Smith Eric L, Shah Akash, Son Sung Jun, Niu Ruijia, Talmo Carl T, Abdeen Ayesha, Ali Muzna, Pinski John, Gordon Matthew, Lozano-Calderon Santiago, Bedair Hany S
Department of Orthopaedics, New England Baptist Hospital, Boston, MA, USA.
Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA.
Arthroplast Today. 2020 Jun 29;6(3):475-479. doi: 10.1016/j.artd.2020.05.004. eCollection 2020 Sep.
The use of megaprostheses in nononcologic patients has been associated with complication rates greater than 50%. In patients with prior periprosthetic joint infection (PJI) with subsequent two-stage reimplantation, this complication rate may be even higher. This study was to investigate the outcomes of megaprostheses in nononcologic patients undergoing revision hip/knee arthroplasty.
We retrospectively studied patients who underwent megaprosthesis replacements from 1999 to 2017 at 5 hospitals with minimum 24 months of follow-up. Patients were stratified based on history of prior PJI (septic vs aseptic) and location of the megaprosthesis (the hip or knee). Postoperative complications were classified as soft-tissue failure, aseptic loosening, structural failure, and infection.
Of the 42 patients, 19 were in the septic cohort and 23 were in the aseptic cohort. The overall complication rate was 28.6%. Complication rates for the septic and aseptic cohorts were 32% and 26%, respectively ( = .74). By anatomic location, there were 2 of 13 (15%) and 10 of 29 (34%) complications in the hip and knee groups, respectively ( = .28). In the septic cohort, there were no (0%) complications in the hip group and 6 of 14 (43%) complications in the knee group ( = .13), all due to infection. In the aseptic cohort, there were 2 of 8 (25%) and 4 of 15 (27%) complications in the hip and knee groups, respectively ( = 1.0).
There is no difference in the postoperative complication rates between the septic or aseptic cohorts undergoing revision hip or knee megaprosthesis replacements. In patients with prior PJI, proximal femoral replacements have improved short-term survivorship compared with distal femoral or proximal tibial replacements.
在非肿瘤患者中使用大型假体的并发症发生率超过50%。在既往有假体周围关节感染（PJI）并随后进行两阶段再植入的患者中，这种并发症发生率可能更高。本研究旨在调查接受髋关节/膝关节翻修置换术的非肿瘤患者使用大型假体的结局。
我们回顾性研究了1999年至2017年在5家医院接受大型假体置换且随访至少24个月的患者。根据既往PJI病史（感染性与无菌性）和大型假体位置（髋关节或膝关节）对患者进行分层。术后并发症分为软组织失败、无菌性松动、结构性失败和感染。
42例患者中，19例在感染性队列，23例在无菌性队列。总体并发症发生率为28.6%。感染性和无菌性队列的并发症发生率分别为32%和26%（P = 0.74）。按解剖位置，髋关节组13例中有2例（15%）发生并发症，膝关节组29例中有10例（34%）发生并发症（P = 0.28）。在感染性队列中，髋关节组无并发症（0%），膝关节组14例中有6例（43%）发生并发症（P = 0.13），均为感染所致。在无菌性队列中，髋关节组8例中有2例（25%）发生并发症，膝关节组15例中有4例（27%）发生并发症（P = 1.0）。
接受髋关节或膝关节大型假体翻修置换的感染性或无菌性队列之间术后并发症发生率无差异。在既往有PJI的患者中，股骨近端置换与股骨远端或胫骨近端置换相比，短期生存率有所提高。
