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Clinical Orthopaedics and Related Research®

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01-10-2013 | Symposium: 2012 Musculoskeletal Infection Society

Treatment Solutions Are Unclear for Perimegaprosthetic Infections

Authors: Lisa B. Ercolano, MD, Tyson Christensen, BS, Richard McGough, MD, Kurt Weiss, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 10/2013

Abstract

Background

Infection about a megaprosthesis is a dreaded complication. Treatment options vary from débridement alone to staged revisions, arthrodesis, and amputation. Indications for how to treat this complication are unclear.

Questions/purposes

We therefore determined (1) the incidence of perimegaprosthetic infections, (2) the methods of treatment, (3) the number of patients who failed their original treatment plan, and (4) the characteristics of the infection.

Methods

We retrospectively identified 291 patients who had megaprostheses implanted between 2001 and 2011 and identified all those surgically treated for a perimegaprosthetic infection during that time. We defined a treatment failure as any unplanned reoperation or death due to uncontrolled infection. All patients with failure had a minimum followup of 1 year (mean, 3.3 years; range, 1–8 years).

Results

Of the 291 patients, 31 (11%) had subsequent infections. Surgical management varied among irrigation and débridement (n = 15), single-stage revisions (n = 11), two-stage revisions (n = 4), and amputations (n = 1). Sixteen patients failed their original treatment plan: 13 required additional surgery and three died. Infections were mostly chronic and single organism with five being methicillin-resistant Staphylococcus aureus.

Conclusions

An 11% incidence of perimegaprosthetic infections is consistent with the increased risk of infection seen in other studies. A variety of surgical methods were employed at our institution and by those contributing to the literature without clear evidence of superiority of one method over another. Given the complicated medical and surgical histories of these patients, individualization in decision making is necessary.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Title: Treatment Solutions Are Unclear for Perimegaprosthetic Infections
Authors: Lisa B. Ercolano, MD
Tyson Christensen, BS
Richard McGough, MD
Kurt Weiss, MD
Publication date: 01-10-2013
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 10/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-2852-7

At a glance: The STEP trials

Springer Medicine

Treatment Solutions Are Unclear for Perimegaprosthetic Infections

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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