Abstract
Introduction
Throughout the world the number of large joint arthroprosthetic implants continues to increase and consequently the number of septic complications with prosthesis mobilizations, periprostehtic bone loss or non-unions. The implant of large resection prosthesis (megaprosthesis) in selected patients could be a good solution both in hip and knee infected prosthesis with bone defects.
The two stage techniques with a first operation to debride, prosthesis components removal and antibiotic spacer implantation followed by a subsequent final prosthetic implant offer great results even in highly complex patients.
Objectives
The purpose of this study is to evaluate retrospectively the outcome after the implantation of megaprosthesis of the lower limbs in prosthetic infected revision.
Methods
We have retrospectively evaluated all the patients we have treated with implantation of megaprosthesis in septic prosthesis revision. Between January 2008 and January 2014 we have treated 25 patients: 18 cases of hip revision and 7 cases of knee revision. All patients were treated with a two steps procedure.
Results
We obtained good results from a clinical, laboratory and radiological point of view with restoration of the function of the affected limb in 22/25 cases. In 3/25 cases the infection recurred and an additional surgery was necessary.
Conclusions
Megaprosthesis in large septic revision can be considered, in extreme cases appropriately selected, an available solution for the orthopedic surgeon able to restore function to the patient. The two steps procedure gives the best results with safety and lower infection recurrence creating a membrane (Chamber Induction Technique) that can protect the prosthesis in a safe environment. This type of complex surgery must be performed in specialized centers where knowledge and technologies are present.
