Abstract
Aims
To evaluate the place of the massive prostheses in the most complex periprosthetic infections cases (PJis).
Method
Between 2011 and 2017, 516 hip and knee revisions for periprosthetic infections had been performed in our hospital by the same senior surgeon. We report a prospective series of 58 patients treated between 2011 and the end of 2017. 26 males and 32 females with on average 69,4 years old (38–86). Infection involved TKA in 39 cases (26 TKA revisions, 11 primary TKA), THA in 18 cases (10 revisions, 7 primary THA), a femoral pseudoarthrosis with posttraumatic gonarthrosis in one case and a septic humeral pseudoarthrosis in one case.
We used one stage procedures in 38 cases (14 hips, 23 knees, 1 shoulder) and 20 two stages surgeries (16 knees and 4 hips). Additional technics used with massive prostheses, all for TKA PJis: 4 massive extensor systemallografts performed two times in a one stage procedure, two local flaps (medial gastronecmienmuscle). Two perioperative hyperbaric procedures used to limit the risks of wound complications.
Results
The average follow-up is 38 months (12–62 months). The rate of sucess to treat the infection at this follow-up is 89,7 %. We report our feedback of the different massive components uses and the qualities/defaults we noted.
The most frequent complication was skin events like wound swelling and delayed cicatrisations in 13 cases. 3 cases of one stages needed a complementary debridement in the three weeks after the surgery with always a good local and infectious evolution.
This series report 5 failures of two stages TKA revisions. In 4 cases, the initial local soft tissues conditions were compromised.
Conclusions
The use of massive prostheses to treat PJIs is a good option for the complex cases. It can be a good alternative of knee arthrodesis. These components must be used, preferentially for oldest patients, in cases of extreme bone loss or extensed osteitis to secure the bone debridement and the quality of the reconstruction. In our series, the one stage procedure is a validated option even by using complementary technics as bone allografts, extensor system allografts or flaps. The two stages procedure is a secondary option, particularly when softtissues status is compromised before or after the debridement, and mostly for the knees.
