Fighting Megaprosthetic Infections: What are the Chances of Winning?

backgroundMegaprosthetic infections continue to be a leading mode of failure after limb salvage surgery. Though challenging, amputations can be avoided with proper management in majority of the cases. This study aims to describe the spectrum of mega-endoprosthetic infections at our institute and assess the treatment efficacy in these patients. MATERIALS AND

methodsAll patients treated for endoprosthetic infection at our institute between 2010 and 2018 were retrospectively analyzed for overall survival of reconstruction method, site and type of megaprosthesis, adjuvant therapy, microbial isolates, surgical and medical management and outcomes.

resultsThirty-five patients (22 males: 13 females) were analyzed following treatment for endoprosthetic infection. Majority were around the knee joint [most commonly with proximal tibia (

conclusionsIn patients with early or acute presentation without frank granulation or pus around the implant, debridement and insertion of antibiotic cement beads was adequate. Two-stage revisions with complete removal of the megaprosthesis showed best results in infections that could be controlled with antimicrobial therapy. More than one exchange of cement spacer was required for uncontrolled infections. Multidisciplinary approach in consultation with the infectious disease team is essential to determine choice of antibiotic cement for beads/spacer as well as appropriate adjuvant antimicrobial therapy to solve the challenging problem of endoprosthetic infections following bone tumor surgery. Adequate and healthy soft tissue cover of the implant should be achieved wherever indicated.