Management of infected extremity endoprostheses: a systematic review
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GENERAL REVIEW
Management of infected extremity endoprostheses: a systematic review Nicholas Nucci1 · Aaron Gazendam2 · Kyle Gouveia3 · Michelle Ghert2 · David Wilson2 Received: 15 April 2020 / Accepted: 7 May 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Endoprosthetic reconstructions have become increasingly common in the setting of significant bone loss. Indications include revision arthroplasty, trauma, and reconstruction in the setting of primary malignancies or bony metastases. Although the use of endoprostheses has several advantages, they carry a high risk of infection. The purpose of this review is to determine the success rates of surgical management of infected endoprostheses. Methods The authors searched databases for relevant studies and screened in duplicate. Data extracted included overall infection rate, timing of infection, follow-up, isolated pathogen and operative treatment strategy, and subsequent failure rate. The overall quality of the evidence with the Methodological Index for non-randomized studies criteria. Results A total of 16 studies and 647 patients met the inclusion criteria. 400 patients had operative management and reported outcomes. Failure rates of patients undergoing debridement, antibiotics, and implant retention (DAIR) were 55.1%. Failure rates of patients who underwent one-stage revision were 45.5%. Failure rates of patients undergoing two-stage revision were 27.3%. Failure occurred at 31.4 months (range, 0–228) postoperatively. Conclusions Rates of periprosthetic joint infection remain high in endoprosthetic reconstructions. Although DAIR procedures were found to have a low success rate, they remain a reasonable option in acute infections given the morbidity of staged revisions. There is a lack of comparative data in the current literature and the heterogeneity and low level of evidence does not allow for between group comparisons of results. Keywords Endoprosthesis · Megaprosthesis · Periprosthetic joint infection · Revision
Introduction Massive bony defects are encountered in the setting of excised bone tumors, trauma, and revision arthroplasty [1, 2]. Megaprostheses or modular endoprostheses have been developed to manage such defects. Advantages include limb salvage, intraoperative adaptability and immediate weight bearing status [2, 3]. Particular to oncologic patients, * Aaron Gazendam [email protected] 1
Northern Ontario School of Medicine, Thunder Bay, ON, Canada
2
Division of Orthopaedics, Department of Surgery, Center for Evidence‑Based Orthopaedics, St. Joseph’s Hospital, McMaster University, Room G522, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
3
Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
treatment advances have enhanced survivability and prognosis from sarcomas, resulting in a large increase in the use of megaprosthesis [4, 5]. Although initially created for the treatment of oncologic conditions, megaprostheses are increasingly being used for non-
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