Abstract
Periprosthetic infection with extensive bone loss is a complex situation. The appropriate management of large bone defects has not been established. Without reconstruction amputation/disarticulation is the likely outcome.
Aim of the study was to Analyse preliminary results of direct exchange endoprosthetic reconstruction for periprosthetic infection associated with segmental bone defects.
Study of patients with periprosthetic infection and severe osteolysis treated by direct exchange tumour prostheses between June, 2005 and May, 2008 (4 – Distal femoral & 2 – Total femoral Replacements). Microbiological evidence of infection was confirmed with regular monitoring of radiograph, crp, esr and wcc. Community based antibiotic therapy was provided by infectious disease team based in our institution.
The mean age and follow up were 74.2 years and 26.5 months respectively. Mean duration of antibiotics was 6 weeks intravenous(community based) and 3.5 months oral. 1 patient required intervention by plastic surgeons at index procedure. Radiographs at 6, 12 & 24 months showed no changes from immediate post-op. CRP, ESR and WBC count were within normal limits at the end of antibiotic therapy. One patient required prolonged pain relief with poor mobility due to instability in the opposite knee. One patient had infection recurrence. Knee range of movements averaged full extension to 95 degrees. The mean oxford knee scores pre and post operatively were 58 and 39.4 respectively.
We conclude that salvage endoprosthetic reconstruction has provided effective pain relief, stability and improved mobility in our experience. It has provided an oppourtunity to avoid amputation. Multidisciplinary support from plastic surgeons and specialist microbiologists is essential.
Correspondence should be addressed to ISTA Secretariat, PO Box 6564, Auburn, CA 95604, USA. Tel: 1-916-454-9884, Fax: 1-916-454-9882, Email: ista@pacbell.net
