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Clinical Orthopaedics and Related Research®

, Volume 471, Issue 10, pp 3204–3213 | Cite as

Treatment Solutions Are Unclear for Perimegaprosthetic Infections

  • Lisa B. ErcolanoEmail author
  • Tyson Christensen
  • Richard McGough
  • Kurt Weiss
Symposium: 2012 Musculoskeletal Infection Society

Abstract

Background

Infection about a megaprosthesis is a dreaded complication. Treatment options vary from débridement alone to staged revisions, arthrodesis, and amputation. Indications for how to treat this complication are unclear.

Questions/purposes

We therefore determined (1) the incidence of perimegaprosthetic infections, (2) the methods of treatment, (3) the number of patients who failed their original treatment plan, and (4) the characteristics of the infection.

Methods

We retrospectively identified 291 patients who had megaprostheses implanted between 2001 and 2011 and identified all those surgically treated for a perimegaprosthetic infection during that time. We defined a treatment failure as any unplanned reoperation or death due to uncontrolled infection. All patients with failure had a minimum followup of 1 year (mean, 3.3 years; range, 1–8 years).

Results

Of the 291 patients, 31 (11%) had subsequent infections. Surgical management varied among irrigation and débridement (n = 15), single-stage revisions (n = 11), two-stage revisions (n = 4), and amputations (n = 1). Sixteen patients failed their original treatment plan: 13 required additional surgery and three died. Infections were mostly chronic and single organism with five being methicillin-resistant Staphylococcus aureus.

Conclusions

An 11% incidence of perimegaprosthetic infections is consistent with the increased risk of infection seen in other studies. A variety of surgical methods were employed at our institution and by those contributing to the literature without clear evidence of superiority of one method over another. Given the complicated medical and surgical histories of these patients, individualization in decision making is necessary.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Keywords

Periprosthetic Joint Infection Infectious Disease Specialist Soft Tissue Coverage Periprosthetic Infection Resection Arthroplasty 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors thank Dr. Mark Goodman for his assistance in developing and bringing the study to completion.

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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Lisa B. Ercolano
    • 1
    Email author
  • Tyson Christensen
    • 2
  • Richard McGough
    • 1
  • Kurt Weiss
    • 1
  1. 1.Department of OrthopaedicsUniversity of PittsburghPittsburghUSA
  2. 2.University of Pittsburgh School of MedicinePittsburghUSA

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