Periprosthetic Joint Infection after Endoprosthetic Reconstruction: Saving the Limb-Salvage

Abstract

Background and Objectives: This study evaluates mega-endoprosthetic survival after periprosthetic joint infection (PJI) and two-staged reconstruction using a cement spacer. Mega-endoprosthetics offers patients an important treatment option for limb salvage. PJI’s are devastating complications which affect between 2-10% of patients and commonly result in additional procedures, amputation, and sometimes death. The difficulty with these infections is attributed to the elusive nature of its diagnosis and complexity of treatment. Aside from this risk, mega-endoprosthetics remain a preferred treatment option for limb salvage. Methods: A retrospective chart review was implemented using Fisher’s exact test for categorical data and the Kaplan-Meier method for prosthesis survival. Patient information was acquired through our institution s electronic medical records. Variables such as diagnosis, complications, length of cement spacer, and number of surgeries were recorded. We analyzed spacer length and prosthesis survival based on these variables. Results: Fisher’s Exact test showed no correlation between length of spacer and amount of repeat surgery (p = 0.245). After two-stage revision and mega-prosthesis insertion, there was a 63.2% chance of complication and a 26.3% chance of amputation. This indicates a 73.7% probability for limb salvage in this sample (Kaplan-Meier). Conclusions: These data suggest long-term viability of mega-endoprostheses after two-stage revision despite a high complication rates.