Fiore Michele, Sambri Andrea, Morante Lorenzo, Bortoli Marta, Parisi Stefania Claudia, Panzavolta Francesco, Alesi Domenico, Neri Elisabetta, Neri Maria Pia, Tedeschi Sara, Zamparini Eleonora, Cevolani Luca, Donati Davide Maria, Viale Pierluigi, Campanacci Domenico Andrea, Zaffagnini Stefano, De Paolis Massimiliano
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
J Clin Med. 2023 Oct 23;12(20):6679. doi: 10.3390/jcm12206679.
Periprosthetic joint infections (PJI) and fracture-related infections (FRI) of the distal femur (DF) may result in massive bone defects. Treatment options include articulated silver-coated (SC) megaprosthesis (MP) in the context of a two-stage protocol. However, there is limited evidence in the literature on this topic. A retrospective review of the prospectively maintained databases of three Institutions was performed. Forty-five patients were included. The mean follow-up time was 43 ± 17.1 months. Eight (17.8%) patients had a recurrent infection. The estimated recurrence-free survival rate was 91.1% (93.5% PJI vs. 85.7% FRI) 2 years following MP implantation, and 75.7% (83.2% PJI vs. 64.3% FRI; = 0.253) after 5 years. No statistically relevant difference was found according to the initial diagnosis (PJI vs. FRI). Among possible risk factors, only resection length was found to significantly worsen the outcomes in terms of infection control ( = 0.031). A total of eight complications not related to infection were found after reimplantation, but only five of them required further surgery. Above-the-knee amputation was performed in two cases (4.4%), both for reinfection. Articulated DF SC MP in a two-stage protocol is a safe and effective treatment for chronic knee infection with severe bone loss.
股骨远端（DF）的人工关节周围感染（PJI）和骨折相关感染（FRI）可能导致大面积骨缺损。治疗选择包括在两阶段方案中使用带关节的镀银（SC）大假体（MP）。然而，关于这一主题的文献证据有限。对三个机构前瞻性维护的数据库进行了回顾性研究。纳入了45例患者。平均随访时间为43±17.1个月。8例（17.8%）患者出现复发性感染。MP植入后2年的无复发生存率估计为91.1%（PJI为93.5%，FRI为85.7%），5年后为75.7%（PJI为83.2%，FRI为64.3%；P = 0.253）。根据初始诊断（PJI与FRI）未发现统计学上的显著差异。在可能的风险因素中，仅发现切除长度在感染控制方面显著恶化了预后（P = 0.031）。再植入后共发现8例与感染无关的并发症，但其中仅5例需要进一步手术。2例（4.4%）患者进行了膝上截肢，均为再感染所致。在两阶段方案中使用带关节的DF SC MP是治疗伴有严重骨质流失的慢性膝关节感染的一种安全有效的方法。
