The use of new megaprosthesis for massive bone loss is an option for the replacement of skeletal segments. There are several clinical scenarios that can be associated with this situation including severe trauma with multiple failed osteosynthesis with a non union or with a previous prosthetic replacement of a neighbouring joint; multiple revision of arthroplasty with or without infections or large resections of tumours. The aim of this work is to evaluate retrospectively both clinical and radiological outcomes and any complications in patients treated with megaprosthesis in SEPTIC BONE DEFECTS in our Hospital from February 2012 to January 2015.

From February 2012 to January 2014 a total of 20 patients were treated with mono-and bi-articular megaprosthesis subdivided as follows: 4 proximal femur, 11 distal femur, 3 total femur, 1 total humerus and 1 proximal humerus. Clinical and serial radiographic evaluations were performed at 6 weeks, 3, 6, 12, 18 and 24 months. Blood parameters with CRP and ESR were monitored for at least 2 months. The mean follow-up of patients was about 24.4 months (range 5 months to 31 months). The mean age of the patients was 53 years (range 37–80years). Of the patients 20, 9 were female and 11 were male. The aetiology was: 11 septic non unions, 3 infected TKA, 4 infected THR and 2 infected tumor prostheses.

We have evaluated retrospectively both clinical and radiological outcomes of 20 patients. They had large bone defects that threatened the viability of the limb. They were treated with megaprosthesis. Although the mean length of follow-up was only 24.4 months they showed encouraging clinical results, with good articulation of the segments, no somato-sensory or motor deficit and acceptable functional recovery. There were three cases of dislocation, one case with rifampicin toxicity, one case with acute prosthetic infection (case that needed debridement and one case with chronic oral antimicrobial.

Megaprosthesis provides a valuable opportunity to restore functionality to patients with highly disabling diseases. The number of complications is not depreciable.

Introduction: The prosthetic replacement of the infected knee is conditioned by the bone stock according with the A.O.R.I. We classified the bone defects on the infected knee following the Windsor protocol. When we find ourselves on a situation with T2-3 F2-3 and/or post-infection prosthetic replacements, we use tumoral knee prosthesis (“third prosthesis”).

The main causes of segmentary bone defects at the knee, appear after high energy injuries, tumoral resections and after infected total knee arthroplasties. Nowadays the treatment of these lesions, supposes a challenge to the orthopaedic surgeons due to the difficulty of the bone and soft tissue lesions.

Material and Methods: We present our first 35 cases involving tumoral knee prosthesis replacements after infected conminutive fractures around the knee, infected replacements and infections after tumoral resections.

Initially we used the prosthesis FINN model (BIOMET©) on 11 cases, while we have used the RHK model (BIOMET©) on the remaining 24. We followed the two-stage reimplantation using antibiotic PMMA spacers either manual or preformed depending on the defect’s size. Exposure of the stiff or ankylosed knee can be especially difficult when preoperative flexion is limited, so in these situations we use the Whitesides technique (tibial tubercle osteotomy). We used platelet derivated growth factors (inductors) associated with hydroxiapatite (conductors) with the goal to obtain the best possible osteo-integration.

Results: Our results are satisfying, considering we are confronting severe bone defects with a poor situation of soft tissues around the knee. We have not observed major complications involving the use of the inductors and conductors mentioned above.

Conclusions: We consider the use of tumoral knee prosthesis (“third prosthesis”) a useful technique which allows us to avoid the disability promoted by the knee arthrodesis, obtaining satisfactory results according to the severe lesions observed.

Introduction and Objectives: Septic non-union can present a variety of problems for the surgeon, the most common being loss of bone continuity and persistence of infection. When conventional treatments fail we begin to use new bone tissue engineering techniques. The aim of this study is to present our experience over the last 5 years with 50 cases of infected non-union in which we used BMP-7.

Materials and Methods: Between 2002 and 2007 we used BMP-7 in 50 patients according to the protocol established by Friedlaender in 2001. Each patient was treated with allograft and BMP-7 and the same surgical technique was used in every case. Follow-up exams were carried out every 2 months with different control X-rays, analysis and cultures were performed to assess the evolution of consolidation and the end of infection.

Results: We achieved the desired consolidation in almost 70% of cases with good functionality of the affected limbs and freedom from infection. On the other hand, in 30% of cases we did not achieve expected consolidation and we saw that infection still persisted.

Discussion and Conclusions: The most critical and influential parameters affecting the end-result of treatment of infected non-union with BMP-7 are persistence of infection, poor vascularization, inadequate stabilization, and defective coverage of the subcutaneous tissue adjacent to the non-union focus.