However, in this manuscript, discussion is limited to femoral implants. Relative to the hip and knee, megaprostheses would include proximal-, distal-, and total femoral replacements, in addition to proximal tibial replacements. Megaprostheses are established implants in oncological settings, whereas their use in trauma and revision arthroplasty is growing. Their use in the lower extremity has transformed the functional prognosis of a patient through limb salvage and immediate postoperative weightbearing, where previously they may have undergone amputation for the same pathology. Megaprostheses are increasingly utilised to manage significant bone loss secondary to trauma, revision arthroplasty, and malignancy. This study indicates judicious use of DAIR can be an appropriate part of the treatment algorithm. The success rate (64.3%) remains on par with other studies evaluating DAIR in megaprostheses and in primary arthroplasty. The use of DAIR in these complex patients can lead to successful outcomes, but the risk of further revision remains high. No patients who underwent DAIR alone suffered complications as a result of the procedure. Five patients (35.7%) required further revision surgery, with four patients cleared of infection. Nine patients (64.3%) successfully cleared their infection following DAIR at a minimum of 5 year follow-up. There were six males and eight females, with a mean age of 67.2 years, and mean ASA of 2.3. Patients included six proximal femoral replacements, five distal femoral replacements, and three total femoral replacements. Patients were followed up for a minimum of 5 years. Patients were managed as part of a multidisciplinary team, with our standardised surgical technique including exchange of all mobile parts, and subsequent antibiotic therapy for a minimum of 3 months. We identified 14 patients who underwent DAIR for a PJI of their femoral megaprostheses, between 20, whom had their index procedure secondary to non-oncological indications. There are significant differences in patient physiology, treatment goals, and associated risks between these patient cohorts. Debridement, antibiotic, and implant retention (DAIR) is an established treatment for PJI, however its use in non-oncological patients with femoral megaprostheses has not been widely reported. Megaprostheses are increasingly utilised outside of the oncological setting, and remain at significant risk of periprosthetic joint infection (PJI).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |