi.org/10.1093/cid/cis803

    Article  PubMed  Google Scholar 

  21. Della Valle C, Parvizi J, Bauer TW et al (2010) Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 18:760–770

    Article  PubMed  Google Scholar 

  22. Tande AJ, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27:302–345. https://doi.org/10.1128/CMR.00111-13

    Article  PubMed  PubMed Central  Google Scholar 

  23. Peters CL, Hickman JM, Erickson J et al (2006) Intramedullary total femoral replacement for salvage of the compromised femur associated with hip and knee arthroplasty. J Arthroplasty 21:53–58. https://doi.org/10.1016/j.arth.2004.12.061

    Article  PubMed  Google Scholar 

  24. Parvizi J, Tarity TD, Slenker N et al (2007) Proximal femoral replacement in patients with non-neoplastic conditions. J Bone Joint Surg Am 89:1036–1043. https://doi.org/10.2106/JBJS.F.00241

    Article  PubMed  Google Scholar 

  25. Sewell MD, Hanna SA, Carrington RW et al (2010) Modular proximal femoral replacement in salvage hip surgery for non-neoplastic conditions. Acta Orthop Belg 76:493–502

    PubMed  Google Scholar 

  26. Grammatopoulos G, Alvand A, Martin H et al (2016) Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications. Bone Jt J 98B:1463–1470. https://doi.org/10.1302/0301-620X.98B11.BJJ-2016-0244.R1

    Article  Google Scholar 

  27. Ramappa M, McMurtry I, Port A (2010) Direct exchange endoprosthetic reconstruction with tumour prosthesis for periprosthetic knee infection associated with segmental bone defects. Strategies Trauma Limb Reconstr 5:31–37. https://doi.org/10.1007/s11751-009-0077-9

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gristina AG, Costerton JW (1984) Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am 15:517–535

    CAS  PubMed  Google Scholar 

  29. Wafa H, Grimer RJ, Reddy K et al (2015) Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients: case-control study. Bone Jt J 97B:252–257. https://doi.org/10.1302/0301-620X.97B2.34554

    Article  Google Scholar 

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Acknowledgements

We wish to thank Russell Williams of RoundlyWorded.com for his editorial recommendations. I personally want to highlight the invaluable experience and many years of work of the former head of our unit, Dr. Xavier Flores, from whom we learned much in the field of periprosthetic joint infections. We further wish to thank our whole multidisciplinary team, including Dr. Carles Pigrau and Dr. Rodriguez-Pardo, members of our Department of Infectious Diseases, Dr. Mayli Lung, member of the Department of Microbiology, and Dr. Juan Carlos Juarez, a member of our center’s Pharmacy Department. I also wish to extend special thanks to my friends from Ramses (Carrer LLeida, Barcelona), where a great deal of this work was done.

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Author notes

  1. Pablo S. Corona and Matias Vicente have contributed equally to this work.

Authors and Affiliations

  1. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain

    Pablo S. Corona, Carles Amat & Luis Carrera

  2. Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig Vall d’Hebron 119-129, 08029, Barcelona, Spain

    Matias Vicente & Mireia Lalanza

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  1. Pablo S. Corona
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Correspondence to Matias Vicente.

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Corona, P.S., Vicente, M., Lalanza, M. et al. Use of modular megaprosthesis in managing chronic end-stage periprosthetic hip and knee infections: Is there an increase in relapse rate?. Eur J Orthop Surg Traumatol 28, 627–636 (2018). https://doi.org/10.1007/s00590-018-2127-9

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  • DOI: https://doi.org/10.1007/s00590-018-2127-9

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