Periprosthetic Joint Infection after Endoprosthetic Reconstruction: Saving the Limb-Salvage

Background: This study evaluates mega-endoprosthetic survival after revision for periprosthetic joint infection (PJI) and two-staged reconstruction using a cement spacer. Mega-endoprosthetics offer patients an important treatment option for limb salvage. However, PJI is a devastating complication which affects between 2-10% of patients. It commonly results in revisions, amputation, and sometimes death. Literature in terms of success rates, limb salvage and Megaprostheses survival after revision for infection is limited. We present here our experience and the impact of length of the spacer in prostheses survival. Methods: A retrospective chart review was implemented using Fisher’s exact test for categorical data and the Kaplan- Meier method for prosthesis survival. Patient information was acquired through our institution’s electronic medical records. Variables such as diagnosis, complications, length of cement spacer, and number of surgeries were recorded. We analyzed spacer length and prosthesis survival based on these variables. Results: Fisher’s Exact test showed no correlation between length of spacer and amount of repeat surgery (P = 0.245). After two-stage revision and mega-prosthesis insertion, there was a 63.2% chance of complication and a 26.3% chance of amputation. This indicates a 73.7% probability for limb salvage in this sample (Kaplan-Meier). Conclusion: These data suggest long-term viability of mega-endoprostheses after two-stage revision despite a high complication rate.