Direct exchange endoprosthetic reconstruction with tumour prosthesis for periprosthetic knee infection associated with segmental bone defects

Abstract

Revision knee arthroplasty for infection poses a treatment challenge. The presence of massive osteolysis limits the treatment options in this cohort. Controversy exists in the management of these patients. Direct exchange arthroplasty has provided good results in the presence of infection, but whether this is appropriate in the presence of massive bone defects associated with the infection is undetermined. We present our experience in revision knee arthroplasty for infection associated with massive bone defects. The aim of the study is to present the preliminary results of a direct exchange endoprosthetic reconstruction with tumour prosthesis for periprosthetic infection associated with segmental bone defects. This is a retrospective study of prospectively collected data, involving six patients with periprosthetic infection and massive bone defects treated by direct exchange tumour prostheses between 2003 and 2007 (four distal femoral replacements and two total femoral replacements). The mean age and follow-up were 74.2 (±5.2) years and 32.5 (±8.2) months respectively. Each patient had an infected revised knee arthroplasty at the time of referral to our institution. Staphylococcus aureus was the most common causal organism. The mean duration of antibiotics was 6 weeks intravenous therapy followed by 3.5 months oral. The recurrences of infection, pain or immobility were outcome criteria considered failures. Our success rate was 80%. Salvage of infected revised knee arthroplasty by direct exchange endoprosthetic reconstruction has provided an effective means of pain relief, joint stability and improved mobility in our cohort. It reduces morbidity through earlier mobilisation and avoids a second major operation.

Megaprostheses for the revision of infected hip arthroplasties with severe bone loss

“…have been published [ 14 , 35 , 36 ]. Nevertheless, few previous studies showed the results of MPs for the treatment of PJIs [ 13 , 14 , 37 – 39 ]. Artiaco et al published a series of 5 patients undergoing RTHA for PJIs with cemented modular MPs (4 two-stage cases and 1 one-stage); after a minimum 36-month follow-up, they observed infection recurrence only in the one-stage patient [ 37 ].…”

“…Artiaco et al published a series of 5 patients undergoing RTHA for PJIs with cemented modular MPs (4 two-stage cases and 1 one-stage); after a minimum 36-month follow-up, they observed infection recurrence only in the one-stage patient [ 37 ]. Ramappa et al reported 6 cases of chronic knee PJIs treated with one-stage exchange of distal and/or total femur MP, at a minimum 18-month follow-up: 5 (80%) patients successfully completed the antibiotic treatment without infection recurrence, pain or reduced mobility [ 39 ]. Corona et al published a series of 29 patients divided into 3 groups according to the type of MP they had received (proximal, distal o total femur arthroplasty); after a mean 48-month follow-up, they showed an infection healing rate of 82.8% (24 patients) [ 13 ].…”

Total femur replacement in a patient with chronic persistence osteomyelitis – A case report

“…Postoperative infection is also a major problem for patients who have TFR with accompanied infections. According to a Ramappa 2010 report, when TFR to treat infection around an prosthesis, 1 in 6 patients had re-infection after 3 months of surgery [ 15 ]. About 17.2% of patients still had postoperative infections as reported by Corona in 2018.…”

One-Stage Hip Revision Arthroplasty Using Megaprosthesis in Severe Bone Loss of The Proximal Femur Due to Radiological Diffuse Osteomyelitis

“…In spite of this, there are some reports through which we could analyze the results of megaprosthesis use for massive proximal femoral bone defects in one-stage hip revision arthroplasty [1,[15][16][17][18]. Corona et al [15], in a cohort of 29 chronic PJI patients, described two one-stage septic revision hip arthroplasty cases: both had complications, one with a total femur arthroplasty sustained a hip dislocation, the other patient with recurrence of infection.…”